Subjective Visual Vertical and Vestibular Evoked Myogenic Potential in Meniere's disease,

Ferreira, Maristela Mian; Lopes, Karen de Carvalho; Grigol, Thaís Alvares de Abreu e Silva; Ganança, Maurício Malavasi; Caovilla, Heloisa Helena

doi:10.1016/j.bjorl.2022.11.005

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original article • Braz. j. otorhinolaryngol. 89 (3) • May-Jun 2023 • https://doi.org/10.1016/j.bjorl.2022.11.005 copy

Subjective Visual Vertical and Vestibular Evoked Myogenic Potential in Meniere's disease^☆ ☆ Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. ,^☆☆ ☆☆ Study carried out at Universidade Federal de São Paulo ‒ Escola Paulista de Medicina (UNIFESP-EPM), Discipline of Otology and Neurotology, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

SVV test evaluates the static otolith system and, cervical and ocular VEMPs, examines the dynamic.
SVV, with the bucket method, and cervical and ocular VEMPs, contribute to the assessment of vestibulopathies.
SVV and cervical and ocular VEMPs together, are advantageous to assess otolith disorders in Meniere’s disease.

Abstract

Objective

To evaluate otolith function by comparing the findings of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential tests in patients in the inter-crisis period of unilateral definite Meniere's disease.

Methods

The sample consisted of an experimental group (n = 22; 10 men and 12 women, mean age 47.32 ± 12.82 years) with definite unilateral Meniere's disease and a control group (n = 14; 5 men and 9 women, with a mean age of 41.64 ± 13.45 years). They all underwent vestibular evaluation by means of Subjective Visual Vertical with the bucket method and, cervical and ocular Vestibular Evoked Myogenic Potential tests. The data were collected and subjected to statistical analysis.

Results

The results of the comparison of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential, the ocular Vestibular Evoked Myogenic Potential and, the association of cervical Vestibular Evoked Myogenic Potential with the ocular Vestibular Evoked Myogenic Potential showed no significant difference, indicating concordance among the tests.

Conclusion

The identified abnormalities and the concordance between the combined proportion of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential findings indicate that the association of these three tests contributes to the identification of sustained and transient otolith dysfunction in the inter-crisis of unilateral definite Meniere’s disease.

Level of evidence

Keywords
Labyrinth diseases; Meniere's disease; Saccule and utricle; Vestibular function tests; Vestibular evoked myogenic potentials

SVV	Group	n	Mean	SD	Median	Min.	Max.	p	ES
Mean (°)	CG	14	1.29 (1.03-1.55)	0.54	1.45 (1.05-1.50)	0.40	2.40	<0.001 ^a a Statistically significant value at the 5% level (p ≤ 0.05). , ^b b Calculated with Welch correction for heteroscedasticity.	2.766^d
Mean (°)	EG	22	2.77 (2.23-3.34)	1.26	2.55 (1.90-3.40)	0.70	5.50		2.766^d

SVV	Result	Group						p-Value
		CG		EG		Total
		n	%	n	%	n	%
Mean	Altered	1	7.14	13	59.09	14	38.89	<0.001 ^a a Statistically significant value at the 5% level (p ≤ 0.05).
Mean	Normal	13	92.86	9	40.91	22	61.11

cVEMP	Group	n	Mean	SD	Median	Min.	Max.	p	ES
P1 Latency (ms)	SE	18	15.24 (13.90-16.70)	3.07	14.21 (12.67-17.83)	11.33	21.50	0.971^b	‒
	AE	19	14.70 (13.69-15.84)	2.47	14.17 (12.92-15.33)	12.08	19.83
	CE	28	14.54 (13.91-15.17)	1.71	14.90 (14.45-15.17)	11.17	17.67
N1 Latency (ms)	SE	18	23.43 (21.95-25.10)	3.36	22.75 (21.08-24.75)	19.25	30.67	0.256^a	‒
	AE	19	23.50 (22.31-24.74)	2.78	23.08 (21.58-25.33)	19.00	27.67
	CE	28	22.29 (21.36-23.17)	2.44	22.75 (21.66-23.50)	17.67	26.50
Inter-amplitude (μV)	SE	18	88.75 (70.39. ‒109.44)	48.49	72.04 (58.85-104.06)	26.63	191.50	0.011b,^d d Statistically significant value at the 5% level (p ≤ 0.05).	‒
	AE	19	136.01 (100.60-179.47)	98.48	94.67 (80.25‒44.24)	46.34	445.86
	CE	28	124.26 (111.57-137.35)	33.36	123.0 (104.54‒37.00)	69.08	190.00
Asymmetry index	CG	14	22.28 (18.96-25.94)	6.41	21.53 (17.72-27.49)	14.11	36.12	0.538^c	0.108^r
Asymmetry index	EG	21	41.92 (27.39-57.23)	36.81	27.29 (14.29-53.76)	1.95	100	0.538^c	0.108^r

oVEMP	Group	n	Mean	SD	Median	Min.	Max.	p	E.S.
N1 Latency (ms)	SE	13	10.26 (9.81-10.58)	0.71	10.42 (10.17-10.50)	8.16	11.08	0.195^a	‒
	AE	16	10.50 (10.30-10.69)	0.47	10.50 (10.46-10.50)	9.42	11.58
	CE	28	10.10 (9.87‒10.33)	0.78	10.11 (9.75-10.17)	8.90	11.42
P1 Latency (ms)	SE	13	14.48 (13.87-15.03)	1.14	14.75 (14.75‒14.75)	12.08	15.92	0.600^a	‒
	AE	16	14.24 (14.34-15.00)	2.59	14.75 (14.34-15.00)	5.00	16.67
	CE	28	14.34 (13.95-14.71)	1.14	13.97 (13.74-15.42)	12.07	16.09
Inter-amplitude (μV)	SE	13	6.26 (3.80-9.03)	4.38	4.42 (2.49-8.46)	1.36	15.16	0.972^a	‒
	AE	16	6.06 (4.64-7.52)	3.10	5.94 (3.82-7.46)	2.10	11.15
	CE	28	5.83 (5.15-6.54)	2.35	5.44 (4.22-6.05)	3.07	12.00
Asymmetry index	CG	14	16.27 (12.63-20.14)	8.26	13.94 (9.74‒20.51)	5.24	33.33	0.015 b,^c c Statistically significant value at the 5% level (p ≤ 0.05).	0.440^r
Asymmetry index	EG	16	41.26 (26.76-57.64)	32.86	28.80 (18.24-58.48)	6.63	100		0.440^r

Test	Parameter	Group	Altered		Normal		Total		p
			n	%	n	%	n	%
cVEMP	Latency P1 (ms)	SE	4	22.22^a	14	77.78^a	18	100	0.014^c, ^e e Statistically significant value at the 5% level (p ≤ 0.05).
		AE	3	15.79^a,b	16	84.21^a,b	19	100
		CE	0	0.00^b	28	100^b	28	100
	Latency N1 (ms)	SE	3	16.67^a	15	83.33^a	18	100	0.040^c, ^e e Statistically significant value at the 5% level (p ≤ 0.05).
		AE	3	15.79^a	16	84.21^a	19	100
		CE	0	0.00^a	28	100^a	28	100
	Inter-amplitude (μV)	SE	5	27.78^a	13	72.22^a	18	100	0.007^c, ^e e Statistically significant value at the 5% level (p ≤ 0.05).
		AE	2	10.53^a,b	17	89.47^a,b	19	100
		CE	0	0.00^b	28	100^b	28	100
	Asymmetry Index (%)	CG	1	7.14	13	92.86	14	100	0.023^d, ^e e Statistically significant value at the 5% level (p ≤ 0.05).
	Asymmetry Index (%)	EG	10	47.62	11	52.38	21	100
oVEMP	N1 Latency (ms)	SE	0	0.00	13	100	13	100	NC
		AE	0	0.00	16	100	16	100
		CE	0	0.00	28	100	28	100
	P1 Latency (ms)	SE	0	0.00	13	100	13	100	0.509
		AE	1	6.25	15	93.75	16	100
		CE	0	0.00	28	100	28	100
	Inter-amplitude (μV)	SE	0	0.00	13	100	13	100	NC
		AE	0	0.00	16	100	16	100
		CE	0	0.00	28	100	28	100
	Asymmetry Index (%)	CG	1	7.14	13	92.86	14	100	0.086
	Asymmetry Index (%)	EG	6	37.50	10	62.50	16	100	0.086

Test	Category	SVV				p
		Altered		Normal
		n	%	n	%
cVEMP	Altered	11	50.00	6	27.27	0.289
cVEMP	Normal	2	9.09	3	13.64	0.289
oVEMP	Altered	7	31.82	5	22.73	>0.999
oVEMP	Normal	6	27.27	4	18.18	>0.999
cVEMP + oVEMP	Altered	7	46.66	4	26.66	0.414
cVEMP + oVEMP	Normal	2	13.33	2	13.33	0.414

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] ⁎ Corresponding author. E-Mail:maristelamian@yahoo.com.br (M.M. Ferreira).