Clinical Signs of Vestibular Dysfunction in Patients with Unilateral Meniere’s Disease

Background: According to the 2015 updated definition of Meniere’s Disease (MD) the main clinical sign of MD patients in remission period is low-to medium-frequency sensorineural hearing loss. The vestibular asymmetry between attacks of vertigo could vary greatly in different patients and its assessment hasn’t become a diagnostic criteria in the latest definition of MD.

Objectives: The study is performed to evaluate the results of the test of spontaneous nystagmus without fixation, headshaking test, caloric test, video head impulse test (VHIT) in patients with definite unilateral MD in order to identify most common signs of vestibular dysfunction for MD patients in remission period.

Material and Method: The study included 23 patients with unilateral definite MD (8 males, 15 females; mean age 57±13.8 years). Mean hearing loss was 57±12dB HL. Spontaneous nystagmus without fixation and headshaking test were assessed in video Frenzel googles. Abnormal caloric test was defined as ≥28% deficit, and abnormal VHIT as presence of saccades,

Results: Spontaneous nystagmus without fixation was detected only in 8,7% (n=2) of patients. Headshaking test was positive in 56,5% (n=13). The caloric test was abnormal in 82,6% (n = 19) of patients, while the vHIT was abnormal in 13% (n = 3) of them.

Conclusion: In clinical examination of MD patients, headshaking test should be used as a quick inexpensive method of detecting vestibular asymmetry. As caloric test reflects the dysfunction of vestibular system in low frequencies and vHIT – in high frequencies, it seems that during MD the detection of unphysiologic low frequency accelerations are predominantly damaged or stay uncompensated during the course of the disease. In laboratory examination of MD patients the dissociation between results of caloric test and vHIT could be considered as a typical sign of MD in differential diagnosis.