Kimberley S Noij1, Barbara S Herrmann2,3, John J Guinan2,4, Steven D Rauch1,2. 1. Department of Otolaryngology. 2. Department of Otolaryngology, Harvard Medical School. 3. Department of Audiology. 4. Eaton Peabody Lab, Massachusetts Eye and Ear Infirmary, Massachusetts.
Abstract
OBJECTIVE: The cervical vestibular evoked myogenic potential (cVEMP) has been used to evaluate patients with Menière's disease (MD). Studied cVEMP metrics include: amplitude, threshold, frequency tuning, and interaural asymmetry ratio (IAR). However, few studies compared these metrics in the same set of MD patients, and methodological differences prevent such a comparison across studies. This study investigates the value of different cVEMP metrics in distinguishing one set of MD patients from age-matched controls. STUDY DESIGN: Prospective study. SETTING: Tertiary care center. PATIENTS: Thirty patients with definite unilateral MD and 23 age-matched controls were prospectively included. All underwent cVEMP testing at 500, 750, 1000, and 2000 Hz on each side. Ears were separated into three groups: affected MD, unaffected MD, and control. MAIN OUTCOME MEASURES: Sound level functions were obtained at each frequency, and normalized peak-to-peak amplitude (VEMPn), VEMP inhibition depth (VEMPid), threshold, frequency-tuning ratio, and IAR were calculated. For all metrics, the differentiation between MD and control ears was compared using receiver operating characteristic (ROC) curves. RESULTS: 500 Hz cVEMP threshold, VEMPn, and VEMPid were similarly good at distinguishing affected MD ears from healthy ears, with ROC area under the curves (AUCs) of more than 0.828 and optimal sensitivities and specificities of at least 80 and 70%. Combinations of these three metrics yielded slightly larger AUCs (>0.880). Tuning ratios and IAR were less effective in separating healthy from affected ears with AUCs ranging from 0.529 to 0.720. CONCLUSION: The cVEMP metrics most useful in distinguishing MD patients from healthy controls are threshold, VEMPn, and VEMPid, using 500 Hz stimuli.
OBJECTIVE: The cervical vestibular evoked myogenic potential (cVEMP) has been used to evaluate patients with Menière's disease (MD). Studied cVEMP metrics include: amplitude, threshold, frequency tuning, and interaural asymmetry ratio (IAR). However, few studies compared these metrics in the same set of MD patients, and methodological differences prevent such a comparison across studies. This study investigates the value of different cVEMP metrics in distinguishing one set of MD patients from age-matched controls. STUDY DESIGN: Prospective study. SETTING: Tertiary care center. PATIENTS: Thirty patients with definite unilateral MD and 23 age-matched controls were prospectively included. All underwent cVEMP testing at 500, 750, 1000, and 2000 Hz on each side. Ears were separated into three groups: affected MD, unaffected MD, and control. MAIN OUTCOME MEASURES: Sound level functions were obtained at each frequency, and normalized peak-to-peak amplitude (VEMPn), VEMP inhibition depth (VEMPid), threshold, frequency-tuning ratio, and IAR were calculated. For all metrics, the differentiation between MD and control ears was compared using receiver operating characteristic (ROC) curves. RESULTS: 500 Hz cVEMP threshold, VEMPn, and VEMPid were similarly good at distinguishing affected MD ears from healthy ears, with ROC area under the curves (AUCs) of more than 0.828 and optimal sensitivities and specificities of at least 80 and 70%. Combinations of these three metrics yielded slightly larger AUCs (>0.880). Tuning ratios and IAR were less effective in separating healthy from affected ears with AUCs ranging from 0.529 to 0.720. CONCLUSION: The cVEMP metrics most useful in distinguishing MD patients from healthy controls are threshold, VEMPn, and VEMPid, using 500 Hz stimuli.
Authors: Kimberley S Noij; Mark J van Tilburg; Barbara S Herrmann; Piotr Marciniak; Steven D Rauch; John J Guinan Journal: Ear Hear Date: 2018 Nov/Dec Impact factor: 3.570
Authors: Jose A Lopez-Escamez; John Carey; Won-Ho Chung; Joel A Goebel; Måns Magnusson; Marco Mandalà; David E Newman-Toker; Michael Strupp; Mamoru Suzuki; Franco Trabalzini; Alexandre Bisdorff Journal: J Vestib Res Date: 2015 Impact factor: 2.435
Authors: Allison S Young; Benjamin Nham; Andrew P Bradshaw; Zeljka Calic; Jacob M Pogson; William P Gibson; G Michael Halmagyi; Miriam S Welgampola Journal: J Neurol Date: 2021-08-22 Impact factor: 4.849
Authors: Raymond van de Berg; Angel Ramos; Vincent van Rompaey; Alexandre Bisdorff; Angelica Perez-Fornos; Jay T Rubinstein; James O Phillips; Michael Strupp; Charles C Della Santina; Nils Guinand Journal: J Vestib Res Date: 2020 Impact factor: 2.354