Detection of Saccular Endolymphatic Hydrops in Ménière's Disease Using a Modified Glycerol cVEMP Test in Combination With the Tuning Property Test

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Abstract

Objective:

To determine the optimal method for detecting saccular endolymphatic hydrops (EH) in patients with Ménière's disease (MD) using a glycerol cervical vestibular evoked myogenic potential (cVEMP) test in combination with a tuning property test.

Study Design:

Prospective patients series.

Setting:

Tertiary referral center.

Patients:

Twenty-three subjects (age: 36–77 years) were enrolled in this study. Seventeen subjects were diagnosed with definite MD. Six subjects were diagnosed with possible MD.

Intervention:

Diagnostic.

Main Outcome Measure:

The corrected amplitudes of p13-n23 (cVEMP) were measured before and after the administration of 10% glycerol (500 ml, 2 h, intravenously). A tuning property index and the p13-n23 amplitude improvement ratio were calculated.

Results:

The positivity rate (PR) during the tuning property test was 55% (definite MD-affected ears), 35% (definite MD-unaffected ears), and 25% (possible MD ears). The PR during the glycerol cVEMP amplitude test was 60, 8, and 0%, respectively. The use of modified criteria for the glycerol cVEMP test in combination with the tuning property test resulted in the PR increasing to 75, 57, and 25%, respectively. The pre-glycerol stage results obtained using the tuning property test almost (except in two ears) completely agreed with the glycerol cVEMP test results by the modified criteria.

Conclusion:

The tuning property test is an easy and useful way of detecting saccular EH. However, the glycerol cVEMP test is required in patients that do not respond to either 500 or 1000 Hz short tone bursts (STB).

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