Saccular dysfunction in Meniere's disease

Objective: The aim of this study was to assess any dysfunction of the saccu lus in patients with unilateral Meniere's disease by monitoring the vestibu lar evoked myogenic potentials (VEMPs) evoked by high level clicks on the S ternomastoid muscles (SCMs). Study Design: The study was a retrospective analysis. Setting: The study was performed in the E.N.T. department of the Lariboisie re Hospital. Patients: Fifty-nine patients aged 18 to 74 years with well-established uni lateral Meniere's disease were included in the study. Interventions: Loud monaural clicks were delivered unilaterally, and the VE MPs were recorded with skin electrodes on the ipsilateral SCM. All the pati ents were also subjected to a pure tone audiometric test and bithermal calo ric testing. The postural performances of 39 patients were analyzed using t he Equitest. Main Outcome Measure: VEMP results were the main outcome measure. Results: The saccular response was absent on the affected side in 54% of th e patients with Meniere's disease. This absence was correlated with the deg ree of low frequency hearing loss but not with canal paresis. Finally, nonf alling patients with saccular dysfunction had a significantly poorer postur al performance than those without such dysfunction in the condition 5. Conclusion: Patients with Meniere's disease could have a saccular dysfuncti on (54% in this series). This saccular impairment correlated with low frequ ency hearing loss but not with canal paresis. Patients without VEMPs had po orer postural performances in condition 5 than those with normal VEMPs. The refore, VEMP testing is useful for detecting patients at risk: in patients with saccular lesion, the dynamic postural performances should be assessed on a movable platform to detect visually dependent patients and to orient v estibular rehabilitation.