Can You Use VEMPs to Diagnose Meniere's Disease?

Introductory
10 mins
Reading
09 February 2022

Description

Yes VEMPs can be used in a number of ways and, like a number of vestibular diagnostic tests associated with Meniere’s disease, the result and the interpretation depend to a large extent of the point along the disease cycle at which the test is performed. For example, as part of a test battery one use of VEMPs would be to determine the extent of residual otolith function, where reduced VEMP amplitudes or absent VEMPs might be expected as the condition becomes more advanced. However, another interesting application is the VEMP tuning curve, which considers the VEMP amplitude across a range of stimulus frequencies. 

In the healthy ear the VEMP (similar concepts apply for both the cervical and ocular VEMP) tuning curve shows a maximal response at around 500 Hz and a progressively reducing amplitude as stimulus frequency increases. However, in a diseased ear the tuning shifts so that the response becomes dominant at around 1000 Hz (Murofushi et al. 2017; Sandhu et al., 2012). The exact mechanism for this shift is unclear but may be attributable to the altered fluid dynamics of the fluid-distended vestibule. Clearly this technique depends on the overall disease stage (e.g. if a VEMP is absent, suggestive of later stages, then a tuning curve cannot be plotted). The postulated mechanism for a tuning curve shift might also suggest that a positive finding should not occur during a remission period even if the patient was a true positive.

To assist you with differentiating Meniere’s disease the Interacoustics Academy has made these tables which suggest expected test results across the test battery in meniere’s disease patients. 

Murofushi, T., Tsubota. M., Suizu, R.  and Yoshimura, E. (2017) Is Alteration of Tuning Property in Cervical Vestibular-Evoked Myogenic Potential Specific for Ménière’s Disease? Front. Neurol. 8 Article 193.

Sandhu, J., Low, R., Rea, P., and Saunders, N. (2012) Altered frequency dynamics of cervical and ocular vestibular evoked myogenic potentials in patients with Ménière’s disease. Otol Neurotol 33. Pages 444-449.


Disclaimer 
The information in the figures are a resource tool based on the needs of medical professionals and students that allows quick access to the typical assessment findings in a range of common vestibular disorders. The resource was developed to provide fast, easy-to-use, and always available information which can aid in reaching the correct diagnosis. The information contained within is provided as an information resource only, and should not be used as a substitute for professional diagnosis and management.

Presenter

Michael Maslin
After working for several years as an audiologist in the UK, Michael completed his Ph.D. in 2010 at The University of Manchester. The topic was plasticity of the human binaural auditory system. He then completed a 3-year post-doctoral research program that built directly on the underpinning work carried out during his Ph.D. In 2015, Michael joined the Interacoustics Academy, offering training and education in audiological and vestibular diagnostics worldwide. Michael now works for the University of Canterbury in Christchurch, New Zealand, exploring his research interests which include electrophysiological measurement of the central auditory system, and the development of clinical protocols and clinical techniques applied in areas such as paediatric audiology and vestibular assessment and management.

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