Utility of the Frequency Tuning Measure of oVEMP in Differentiating Meniere’s Disease from BPPV

Abstract

Background: Utility of frequency tuning of ocular vestibular evoked myogenic potential (oVEMP) for evaluation of utricular function in individuals with Meniere’s disease is a recent development. However, there is dearth of studies regarding its utility in differential diagnosis of Meniere’s disease from other vestibular pathologies. Purpose: The present study aimed at investigating the feasibility of frequency tuning of oVEMP in discriminating Meniere’s disease from benign paroxysmal positional vertigo (BPPV). Research Design: Static group comparison. Study Sample: oVEMPs were acquired from 36 individuals, each with unilateral Meniere’s disease and unilateral BPPV. Thirty-six age- and gender-matched healthy individuals formed comparison group for each of the two clinical groups. Intervention: Contralateral oVEMPs were recorded from both ears of all the participants. Data Collection and Analyses: The responses pertaining to octave and mid-octave frequencies from 250 to 4000 Hz, one frequency presented at a time, were recorded from infra-orbital electrodes (noninverting placed 1 cm below the lower eyelid and inverting 2 cm below the inverting on the cheek) with forehead as ground. Starting intensity was 125 dB peSPL with subsequent reductions in 10-dB steps to arrive at threshold. The stimuli were delivered to the ear at a rate of 5.1 Hz. The frequency corresponding to the largest peak-to-peak amplitude, best threshold, and/or largest peak-to-peak amplitude at thresholds was considered as the tuning frequency. Proportions of ears with frequency tuning at a particular frequency were compared between the groups Results: The frequency tuning at 1000 Hz was found to exist in a significantly higher proportion of affected ears with Meniere’s disease than the comparison group as well as ears with BPPV (p < 0.05). Using a criterion point of frequency tuning at 875 Hz, the sensitivity and specificity for identifying Meniere’s disease was found to be 68% and 100%, respectively. Conclusion: The shift in frequency tuning is an efficient parameter for not only discriminating Meniere’s disease from healthy individuals but also distinguishing it from BPPV. Therefore, frequency tuning is recommended as a test parameter of oVEMP for identification of Meniere’s disease.