Improving VEMP measurement for potential diagnosis of Ménière's Disease Seminar

Ménière disease (MD) causes hearing and balance disorder and is associated with raised endolymph pressure in the inner ear. Previously studies have reported change in the tuning of Vestibular Evoked Myogenic Potentials (VEMPs) with MD that are thought to reflect changes in the properties of the saccule due to endolymphatic hydrops. Cervical (c) VEMPs can be elicited with loud low frequency sounds and are thought to reflect saccular activity.

This presentation will summarise normative studies attempting to improve the measurement of the VEMP reflex through 1. Altering the stimulation paradigm and 2. Using objective (statistical) rather than subjective analysis of responses. Using high rate stimulation has potential to reduce the recording time of VEMP, but we found that response presence falls off at high rates. 10 Hz stimulation halves recording time compared to the standard 5 Hz rate with no reduction in wave presence. Subjective response detection showed moderate, but not good inter-rater reliability. Using the objective Hotellings T2 measure may reduce this variability and gave significantly lower threshold estimates than 2 of 3 expert raters. We then applied the new stimulation and analysis paradigm to 15 patients with MD and 30 controls to measure tuning from 250 to 1 kHz. Changes in tuning curves were consistent with previous literature and 500 Hz thresholds can discriminate control groups, worst and least affected MD ears. Future work will compare the sensitivity and specificity of tuning curves for MD with electrocochleography.

(We are also interested in using VEMP and other vestibular measurements to explore the effects of cochlear implantation on balance function, although that is beyond the scope of this presentation.)