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Saccular dysfunction in Meniere's disease
C de Waele1, P T Huy, J P Diard
1Laboratoire de Neurobiologie des Réseaux Sensori-Moteurs, Hôpital Lariboisière, Paris, France. cdw@ccr.jussieu.fr
Objective:
The aim of this study was to assess any dysfunction of the sacculus in patients with unilateral Meniere's disease by monitoring the vestibular evoked myogenic potentials (VEMPs) evoked by high level clicks on the Stemomastoid muscles (SCMs).
Study Design:
The study was a retrospective analysis.
Setting:
The study was performed in the E.N.T. department of the Lariboisière Hospital.
Patients:
Fifty-nine patients aged 18 to 74 years with well-established unilateral Meniere's disease were included in the study.
Interventions:
Loud monaural clicks were delivered unilaterally, and the VEMPs were recorded with skin electrodes on the ipsilateral SCM. All the patients were also subjected to a pure tone audiometric test and bithermal caloric testing. The postural performances of 39 patients were analyzed using the Equitest.
Main Outcome Measure:
VEMP results were the main outcome measure.
Results:
The saccular response was absent on the affected side in 54% of the patients with Meniere's disease. This absence was correlated with the degree of low frequency hearing loss but not with canal paresis. Finally, nonfalling patients with saccular dysfunction had a significantly poorer postural performance than those without such dysfunction in the condition 5.
Conclusion:
Patients with Meniere's disease could have a saccular dysfunction (54% in this series). This saccular impairment correlated with low frequency hearing loss but not with canal paresis. Patients without VEMPs had poorer postural performances in condition 5 than those with normal VEMPs. Therefore, VEMP testing is useful for detecting patients at risk: in patients with saccular lesion, the dynamic postural performances should be assessed on a movable platform to detect visually dependent patients and to orient vestibular rehabilitation.