Application Of Vestibular Evoked Myogenic Potential And Vestibular Autorotation Test In The Diagnosis And Evaluation Of Meniere’s Disease

Objective: To explore the significance of vestibular evoked myogenic potential(VEMP)and vestibular autorotation test(VAT)in the diagnosis and evaluation of Meniere’s Disease(MD).Then analyze the relationship between the degree of vestibular system dysfunction and hearing impairment in patients with Meniere’s disease.Methods: A total of 58 patients with definite unilateral Meniere’s disease at the Department of Otorhinolaryngology,Tianjin Medical University General Hospital from July 2018 to February 2019 were selected.They were divided into groups by stage according to the guidelines 2017 Diagnosis and Treatment of Meniere’s Disease: 1 stage with 11 cases,2 stage with 14 cases,3 stage with 21 cases and 4 with 12 cases.Another 30 healthy adults(60 ears)were selected as controls.Cervical vestibular evoked myogenic potential(c VEMP),ocular vestibular evoked myogenic potential(o VEMP)and VAT were examined in all subjects,and following parameters were recorded: induction rate of c VEMP/o VEMP,P1 and N1 latency,N1-P1 amplitude,interaural asymmetric ratio(IAR),abnormal rate of VAT,abnormal rates of various VAT parameters(horizontal or vertical gain,horizontal or vertical phase shift,asymmetry).We then analyzed and compared the results of these parameters between the case and control group or between different stages of the case group.Results: 1.The induction rate、amplitude of cVEMP/oVEMP in the case group were significantly lower than those in the control group and the interaural asymmetry ratio was increased(P<0.05).The latency of P1 and N1 was prolonged in c VEMP(P<0.05)but not change in o VEMP(P>0.05);parameters of c VEMP/o VEMP between the sicken and health ears showed no significant difference(P>0.05).2.The induction rate of cVEMP in Meniere’s patients from 1 stage to 4 stage were 100%,85.7%,81%,58.3%;o VEMP were 72.7%,85.7%,66.7%,50%;there were statistical significance(P <0.05)comparised with the control group except for the stage 1 c VEMP.With the increase of hearing staging,the induction rate of c VEMP and o VEMP generally showed a downward trend.3.The P1、N1 latency of c VEMP and amplitudes of c VEMP/o VEMP in different hearing staging groups were statistically significant(P<0.05),they were obviously different between stage 1、2 and stage 3、4;and an overall decrease of amplitudes were observed with the increase of hearing impairment;the P1、N1 latency of o VEMP and asymmetry ratio of c VEMP/o VEMP in each group showed no significant difference(P>0.05).4.Abnormal rate of VAT in Meniere’s patients from 1 stage to 4 stage were 75.0%,84.6%,90.0%,100.0%,which showed an overall upward trend;The abnormal rate of VAT、gain and asymmetry in the case group were higher than those in the control group with significant difference(P<0.05)except for the abnormal rate of phase(P>0.05).Among those VAT parameters,the horizontal gain reduction and the asymmetry abnormality were highly accurate for the diagnosis of MD,their sensitivities were 60.4%、43.4% respectively and specificities were 100.0% and 96.7 %.Abnormal rate of VAT and c VEMP showed significant difference(P<0.05)but o VEMP showed no difference(P>0.05),abnormal rate of VAT(88.7%)was higher than c VEMP(56.6%).Conclusion: Different degrees of vestibular dysfunction may occur in patients with Meniere’s disease.With the increase of hearing stage,the induction rate and amplitude of c VEMP/o VEMP show an overall downward trend,and the abnormal rate of VAT shows upward,indicating that the degree of damage to the otolith and vestibular ocular reflex function in Meniere’s disease patient may gradually increase along with the decrease of hearing.VAT shows higher sensitivity in Meniere’s diagnosis,most patients expressed as the horizontal gain reduction or the asymmetry abnormality.VEMP combined with VAT can commendably evaluate the function of the utricle,saccule as well as horizontal and vertical vestibular function in Meniere’s disease,which can more comprehensively diagnose and differentiate Meniere’s disease.Also,the evaluation of staging conditions provides an objective basis to further guide clinical diagnosis and treatment of Meniere’s disease.