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Vol. 26, Art. 26 (pp. 627-654)    |    2025       

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The state of vestibular function in patients with meniere's disease of varying disease severity

Poddubny A.A.1 , Maryenko I.P.2 , Zabrodets G.V.2 , Greben N.I.1,
Yeremenko J.Ye.1

1Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic of Belarus, F. Skoriny str. 24, 220114
2Republican Scientific and Practical Center of Otorhinolaryngology, Minsk, Republic of Belarus, Sukhaya str. 8, 220006

Brief summary

Ménière's disease (MD) is a chronic inner ear disorder characterized by the classic triad of symptoms: recurrent episodes of vertigo, fluctuating sensorineural hearing loss, and tinnitus, often accompanied by aural fullness. Despite a long history of study, the pathogenesis of the disease remains insufficiently clear, and diagnosis and patient stratification by disease severity continue to pose significant challenges for clinicians. Objective. To analyze the state of vestibular function in patients with MD of varying severity. Materials and Methods. Seventy-four patients with MD, verified according to the Barany Society criteria, were examined. Three clinical subgroups were formed based on disease severity: mild (n=25), moderate (n=22), and severe (n=19). A comprehensive examination was performed, including vestibulometry, and registration of cervical (cVEMP) and ocular (oVEMP) vestibular evoked myogenic potentials. The control group consisted of 16 healthy volunteers. Results. Vestibulometry revealed a significantly more frequent detection of provocation-induced nystagmus (PN) during the Valsalva maneuver, directed towards the ear affected during an MD attack, in 11 (18.6%) patients. This was significantly more frequent than the detection of PN in other tests (p<0.05) and comparable to the proportion of spontaneous nystagmus detected (9 (15.2%)). A progressive impairment of vestibular analyzer function was revealed with increasing MD severity. The amplitude parameters of oVEMPs were significantly reduced in all patient subgroups compared to the control group (p<0.05), confirming dysfunction of the utricular otolithic receptor. The most significant changes in cVEMPs were found in the severe subgroup: a statistically significant shortening of P13 latencies to 3.86 [2.00; 4.72] ms (p=0.04) and N23 latencies to 3.32 [2.46; 5.42] ms (p=0.026) against a background of reduced peak amplitudes. A statistically significant increase in the proportion of patients with absent cVEMP responses was established, from 12.5% in mild MD to 56% in severe MD (p<0.05). A moderate positive correlation was found between absent oVEMP and cVEMP responses (rₛ=0.64; p<0.05), indicating concomitant involvement of both parts of the otolithic receptor. Conclusions. The study results demonstrate the progressive nature of vestibular dysfunction in MD with predominant involvement of the saccular otolithic receptor and changes in the temporal characteristics of the vestibulocollic reflex. VEMP parameters, especially amplitude characteristics and latencies, are sensitive markers of the severity of the pathological process and can be used for objective patient stratification. The simultaneous absence of oVEMP and cVEMP responses may serve as a marker of the severity of otolithic receptor degeneration in MD. A comprehensive analysis of VEMPs provides valuable information for understanding the pathophysiology of the disease and for developing individualized approaches to the treatment and monitoring of patients with MD.


Key words

Meniere's disease, endolymphatic hydrops, vestibulometry, vestibular evoked myogenic potentials, nystagmus

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