Does Vestibular Rehabilitation Influence Vestibular Evoked Myogenic Potential (VEMP) ‎in Patients with Meniere’s Disease?‎

Document Type : Original Article

Authors

1 Rehabilitation Science Research Center, Zahedan University of Medical science, Zahedan, Iran

2 Department of ENT Disorder, Al-Zahra Hospital, Zahedan University of Medical science, ‎Zahedan, Iran

Abstract

Purpose:
Meniere’s disease is a disorder associated with balance problems. This study aimed to explore characteristics of vestibular myogenic evoked potentials (VEMP) and the possible effect of vestibular rehabilitation program on these responses in patients with unilateral Meniere's disease.
Methods:
23 patients with a definite unilateral Meniere’s disease and 15 healthy control subjects were included in this study. All patients underwent a complete auditory-vestibular test battery. The vestibular rehabilitation program was performed in 4 weeks for the case group. Vestibular myogenic evoked potentials were evaluated before and after receiving the treatment program.
Results:
The prevalence level of VEMP response at the frequency of 500 Hz in the affected, non-affected and control ears were 82.60%, 95.7% and 100, respectively, and in response to 1000 Hz, they were 87%, 95.7% and 100%, respectively.
There was no significant difference in average amplitude of the p13-n23 component between the two studied groups, whereas there was a significant difference in the asymmetry ratios in people with Meniere's disease (equivalent to 37.78% and 24.31% at frequencies of 500 and 1000 Hz, respectively) compared to the control group (6.88% and 7.90%). In addition, the average amplitude ratio of 500/1000 Hz in the affected ear (1.19±0.47) was much lower than that of the non-affected ear (1.54±0.28) (p= 0.006). The vestibular rehabilitation program for one month did not significantly affect the asymmetry ratios (p= 0.26) and other characteristics of VEMP response.
Conclusion:
VEMP test can be used to discriminate with a good degree of clinical accuracy between Meniere’s ears (unilateral) and those of healthy controls, however, one-month vestibular rehabilitation does not affect VEMP-related parameters.

Keywords


  1. Morita Y, Takahashi K, Ohshima S, Yagi C, et al. Is vestibular Meniere's disease associated with endolymphatic hydrops? Front Surg 2020; 7: 601692.
  2. Alford BR. Committee on hearing and equilibrium, report on subcommitte on equilibrium and its measurement, Meniere's disease: criteria for diagnosis and evaluation if therapy for reporting. Trans Am Acad Ophthalmol Otolaryngol 1972; 76: 1462-1464.
  3. Angeli SI, Goncalves S. Cervical VEMP tuning changes by Meniere's disease stages. Laryngoscope Investigative Otolaryngology 2019; 4(5): 543-549.
  4. Jerin C, Berman A, Krause E, Ertl-Wagner B, Gürkov R. Ocular vestibular evoked myogenic potential frequency tuning in certain Meniere's disease. Hear Res 2014; 310: 54-59.
  5. Maxwell R, Jerin C, Gürkov R. Utilisation of multi-frequency VEMPs improves diagnostic accuracy for Meniere’s disease. Eur Arch Otorhinolaryngol 2017; 274(1): 85-93.
  6. Rosengren SM, Kingma H. New perspectives on vestibular evoked myogenic potentials. Curr Opin Neurol 2013; 26(1): 74-80.
  7. Akkuzu G, Akkuzu B, Ozluoglu LN. Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere’s disease. Eur Arch Otorhinolaryngol 2006; 263(6): 510-517.
  8. Egami N, Ushio M, Yamasoba T, Yamaguchi T, et al. The diagnostic value of vestibular evoked myogenic potentials in patients with Meniere's disease. J Vestib Res 2013; 23(4-5): 249-257.
  9. Timmer FC, Zhou G, Guinan JJ, Kujawa SG, et al. Vestibular evoked myogenic potential (VEMP) in patients with Ménière's disease with drop attacks. Laryngoscope 2006; 116(5): 776-779.
  10. Young YH. Potential application of ocular and cervical vestibular‐evoked myogenic potentials in Meniere's disease: a review. Laryngoscope 2013; 123(2): 484-491.
  11. Rauch SD, Zhou G, Kujawa SG, Guinan JJ, Herrmann BS. Vestibular evoked myogenic potentials show altered tuning in patients with Meniere’s disease. Otol Neurotol 2004; 25(3): 333-338.
  12. Murofushi T. Clinical application of vestibular evoked myogenic potential (VEMP). Auris Nasus Larynx 2016; 43(4): 367-376.
  13. Esch B, Scheer-Horst E, Zaag-Loonen H, Bruintjes T, Benthem P. The effect of vestibular rehabilitation in patients with Ménière’s disease: a systematic review. Otolaryngol Head Neck Surg 2017; 156(3): 426-434.
  14. Matsumura M, Murofushi T. Vestibular Rehabilitation after Vestibulopathy Focusing on the Application of Virtual Reality. MDPI 2021; 2(2): 5.
  15. Perez N, Santandreu E, Benitez J, Rey-Martinez J. Improvement of postural control in patients with peripheral vestibulopathy. Eur Arch Otorhinolaryngol 2006; 263(5): 414-420.
  16. Jeong J, Jung J, Lee JM, Suh MJ, et al. Effects of saccular function on recovery of subjective dizziness after vestibular rehabilitation. Otol Neurotol 2017; 38(7): 1017-1023.
  17. Jomin G, Kumar K, Ebenezer A. Comparison of vestibular evoked myogenic potential and dizziness handicap inventory in patient with peripheral vestibular lesions between pre and post vestibular rehabilitation. Int Tinnitus J 2019; 23(2): 69-73.
  18. Millar JL, Gimmon Y, Roberts D, Schubert MC. Improvement after vestibular rehabilitation not explained by improved passive VOR gain. Front Neurol 2020; 11: 79.
  19. Okuno T, Sando I. Localization, frequency, and severity of endolymphatic hydrops and the pathology of the labyrinthine membrane in Meniere's disease. Ann Otol Rhinol Laryngol 1987; 96(4): 438-445.
  20. Kohut RI, Hinojosa R, Thompson JN, Ryu JH. Idiopathic Perilymphatic Fistulae: A Temporal Bone Histopathological Study: Clinical, Surgical and Histopathological Correlations. Arch Otolaryngol Head Neck Surg 1995; 121(4): 412-420.
  21. Welgampola M, Colebatch J. Characteristics of tone burst-evoked myogenic potentials in the sternocleidomastoid muscles. Otol Neurotol 2001; 22(6): 796-802.
  22. Murray KJ, Hill K, Phillips B, Waterston J. Does otolith organ dysfunction influence outcomes after a customized program of vestibular rehabilitation? J Neurol Phys Ther 2010; 34(2): 70-75.
  23. Maire R, van Melle G. Dynamic Asymmetry of the Vestibulo‐ocular Reflex in Unilateral Peripheral Vestibular and Cochleovestibular Loss. Laryngoscope 2000; 110(2): 256-263.
  24. Heide G, Freitag S, Wollenberg I, Iro H, et al. Click evoked myogenic potentials in the differential diagnosis of acute vertigo. J Neurol Neurosurg Psychiatry 1999; 66(6): 787-790.