Monothermal differential caloric testing in patients with Menière's disease

The monothermal differential caloric test allows determination of vestibular recruitment and decruitment, variables which may help discriminate peripheral from central vestibular lesions. Previous reports indicated a strong association between vestibular recruitment and Menière's disease. This study examined patients having unilateral Menière's disease. Nystagmus beat frequency (NBF) and slow-component velocity (SCV) responses were recorded by electronystagmography (ENG). Electronystagmographic findings showing unilateral dysfunction were present in 54% of patients by slow-component velocity and in 31% by nystagmus beat frequency. Unilateral hypofunction was the most frequent lateralizing ENG finding. Absolute vestibular recruitment occurred in less than 10% of patients but relative recruitment was found in nearly 20% of patients. Slow-component velocity had higher sensitivity than nystagmus beat frequency, with excellent clinical concordance. Monothermal caloric testing as described in this study best detects peripheral vestibular disease in Meniere's patients using slow-component velocity to determine unilateral hypofunction and relative vestibular recruitment.