Application of multivariate statistics to vestibular testing: Discriminating between Menière's disease and migraine associated dizziness

2001 ◽  
Vol 11 (1) ◽  
pp. 53-65 ◽  
Author(s):  
P.S. Dimitri ◽  
C. Wall ◽  
J.G. Oas ◽  
S.D. Rauch
Keyword(s):  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Classification Rate ◽  
Ocular Reflex ◽  
Vestibular Testing ◽  
Vestibulo Ocular Reflex ◽  
Ménière's Disease

Menière's disease (MD) and migraine associated dizziness (MAD) are two disorders that can have similar symptomatologies, but differ vastly in treatment. Vestibular testing is sometimes used to help differentiate between these disorders, but the inefficiency of a human interpreter analyzing a multitude of variables independently decreases its utility. Our hypothesis was that we could objectively discriminate between patients with MD and those with MAD using select variables from the vestibular test battery. Sinusoidal harmonic acceleration test variables were reduced to three vestibulo-ocular reflex physiologic parameters: gain, time constant, and asymmetry. A combination of these parameters plus a measurement of reduced vestibular response from caloric testing allowed us to achieve a joint classification rate of 91%, independent quadratic classification algorithm. Data from posturography were not useful for this type of differentiation. Overall, our classification function can be used as an unbiased assistant to discriminate between MD and MAD and gave us insight into the pathophysiologic differences between the two disorders.

Autorotation Test of the Horizontal Vestibulo-Ocular Reflex in Meniere's Disease

1993 ◽  
Vol 109 (3) ◽  
pp. 399-412 ◽  
Author(s):  
Matthew Ng ◽  
Linda L. Davis ◽  
Dennis P. O'Leary
Keyword(s):  
High Frequency ◽  
Meniere’S Disease ◽  
Head Movements ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Ménière's Disease

Sixty-four patients with the diagnosis of Meniere's disease were tested at the House Ear Clinic with an active head-rotation test system, the Vestibular Autorotation Test (VAT). The VAT is a portable, computerized test that measures the horizontal vestibulo-ocular reflex (VOR) with the use of high-frequency (2 to 6 Hz) active head movements to obtain gain and phase. The purpose of this study was to characterize the horizontal VOR at high frequencies in patients with Meniere's disease. At frequencies from 5 to 6 Hz, all patients demonstrated horizontal phase greater than 180 degrees and 85% showed abnormal VAT results. The most common patterns were decreased gain or increased phase values, or both, relative to normative data. No significant differences in the degree of abnormality in gain and phase were noted among groups of patients when the patients were clinically staged. We conclude that, in our test population of patients with Meniere's disease, the VAT shows common gain and phase patterns and abnormalities of the horizontal VOR. This may contribute to high retinal image velocities, which render the patient unable to stabilize retinal images during locomotion (visual field image slip), in as many as 85% of the patients tested, regardless of clinical stage. Such high-frequency testing can reveal abnormalities of the horizontal VOR not apparent from conventional vestibular testing. Thus VAT provides additional information about the functioning VOR when combined with the present vestibular test battery. (OTOLARYNGOL HEAD NECK SURG 1993;109:399–412.)

Disruption of self-motion perception without vestibular reflex alteration in ménière’s disease

2021 ◽  
pp. 1-11
Author(s):  
Mario Faralli ◽  
Michele Ori ◽  
Giampietro Ricci ◽  
Mauro Roscini ◽  
Roberto Panichi ◽  
...  
Keyword(s):  
Motion Perception ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Whole Body ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Ocular Reflex ◽  
Ménière's Disease ◽  
Self Motion

BACKGROUND: Self-motion misperception has been observed in vestibular patients during asymmetric body oscillations. This misperception is correlated with the patient’s vestibular discomfort. OBJECTIVE: To investigate whether or not self-motion misperception persists in post-ictal patients with Ménière’s disease (MD). METHODS: Twenty-eight MD patients were investigated while in the post-ictal interval. Self-motion perception was studied by examining the displacement of a memorized visual target after sequences of opposite directed fast-slow asymmetric whole body rotations in the dark. The difference in target representation was analyzed and correlated with the Dizziness Handicap Inventory (DHI) score. The vestibulo-ocular reflex (VOR) and clinical tests for ocular reflex were also evaluated. RESULTS: All MD patients showed a noticeable difference in target representation after asymmetric rotation depending on the direction of the fast/slow rotations. This side difference suggests disruption of motion perception. The DHI score was correlated with the amount of motion misperception. In contrast, VOR and clinical trials were altered in only half of these patients. CONCLUSIONS: Asymmetric rotation reveals disruption of self-motion perception in MD patients during the post-ictal interval, even in the absence of ocular reflex impairment. Motion misperception may cause persistent vestibular discomfort in these patients.

Multivariate vestibular testing: Laterality of unilateral Ménière's disease

2002 ◽  
Vol 11 (6) ◽  
pp. 405-412
Author(s):  
P.S. Dimitri ◽  
C. Wall ◽  
S.D. Rauch
Keyword(s):  
Discrimination Performance ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Positional Nystagmus ◽  
Menière's Disease ◽  
Vestibular Testing ◽  
Ménière's Disease ◽  
Directional Preponderance

This paper discusses the use of vestibular testing to discriminate between right (n = 29) and left (n = 27) Ménière's disease. We examined reduced vestibular response (RVR), directional preponderance, and spontaneous and positional nystagmus measurements from electronystagmography, as well as the asymmetry measurements from the sinusoidal harmonic acceleration test, to determine whether multivariate logistic regression could improve upon the discrimination performance of RVR alone. We found that patients with a spontaneous or positional nystagmus often had a “recovery nystagmus”, beating in the opposite direction of that predicted for an acute lesion. When present, the direction and magnitude of such nystagmus could be used in the classification algorithm to increase the discriminatory power over RVR alone, but in these patients the rotation test asymmetry measurements were rendered useless. In the absence of spontaneous or positional nystagmus, asymmetry measurements significantly enhanced right/left discrimination. Directional preponderance was insignificant in determining the side of lesion.

scholarly journals Cochlear Meniere's: A Distinct Clinical Entity With Isolated Cochlear Hydrops on High-Resolution MRI?

2021 ◽  
Vol 8 ◽  
Author(s):  
Jose E. Alonso ◽  
Gail P. Ishiyama ◽  
Rance J. T. Fujiwara ◽  
Nancy Pham ◽  
Luke Ledbetter ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Endolymphatic Hydrops ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Vestibular Testing ◽  
History Of ◽  
Ménière's Disease

Objective: Describe the clinical characteristics of patients with isolated cochlear endolymphatic hydrops (EH).Study design: Clinical case series.Setting: Tertiary Neurotology referral clinic.Patients: All subjects presenting to a University Neurotology clinic during a 1-year period from July 2015 until August 2016 who had isolated cochlear EH on MRI. Patients with a history of temporal bone surgery prior to the MRI were excluded.Intervention: High-resolution delayed-intravenous contrast MRI.Main outcome measures: Audiometric and vestibular testing, clinical history analysis.Results: 10 subjects demonstrated isolated, unilateral cochlear hydrops on MRI. None of these patients met the criteria for Meniere's disease. Mean age of the group was 66.4 years and most were males (70%). Unilateral aural fullness (70%), tinnitus (80%), and hearing loss (90%) were frequently observed. Only one patient presented with unsteadiness (10%) and one patient had a single isolated spell of positional vertigo 1 month prior to the MRI (10%) but no further vertigo spells in the 4 years following the MRI. The mean PTA was 37.8 dB which was significantly decreased from the non-affected ear with PTA of 17.9 (p < 0.001). One patient developed vertiginous spells and unsteadiness 4 years after initial presentation and a repeat MRI revealed progression to utricular, saccular and cochlear hydrops. Vestibular testing was obtained in five patients with one patient presenting with 50% caloric paresis and all others normal. The most common treatment tried was acetazolamide in seven patients with 86% reporting subjective clinical improvement. Two out of the 10 patients had a history of migraine (20%).Conclusions: Patients with MRI exhibiting isolated cochlear EH present with predominantly auditory symptoms: mild to moderate low-frequency hearing loss, aural fullness, tinnitus without significant vertigo. Isolated cochlear hydrops is more common in males, average age in mid-60's and there is a low comorbidity of migraine headaches. This contrasts significantly with patients with isolated saccular hydrops on MRI from our prior studies. We believe that isolated cochlear EH with hearing loss but no vertigo is distinct from Meniere's disease or its variant delayed endolymphatic hydrops. We propose that cochlear Meniere's disease represents a distinct clinical entity that could be a variant of Meniere's disease.

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