Cervical VEMP tuning changes by Meniere's disease stages

Simon I. Angeli, Stefania Goncalves

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objective: To determine if changes in cervical vestibular-evoked myogenic potential (cVEMP) testing reflect the different stages of cochlea-saccular hydrops in Meniere's disease (MD). Methods: This is a case-control retrospective series. Forty-seven patients with unilateral MD by American Academy of Otolaryngology–Head and Neck Surgery diagnostic and staging criteria, and 30 with non-MD vertigo as control. Meniere patients were further classified based on symptoms at the time of testing as active or stable. Subsequently, patients underwent cVEMP testing by tone-burst stimuli at 500 and 1,000 Hz. The main outcome measure was to compare the cVEMP 1,000 and 500 Hz amplitude ratio in ears with MD and non-MD vertigo, and in active versus stable MD. Results: The cVEMP 1,000/500 Hz amplitude ratio was higher in Meniere's ears (mean = 1.14 μV, SD = 0.25) than in non-Meniere's ears (mean = 0.96 μV, SD = 0.2) (Student's t test, P =.001), and higher in active (mean = 1.22 μV, SD = 0.25) than in stable MD (mean = 1.00 μV, SD = 0.18) (P =.0035). The diagnostic value of cVEMP 1,000/500 Hz amplitude ratio to differentiate MD versus non-MD vertigo was evaluated with a receiver-operating characteristics (ROC) curve and the area under the curve (AUC) was 0.716 (95% confidence interval [CI] [0.591, 0.829]). The ideal cutoff point was 0.9435 with sensitivity and specificity values of 83% and 53%, respectively. The sensitivity and specificity values for this test to differentiate active versus stable MD were 68% and 81%, respectively, with AUC 0.746 (95% CI [0.607, 0.885]) and cutoff value of 1.048. In all ears, the 1,000/500 Hz amplitude ratio increased by a decrease of the 500 Hz amplitude with increasing age. Conclusion: The cVEMP 1,000/500 Hz amplitude ratio is elevated in ears with MD but not in those with non-MD vertigo. After corrected by age, this ratio is higher in active but not in stable MD, probably reflecting dynamic changes in saccular membrane motion mechanics in hydrops, and may be a useful marker of disease progression and the effect of therapy. Level of Evidence: IV.

Original languageEnglish (US)
Pages (from-to)543-549
Number of pages7
JournalLaryngoscope investigative otolaryngology
Issue number5
StatePublished - Oct 1 2019
Externally publishedYes


  • cVEMP
  • dizziness
  • hydrops
  • Meniere's

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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