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Ferreira MM, Lopes KDC, Grigol TADAES, Ganança MM, Caovilla HH. Subjective Visual Vertical and Vestibular Evoked Myogenic Potential in Meniere's disease. Braz J Otorhinolaryngol 2022; 89:485-493. [PMID: 36670010 PMCID: PMC10165191 DOI: 10.1016/j.bjorl.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/11/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate otolith function by comparing the findings of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential tests in patients in the inter-crisis period of unilateral definite Meniere's disease. METHODS The sample consisted of an experimental group (n=22; 10 men and 12 women, mean age 47.32±12.82 years) with definite unilateral Meniere's disease and a control group (n=14; 5 men and 9 women, with a mean age of 41.64±13.45 years). They all underwent vestibular evaluation by means of Subjective Visual Vertical with the bucket method and, cervical and ocular Vestibular Evoked Myogenic Potential tests. The data were collected and subjected to statistical analysis. RESULTS The results of the comparison of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential, the ocular Vestibular Evoked Myogenic Potential and, the association of cervical Vestibular Evoked Myogenic Potential with the ocular Vestibular Evoked Myogenic Potential showed no significant difference, indicating concordance among the tests. CONCLUSION The identified abnormalities and the concordance between the combined proportion of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential findings indicate that the association of these three tests contributes to the identification of sustained and transient otolith dysfunction in the inter-crisis of unilateral definite Meniere's disease. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Maristela Mian Ferreira
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Discipline of Otology and Neurotology, São Paulo, SP, Brazil.
| | - Karen de Carvalho Lopes
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Discipline of Otology and Neurotology, São Paulo, SP, Brazil
| | | | - Maurício Malavasi Ganança
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Discipline of Otology and Neurotology, São Paulo, SP, Brazil
| | - Heloisa Helena Caovilla
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Discipline of Otology and Neurotology, São Paulo, SP, Brazil
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Wegmann-Vicuña R, Manrique-Huarte R, Calavia-Gil D, Martín-Sanz E, Marques P, Perez-Fernandez N. Low-Dose Intratympanic Gentamicin for Unilateral Ménière‘s Disease: Accuracy of Early Vestibulo-Ocular Reflex Gain Reduction in Predicting Long-Term Clinical Outcome. Front Neurol 2022; 13:808570. [PMID: 35370892 PMCID: PMC8973913 DOI: 10.3389/fneur.2022.808570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe number of intratympanic gentamicin (ITG) injections needed to achieve vertigo control in patients with intractable Ménière's disease (MD) may vary from a single dose to several instillations. Changes in different vestibular test results have been used to define an endpoint of treatment, including the decrease of the vestibulo-ocular reflex (VOR) gain elicited by the head-impulse test.ObjectiveTo assess the accuracy of the VOR gain reduction after horizontal canal stimulation, as measured with the video head-impulse test (vHIT) 1 month after the first intratympanic injection, in predicting the need for one or more instillations to control vertigo spells in the long term.MethodsThe VOR gain reduction was calculated in 47 patients submitted to (ITG) therapy 1 month after the first instillation.ResultsSingle intratympanic treatment with gentamicin has a 59.6% efficacy in vertigo control in the long term. Hearing change in the immediate period after treatment (1 month) is not significant to pre-treatment result and is similar for patients who needed multiple doses due to recurrence. Chronic disequilibrium and the need for vestibular rehabilitation were less frequent in patients with a good control of vertigo with just one single injection of gentamicin. A fair accuracy was obtained for the VOR gain reduction of the horizontal canal (area under the curve = 0.729 in the Receiver Operating Characteristic analysis) in predicting the need for one or more ITG.ConclusionsSingle intratympanic treatment with gentamicin is an effective treatment for patients with MD. That modality of treatment has very limited damaging effect in hearing. The degree of vestibular deficit induced by the treatment is significant as measured by the reduction in the gain of the VOR but not useful for prognostic purposes.
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Affiliation(s)
- Ricardo Wegmann-Vicuña
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Otorhinolaryngology, Hospital Quirónsalud, Barcelona, Spain
| | | | - Diego Calavia-Gil
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Eduardo Martín-Sanz
- Department of Otolaryngology, University Hospital of Getafe, Madrid, Spain
- Department of Medicine, School of Biomedical Sciences and Health, Universidad Europea de Madrid, Madrid, Spain
| | - Pedro Marques
- Department of Otorhinolaryngology, S. João Hospital Centre, Porto, Portugal
| | - Nicolas Perez-Fernandez
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Madrid, Spain
- *Correspondence: Nicolas Perez-Fernandez
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Macambira YKDS, Carnaúba ATL, Fernandes LCBC, Bueno NB, Menezes PDL. Aging and wave-component latency delays in oVEMP and cVEMP: a systematic review with meta-analysis. Braz J Otorhinolaryngol 2017; 83:475-487. [PMID: 28237301 PMCID: PMC9442875 DOI: 10.1016/j.bjorl.2016.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/30/2016] [Accepted: 12/07/2016] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION The natural aging process may result in morphological changes in the vestibular system and in the afferent neural pathway, including loss of hair cells, decreased numbers of vestibular nerve cells, and loss of neurons in the vestibular nucleus. Thus, with advancing age, there should be a decrease in amplitudes and an increase in latencies of the vestibular evoked myogenic potentials, especially the prolongation of p13 latency. Moreover, many investigations have found no significant differences in latencies with advancing age. OBJECTIVE To determine if there are significant differences in the latencies of cervical and ocular evoked myogenic potentials between elderly and adult patients. METHODS This is a systematic review with meta-analysis of observational studies, comparing the differences of these parameters between elderly and young adults, without language or date restrictions, in the following databases: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature databases: OpenGrey.eu and DissOnline, as well as Research Gate. RESULTS The n1 oVEMP latencies had a mean delay in the elderly of 2.32ms with 95% CI of 0.55-4.10ms. The overall effect test showed p=0.01, disclosing that such difference was significant. The heterogeneity found was I2=96% (p<0.001). Evaluation of p1 latency was not possible due to the low number of articles selected for this condition. cVEMP analysis was performed in 13 articles. For the p13 component, the mean latency delay in the elderly was 1.34ms with 95% CI of 0.56-2.11ms. The overall effect test showed a p<0.001, with heterogeneity value I2=92% (p<0.001). For the n23 component, the mean latency delay for the elderly was 2.82ms with 95% CI of 0.33-5.30ms. The overall effect test showed p=0.03. The heterogeneity found was I2=99% (p<0.001). CONCLUSION The latency of oVEMP n1 wave component and latencies of cVEMP p13 and n23 wave components are longer in the elderly aged >60 years than in young adults.
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Affiliation(s)
| | - Aline Tenório Lins Carnaúba
- Universidade Federal de Alagoas (UFAL), Rede Nordeste de Biotecnologia (RENORBIO), Biotecnologia em Saúde, Maceió, AL, Brazil
| | - Luciana Castelo Branco Camurça Fernandes
- Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brazil; Universidade Federal de São Paulo (UNIFESP), Distúrbio da Comunicação, São Paulo, SP, Brazil
| | - Nassib Bezerra Bueno
- Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil; Universidade Federal de São Paulo (UNIFESP), Ciências, São Paulo, SP, Brazil
| | - Pedro de Lemos Menezes
- Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brazil; Universidade de São Paulo (USP), Física aplicada à Medicina, São Paulo, SP, Brazil.
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Johnson SA, O’Beirne GA, Lin E, Gourley J, Hornibrook J. oVEMPs and cVEMPs in patients with 'clinically certain' Menière's disease. Acta Otolaryngol 2016; 136:1029-34. [PMID: 27121497 DOI: 10.1080/00016489.2016.1175663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To measure ocular vestibular-evoked myogenic potentials (oVEMPs) and cervical vestibular-evoked myogenic potentials (cVEMPS) in Menière's disease patients with confirmed cochlear hydrops and in the normal ears of volunteers. METHODS oVEMPs and cVEMPs were measured in 18 patients with a symptomatic diagnosis of Menière's disease and tone burst electrocochleographic confirmation of hydrops, and in the ears of 22 volunteers. RESULTS Threshold measures: For cVEMP: no significant differences between Menière's ears and controls; for oVEMP: significantly elevated thresholds in affected ears of Menière's ears compared with their unaffected ears, but not with controls. Latency measures: cVEMP N1 peaks were significantly prolonged compared with the left and right ears of controls, but not with the non-affected ear. Amplitude measures: cVEMP P1N1 and N1P2 measures were significantly reduced compared with the right ear of controls, but not with the non-affected ear; For oVEMP, N2P2 amplitudes were significantly reduced compared with both ears of controls but not with the non-affected ear. CONCLUSION Abnormalities of oVEMPs and cVEMPs were found in 18 Menière's disease patients who had an independent confirmation of cochlear hydrops. The overlap of the results from Menière's patients compared with normal controls limits the use of VEMP abnormalities as a sole reliable diagnostic test for Menière's disease.
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Affiliation(s)
- Sarah-Anne Johnson
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | - Greg A. O’Beirne
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | - Emily Lin
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | - John Gourley
- Department of Otolaryngology-Head and Neck Surgery and Audiology, Christchurch Hospital, Christchurch, New Zealand
| | - Jeremy Hornibrook
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
- Department of Otolaryngology-Head and Neck Surgery and Audiology, Christchurch Hospital, Christchurch, New Zealand
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Silva TR, de Resende LM, Santos MAR. Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease. Braz J Otorhinolaryngol 2016; 83:330-340. [PMID: 27320652 PMCID: PMC9444740 DOI: 10.1016/j.bjorl.2016.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/27/2016] [Accepted: 04/09/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response to high-intensity sounds. This study presents a combined or simultaneous technique of cervical and ocular vestibular evoked myogenic potential in individuals with changes in the vestibular system, for use in otoneurologic diagnosis. OBJECTIVE To characterize the records and analyze the results of combined cervical and ocular VEMP in individuals with vestibular hyporeflexia and in those with Ménière's disease. METHODS The study included 120 subjects: 30 subjects with vestibular hyporeflexia, 30 with Ménière's disease, and 60 individuals with normal hearing. Data collection was performed by simultaneously recording the cervical and ocular vestibular evoked myogenic potential. RESULTS There were differences between the study groups (individuals with vestibular hyporeflexia and individuals with Ménière's disease) and the control group for most of wave parameters in combined cervical and ocular vestibular evoked myogenic potential. For cervical vestibular evoked myogenic potential, it was observed that the prolongation of latency of the P13 and N23 waves was the most frequent finding in the group with vestibular hyporeflexia and in the group with Ménière's disease. For ocular vestibular evoked myogenic potential, prolonged latency of N10 and P15 waves was the most frequent finding in the study groups. CONCLUSION Combined cervical and ocular vestibular evoked myogenic potential presented relevant results for individuals with vestibular hyporeflexia and for those with Ménière's disease. There were differences between the study groups and the control group for most of the wave parameters in combined cervical and ocular vestibular evoked myogenic potential.
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Affiliation(s)
- Tatiana Rocha Silva
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Programa de Pós-graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil.
| | - Luciana Macedo de Resende
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Fonoaudiologia, Belo Horizonte, MG, Brazil
| | - Marco Aurélio Rocha Santos
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Programa de Pós-graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil
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Clinical Value of Vestibular Evoked Myogenic Potential in Assessing the Stage and Predicting the Hearing Results in Ménière's Disease. Clin Exp Otorhinolaryngol 2013; 6:57-62. [PMID: 23799160 PMCID: PMC3687062 DOI: 10.3342/ceo.2013.6.2.57] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/20/2012] [Accepted: 06/29/2012] [Indexed: 11/16/2022] Open
Abstract
Objectives Our goal was to find the clinical value of cervical vestibular evoked myogenic potential (VEMP) in Ménière's disease (MD) and to evaluate whether the VEMP results can be useful in assessing the stage of MD. Furthermore, we tried to evaluate the clinical effectiveness of VEMP in predicting hearing outcomes. Methods The amplitude, peak latency and interaural amplitude difference (IAD) ratio were obtained using cervical VEMP. The VEMP results of MD were compared with those of normal subjects, and the MD stages were compared with the IAD ratio. Finally, the hearing changes were analyzed according to their VEMP results. Results In clinically definite unilateral MD (n=41), the prevalence of cervical VEMP abnormality in the IAD ratio was 34.1%. When compared with normal subjects (n=33), the VEMP profile of MD patients showed a low amplitude and a similar latency. The mean IAD ratio in MD was 23%, which was significantly different from that of normal subjects (P=0.01). As the stage increased, the IAD ratio significantly increased (P=0.09). After stratification by initial hearing level, stage I and II subjects (hearing threshold, 0-40 dB) with an abnormal IAD ratio showed a decrease in hearing over time compared to those with a normal IAD ratio (P=0.08). Conclusion VEMP parameters have an important clinical role in MD. Especially, the IAD ratio can be used to assess the stage of MD. An abnormal IAD ratio may be used as a predictor of poor hearing outcomes in subjects with early stage MD.
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Taylor RL, Wijewardene AA, Gibson WP, Black DA, Halmagyi GM, Welgampola MS. The vestibular evoked-potential profile of Ménière’s disease. Clin Neurophysiol 2011; 122:1256-63. [DOI: 10.1016/j.clinph.2010.11.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 10/25/2010] [Accepted: 11/14/2010] [Indexed: 11/16/2022]
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