Multivariate vestibular testing: Laterality of unilateral Ménière's disease

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.

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

Journal of Vestibular Research ◽

10.3233/ves-2001-11106 ◽

2001 ◽

Vol 11 (1) ◽

pp. 53-65 ◽

Cited By ~ 5

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.

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Positional Nystagmus after Acute Vertiginous Attack in Meniere’s Disease

Audiology Research ◽

10.3390/audiolres11010007 ◽

2021 ◽

Vol 11 (1) ◽

pp. 55-62

Author(s):

Haemin Noh ◽

Dong-Han Lee ◽

Jung Eun Shin ◽

Chang-Hee Kim

Keyword(s):

Inner Ear ◽

Meniere’S Disease ◽

Menière’S Disease ◽

The Other ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Positional Nystagmus ◽

Menière's Disease ◽

Ménière's Disease ◽

Paroxysmal Positional Vertigo

There have been no reports regarding nystagmus observed immediately after the end of an acute vertiginous attack in patients with Meniere’s disease. The aim of this study was to demonstrate positional direction-changing nystagmus in patients with Meniere’s disease, and to discuss the mechanism that underlies this nystagmus. Video-nystagmography was recorded in two patients with definite Meniere’s disease, who showed positional direction-changing nystagmus during the period immediately after a vertigo attack. In one patient, video-nystagmographic recording was conducted 5 h after an episode of vertigo attack, and it showed very weak, persistent positional geotropic direction-changing nystagmus. In the other patient, video-nystagmographic recording was conducted 23 h after an episode of vertigo attack, and it showed very weak, persistent positional apogeotropic direction-changing nystagmus. Our patients exhibited very weak, persistent positional direction-changing nystagmus, which was geotropic in one and apogeotropic in the other. This type of positional nystagmus has been reported in other inner ear disorders and it cannot be clearly explained by typical benign paroxysmal positional vertigo. The change in chemical composition and/or electrolyte concentration of the inner ear fluid, although still unclear, may underlie the production of this characteristic nystagmus in these patients.

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

Frontiers in Surgery ◽

10.3389/fsurg.2021.680260 ◽

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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