Inter-frequency amplitude ratio of oVEMP for differentiating Meniere’s disease from BPPV: clinical validation using a double-blind approach

Utility of Inter-Frequency Amplitude Ratio of Vestibular-Evoked Myogenic Potentials in Identifying Meniere's Disease: A Systematic Review and Meta-Analysis

OBJECTIVES

A recently devised parameter of vestibular-evoked myogenic potential (VEMP) based on the principles of frequency tuning is the inter-frequency amplitude ratio (IFAR). It refers to the ratio of the amplitude of 1000 Hz tone burst evoked VEMP to 500 Hz evoked tone burst. A pathology like Meniere's disease changes the frequency response and alters the frequency tuning of the otolith organs. Because IFAR is based on the principle of frequency tuning of VEMP, it is likely to help identify Meniere's disease. Few studies in the last decade have investigated the utility of IFAR in identifying Meniere's disease. However, a systematic review and a meta-analysis on IFAR in Meniere's disease are lacking. The present study investigates whether the IFAR of VEMP helps identify Meniere's disease and differentiates it from healthy ears and other vestibular pathologies.

DESIGN

The present study is a systematic review and a meta-analysis. The studies investigating the IFAR of cervical and ocular VEMPs in Meniere's disease, healthy controls, and other vestibular pathologies were searched across research databases such as PubMed, Science Direct, and Scopus. The search strategy was developed using the PICO (population, intervention, comparison, and outcomes) format, and Medical Subject Headings (MeSH) terms and Boolean operators were employed. The systematic review was performed using the Rayyan software, whereas the Review Manager software was used to carry out the meta-analysis. A total of 16,605 articles were retrieved from the databases. After the duplicate removal, 2472 articles remained. These were eliminated using title screening, abstract screening, and full-length inspections. A total of nine articles were found eligible for quality assessment and meta-analysis, and the New Castle-Ottawa Scale was used for quality assessment. After the data extraction, 24 six articles were found to have the desired data format for the meta-analysis.

RESULTS

The results showed significantly higher IFAR in the affected ears of individuals in the Meniere's disease group than in the control group's unaffected ears. There was no significant difference between the unaffected ears of individuals in the Meniere's disease group and the ears of the control group. The only study on Meniere's disease and benign paroxysmal positional vertigo found significantly larger ocular VEMP IFAR in ears with Meniere's disease than in benign paroxysmal positional vertigo.

CONCLUSIONS

This systematic review and meta-analysis found IFAR efficient in differentiating Meniere's disease from healthy controls. We also found an enhanced IFAR as a potential marker for Meniere's disease. However, more investigations are needed to confirm the utility of an enhanced IFAR value in the exclusive identification of Meniere's disease.

Effects of aging on ocular vestibular-evoked myogenic potential using ER-3A insert earphone and B81 bone vibrator

Purpose

Aging is a process associated with degeneration and dysfunction of peripheral vestibular system or apparatus. This study aimed to investigate the influence of aging on ocular vestibular-evoked myogenic potential (oVEMP) response rates and recording parameters using the B81 bone vibrator and compare them with air conduction stimuli (ACS) oVEMP response characteristics.

Methods

In 60 healthy participants aged 10–71 years (mean age 39.9; 29 male participants), the oVEMP response was elicited using a B81 bone vibrator and an ER-3A insert earphone. The effects of age and stimulus on oVEMP response rates and recording parameters were evaluated.

Results

Response rates and amplitudes declined with aging using either ACS or bone-conducted vibration (BCV) stimulation, particularly in individuals over 60 years of age, whereas thresholds increased and N1 latencies were prolonged. BCV showed fewer risks of absent oVEMP response than ACS (p = 0.002). BCV acquired higher amplitudes (p < 0.001), lower thresholds, and shorter N1 and P1 latencies (all p < 0.001) than ACS.

Conclusions

The absence of an oVEMP response may be attributed to aging rather than a concurrent vestibular disorder. B81-BCV likely produces higher mechanical drives to the vestibular hair cells at safer and non-traumatic levels compared with ACS and therefore may be more likely to evoke a response in the elderly cohort, whose vestibular function and mechanical sensitivity have declined. Thus, B81-BCV stimulation is more effective and safer to elicit oVEMPs, and it should be recommended when ACS fails in the clinic, particularly in the elderly population.

Simultaneous Multifrequency (SiMFy) Stimulus: A Novel and Reliable Stimulus for Frequency Tuning of Ocular Vestibular-Evoked Myogenic Potentials

BACKGROUND

Frequency tuning of ocular vestibular evoked myogenic potential (oVEMP) refers to the frequency of tone burst that produces the largest amplitude oVEMP. There is an ever-growing pool of published studies that found the frequency tuning of oVEMP distinctly different in Ménière's disease than the age-matched controls and benign paroxysmal positional vertigo. However, recording oVEMP in response to many frequencies makes an already lengthy vestibular test battery even more cumbersome and time-consuming.

PURPOSE

The aim of this study was to develop a novel time-saving stimulus that produces reliable results.

RESEARCH DESIGN

Prospective study.

STUDY SAMPLE

The study included 25 young, healthy adults.

DATA COLLECTION

The tone-bursts of 2000, 1500, 1000, 750, 500, and 250 Hz were generated and sequenced in this order to prepare a stimulus for simultaneous multifrequency (SiMFy) oVEMP. The response parameters of SiMFy and conventional oVEMP methods were compared.

RESULTS

No significant difference in peak-to-peak amplitude and frequency tuning existed between conventional and SiMFy oVEMP (p > 0.05). SiMFy had better test-retest reliability and was less time-consuming than the conventional oVEMP.

CONCLUSIONS

SiMFy is a time-saving and reliable stimulus for obtaining frequency tuning of oVEMP with no compromise on the outcomes. It can be immediately applied in most commercially available evoked potential systems with a facility for loading an external stimulus.

Simultaneous Multifrequency (SiMFy) Stimulus: A Novel and Reliable Stimulus for Frequency Tuning of Ocular Vestibular-Evoked Myogenic Potentials

Background Frequency tuning of ocular vestibular evoked myogenic potential (oVEMP) refers to the frequency of tone burst that produces the largest amplitude oVEMP. There is an ever-growing pool of published studies that found the frequency tuning of oVEMP distinctly different in Ménière's disease than the age-matched controls and benign paroxysmal positional vertigo. However, recording oVEMP in response to many frequencies makes an already lengthy vestibular test battery even more cumbersome and time-consuming.

Purpose The aim of this study was to develop a novel time-saving stimulus that produces reliable results.

Research Design Prospective study.

Study Sample The study included 25 young, healthy adults.

Data Collection The tone-bursts of 2000, 1500, 1000, 750, 500, and 250 Hz were generated and sequenced in this order to prepare a stimulus for simultaneous multifrequency (SiMFy) oVEMP. The response parameters of SiMFy and conventional oVEMP methods were compared.

Results No significant difference in peak-to-peak amplitude and frequency tuning existed between conventional and SiMFy oVEMP (p > 0.05). SiMFy had better test–retest reliability and was less time-consuming than the conventional oVEMP.

Conclusions SiMFy is a time-saving and reliable stimulus for obtaining frequency tuning of oVEMP with no compromise on the outcomes. It can be immediately applied in most commercially available evoked potential systems with a facility for loading an external stimulus.

Effect of advancing age on inter-frequency amplitude ratio of ocular vestibular evoked myogenic potentials

OBJECTIVE

The inter-frequency amplitude ratio (IFAR) is the ratio of the amplitude of 1000-Hz tone-burst evoked ocular vestibular evoked myogenic potential (oVEMP) to the 500 Hz tone-burst evoked oVEMP. Since IFAR is an amplitude-based parameter, and the amplitudes of oVEMP for different frequencies are differentially affected by ageing, IFAR could potentially be affected by the ageing process. Therefore, we aimed to examine the effects of ageing on the IFAR of oVEMPs.

DESIGN

Multiple static groups comparison.

STUDY SAMPLE

We recorded oVEMPs for 500 Hz and 1000 Hz tone-bursts from 270 healthy individuals, each included in one of the six age groups.

RESULTS

The IFAR was significantly larger in the ≥60 years age group than the age groups up to 49 years. Furthermore, the IFAR in the 50-59 years age group was significantly larger than all the other age groups up to 39 years. There was a significant positive correlation between age and IFARs (p < 0.01).

CONCLUSIONS

IFAR, a sensitive tool in the test battery for the diagnosis of Meniere's disease, is affected even in healthy individuals due to ageing; hence its cautious interpretation is recommended when evaluating adults >50 years of age who are suspected of having Meniere's disease.

Intersession Variations in Frequency Tuning of Ocular Vestibular Evoked Myogenic Potentials in Healthy Individuals

Objective Frequency tuning of ocular vestibular evoked myogenic potential (oVEMP), which is the stimulus frequency corresponding to the largest oVEMP amplitude, has been used to diagnose cases with Ménière's disease and differentiate them from cases with benign paroxysmal positional vertigo with a high degree of sensitivity and specificity. However, this measure of oVEMP is carved out of the peak-to-peak amplitude of oVEMP, and studies on test-retest reliability of amplitude of oVEMP have shown moderate-to-excellent reliability of amplitude. This would theoretically render the frequency tuning of oVEMP susceptible to variations across multiple recordings. This being the case, erroneous conclusions regarding the presence of Ménière's disease could be made if the frequency tuning varies between recordings. However, there is no published report regarding the test-retest reliability of frequency tuning measure of oVEMP even in healthy individuals, to the best of our knowledge. Therefore, this study aimed to study the test-retest reliability of frequency tuning of oVEMP in healthy individuals. Method The study included 20 healthy adults in the age range of 18-25 years. All participants underwent oVEMP recording in 4 different sessions, with each session consisting of oVEMP recording for octave and midoctave tone-burst frequencies from 250 to 2000 Hz. Results The results revealed no significant difference in frequency tuning of oVEMP among the sessions (p > .05). The intraclass correlation coefficient for frequency tuning data was found to be .857. Conclusion The frequency tuning of oVEMP has excellent test-retest reliability and therefore lends itself to applications requiring multiple sessions of recording.

A Novel Stimulation Paradigm for Obtaining Interfrequency Amplitude Ratio of Ocular Vestibular Evoked Myogenic Potentials

Purpose Interfrequency amplitude ratio (IFAR), the ratio of amplitude between ocular vestibular evoked myogenic potentials (oVEMPs) for tone bursts of 500 and 1000 Hz, aids in identification of Ménière's disease with high sensitivity and specificity. However, it requires recording of oVEMP for 2 frequencies, which doubles the time of recording. Use of simultaneous recording of responses for both frequencies could potentially bring down testing time. Simultaneous recording might be possible by modifying the oddball paradigm and using a ratio of 1:1 for the 2 frequencies. This might also reduce variation in oVEMP amplitude between frequencies due to changes in gaze angle between the recordings. However, it remains to be explored whether or not the use of modified oddball paradigm to record oVEMP (MoVEMP) will produce comparable responses to conventional sequential recording of oVEMP (CoVEMP) for obtaining IFAR. Hence, the study aimed to compare MoVEMP and CoVEMP on various measures of oVEMP. Method The study included 29 healthy adults in the age range of 18-30 years, 23 of which were used for validation and 6 for finding test-retest reliability. All participants underwent contralateral oVEMP recording using 500- and 1000-Hz tone bursts presented using MoVEMP and CoVEMP paradigms. Results Comparable outcomes on latencies, amplitude, and IFAR were obtained between CoVEMP and MoVEMP. Furthermore, MoVEMP took significantly lesser time per ear and also produced better test-retest reliability than CoVEMP. Conclusion MoVEMP is a quicker and more reliable clinical stimulation paradigm for obtaining IFAR than CoVEMP.