(072) Can VEMP Frequency Tuning Differentiate Meniere’s from Other Vestibulopathies?

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

Presenting Author(s)

Aparna Govindan, MD

House Staff
Icahn School of Medicine at Mount Sinai
new york, New York, United States

Co-Author(s)

MS

Mia M. Saade, BS

Medical Student
Icahn School of Medicine at Mount Sinai
New York, New York, United States
KF

Karla Fernandez, AuD

New York Eye And Ear Infirmary of Mount Sinai, USA
SC

Susmita Chennareddy, Other

Icahn School of Medicine at Mount Sinai, USA
Zachary G. Schwam, MD

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York, NY, United States
MM

Maria Mavrommatis, MD

Resident physician
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Senior Author(s)

Enrique R. Perez, MD

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York, NY, United States

Disclosure(s):

Aparna Govindan, MD: No relevant relationships to disclose.

Mia M. Saade, BS: No relevant relationships to disclose.

Zachary G. Schwam, MD: No relevant relationships to disclose.

Maria Mavrommatis, MD: No relevant relationships to disclose.

Introduction: Meniere’s disease (MD) is largely diagnosed with clinical criteria supported by audiometry. Recently, vestibular evoked myogenic potential (VEMP) testing has emerged as a diagnostic tool despite variability in the assessment and application of frequency tuning criteria. This study aims to analyze the diagnostic value of the 1000/500 Hz amplitude ratio (AR) of ocular VEMP (oVEMP) and cervical VEMP (cVEMP) in patients with MD and non-MD vestibulopathy.

Methods: A retrospective review of patients with vestibular testing from 2020 to 2022 at a tertiary care center was done. Patients were grouped by MD or non-MD vestibulopathy. A subset analysis was performed on MD with vestibular migraine (VM). The primary outcome was the 1000/500 Hz AR. A positive ratio cutoff was >0.94 for cVEMP, >0.92 for oVEMP, and absent response was designated a value of 1. Value designations were determined from preexisting literature. Descriptive statistics, univariate and regression analyses were performed.

Results: Review yielded 93 ears in 91 patients (mean age 47.9, range 18-77), with 41 MD and 50 non-MD patients. Differences in age, gender, and ethnicity were not significant (p=0.81, p=0.53, p=0.45). There was no significant difference in the 1000/500 Hz AR between MD and non-MD (p=0.91), nor in subset analyses of MD cohort disease activity (p=0.33), stage (p=0.22), or concomitant VM (p=0.75). Increasing age correlated with decreasing 500 Hz values in the MD (p=0.005) and non-MD cohort (p=0.002). Increasing age correlated with decreasing 1000 Hz values only in MD (p=0.039). Age corrected linear regression showed no significant association between VEMP amplitudes and MD diagnosis.

Conclusions: The 1000/500 Hz AR, or the “VEMP tuning,” may not distinguish MD from non-MD vestibulopathy. To our knowledge, this is the largest study to date on the diagnostic utility of VEMP to distinguish MD from non-MD vestibulopathy, including those with VM, superior semicircular canal dehiscence, benign paroxysmal positional vertigo, labyrinthitis, and uncompensated vestibulopathy of unknown etiology.