This study sets out to determine the most useful metrics to use from cervical-vestibular evoked myogenic potential (c-VEMP) tests when the diagnosis of Meniere’s disease (MD) is unclear, or as a follow-up tool. It is known that cVEMPs can detect saccular and inferior vestibular nerve dysfunction, and their use in superior semicircular canal dysfunction is well-established. However, although there has been previous literature published on the use of this test in MD, as the authors argue, there is significant heterogeneity in regard to the specific metrics and muscle normalisation utilised. This issue was addressed here by comparing the various c-VEMP metrics in confirmed MD patients against healthy age-matched controls and provided sensitivities and specificities for each, with a focus on consistent methodology. The c-VEMP metrics under investigation are amplitude, threshold, frequency tuning, and inter-aural asymmetry ratio. Thirty patients with MD and 23 age-matched controls were investigated. The results of this technical study identified the three most useful metrics to standardise: 500Hz c-VEMP threshold, a normalised peak to peak amplitude and VEMP inhibition depth. The reality of the clinical application of c-VEMP testing for patients with possible MD, but who in fact may have a different or co-existent balance disorder, is that this study has not addressed that situation, as the controls here were symptom-free. The authors do acknowledge that more work is needed to address this diagnostic dilemma.

Cervical Vestibular Evoked Myogenic Potentials in Meniere’s Disease: A Comparison of Response Metrics.
Noij KS, Herrmann BS , Guinan JJ Jr, Rauch SD.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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