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IntroductionKnowledge of the natural and temporal course of a disease is important when deciding if an intervention is appropriate. In the case of Ménière’s disease (MD), there is some evidence that attacks diminish over time, but the topic remains controversial. A conservative approach to surgery is usually followed in northern Europe, and leads to strict patient selection before considering surgery. Here, we describe the evolution of vertigo attacks among a group of intractable MD patients in whom surgery was considered.MethodsRetrospective cohort study in a Ménière’s disease expert center. Patients with definite unilateral Ménière’s disease and persisting vertigo attacks despite treatment with intratympanic steroid injections were included. All patients had been waitlisted for participation in a planned trial assessing non-ablative surgery. They were waitlisted between June 2016 and June 2021 without undergoing the surgical intervention. In September 2022, data were collected from patient’s files and follow-up telephone interviews were conducted to assess the evolution of their vertigo attacks.ResultsThirty-five patients (54% male, mean age of onset 52 years, 51% right sided) were included in the analysis. Twenty-five patients (71%) eventually declined surgery. Of the 33 patients with complete information on vertigo attacks, 21 (64%) were free of vertigo attacks upon data collection, after a median disease duration of 5.3 years. Patients who did undergo surgery, had longer duration of disease than patients who did not.DiscussionEven in a population with intractable MD, most patients will experience relief of symptoms over time. On one hand, active treatment may accelerate relief of symptoms, but on the other hand, non-ablative therapies are of debatable effect and ablative intervention carries a risk of life long side effects. Therefore, any active intervention should be carefully considered.

IntroductionVestibular disorders have a high prevalence and impact on general health. Currently questionnaires to measure vestibular symptoms and the impact on daily life, do not capture disease-specific symptoms or induce recall bias. The DizzyQuest was introduced, to measure vestibular symptoms in the flow of daily life, using the ecological momentary assessment (EMA) strategy. The development and content validity of the DizzyQuest are described in this article.MethodsThe development process consisted of two stages: First, the development of a concept version of the DizzyQuest based on the conceptual model of positive health, semi-structured interviews with patients diagnosed with bilateral vestibulopathy (BV) and expert input. Second, the assessment of content validity through a 4-week pilot trial, followed by focus group meetings with patients and professionals separately.ResultsPatient interviews, an expert meeting and a conceptual model resulted in the first pilot version of the DizzyQuest, which included a morning-, within-day-, evening- and attack-questionnaire. To report patient characteristics, complimentary patient- and doctor-questionnaires were added. The pilot trial (N = 5) and two patient focus group meetings resulted in multiple suggestions for response options. Two professional focus group meetings provided recommendations for sampling time and sampling schedule. As a result, two versions of the DizzyQuest were developed, consisting of a regular DizzyQuest (DQ) and an extended DizzyQuest-XL (DQ-XL).ConclusionThe DizzyQuest enables the administration of multiple questionnaires during the flow of daily life, therefore increasing reliability and ecological validity. The DQ and DQ-XL, using a big data approach, has the potential to improve precision medicine.

ObjectiveTo investigate whether multi-frequency Vestibular Evoked Myogenic Potential (VEMP) testing at 500, 750, 1,000, and 2,000 Hz, would improve the detection of present dynamic otolith responses in patients with bilateral vestibulopathy (BV).MethodsProspective study in a tertiary referral center. BV patients underwent multi-frequency VEMP testing. Cervical VEMPs and ocular VEMPs were recorded with the Neuro-Audio system (v2010, Neurosoft, Ivanovo, Russia). The stimuli included air-conducted tone bursts of 500, 750, 1,000, and 2,000 Hz, at a stimulation rate of 13 Hz. Outcome measures included the percentage of present and absent VEMP responses, and VEMP thresholds. Outcomes were compared between frequencies and type of VEMPs (cVEMPs, oVEMPs). VEMP outcomes obtained with the 500 Hz stimulus, were also compared to normative values obtained in healthy subjects.ResultsForty-nine BV patients completed VEMP testing: 47 patients completed cVEMP testing and 48 patients completed oVEMP testing. Six to 15 % more present VEMP responses were obtained with multifrequency testing, compared to only testing at 500 Hz. The 2,000 Hz stimulus elicited significantly fewer present cVEMP responses (right and left ears) and oVEMP responses (right ears) compared to the other frequencies (p ≤ 0.044). Using multi-frequency testing, 78% of BV patients demonstrated at least one present VEMP response in at least one ear. In 46% a present VEMP response was found bilaterally. BV patients demonstrated a significantly higher percentage of absent VEMP responses and significantly higher VEMP thresholds than healthy subjects, when corrected for age (p ≤ 0.002). Based on these results, a pragmatic VEMP testing paradigm is proposed, taking into account multi-frequency VEMP testing.ConclusionMulti-frequency VEMP testing improves the detection rate of present otolith responses in BV patients. Therefore, multi-frequency VEMPs should be considered when evaluation of (residual) otolith function is indicated.

Introduction: Bilateral vestibulopathy (BV) is a chronic condition in which vestibular function is severely impaired or absent on both ears. Oscillopsia is one of the main symptoms of BV. Oscillopsia can be quantified objectively by functional vestibular tests, and subjectively by questionnaires. Recently, a new technique for testing functionally effective gaze stabilization was developed: the functional Head Impulse Test (fHIT). This study compared the fHIT with the Dynamic Visual Acuity assessed on a treadmill (DVAtreadmill) and Oscillopsia Severity Questionnaire (OSQ) in the context of objectifying the experience of oscillopsia in patients with BV.Methods: Inclusion criteria comprised: (1) summated slow phase velocity of nystagmus of

ObjectiveTo determine the influence of daily use of spectacles to correct a refractive error, on the vestibulo-ocular reflex (VOR) gain measured with the video head impulse test (vHIT).Study designThis prospective study enrolled subjects between 18 and 80 years old with and without a refractive error. Subjects were classified into three groups: (1) contact lenses, (2) spectacles, and (3) control group without visual impairment. Exclusion criteria comprised ophthalmic pathology, history of vestibular disorders, and alternated use of spectacles and contact lenses in daily life. Corrective spectacles were removed seconds before testing. One examiner performed all vHIT’s under standardized circumstances using the EyeSeeCam system. This system calculated the horizontal VOR gain for rightward and leftward head rotations separately.ResultsNo statistically significant difference was found in VOR gain between the control group (n = 16), spectacles group (n = 48), and contact lenses group (n = 15) (p = 0.111). Both the spectacles group and contact lenses group showed no statistically significant correlation between VOR gain and amount of refractive error, for rightwards (p = 0.071) and leftwards (p = 0.716) head rotations. There was no statistical significant difference in VOR gain between testing monocularly or binocularly (p = 0.132) and between testing with or without wearing contact lenses (p = 0.800).ConclusionIn this study, VOR gain was not influenced by wearing corrective spectacles or contact lenses on a daily basis. Based on this study, no corrective measures are necessary when performing the vHIT on subjects with a refractive error, regardless of the way of correction.

AbstractObjectiveThe purpose of this exploratory study was to investigate whether a quantitative image analysis of the labyrinth in conventional MRI scans using a radiomics approach showed differences between patients with Ménière’s disease and the control group.Materials and methodsIn this retrospective study, MRI scans of the affected labyrinths of 24 patients with Ménière’s disease were compared to the MRI scans of labyrinths of 29 patients with an idiopathic asymmetrical sensorineural hearing loss. The 1,5T and 3T MRI scans had been previously made in a clinical setting between 2008 and 2015. 3D Slicer 4.4 was used to extract several substructures of the labyrinth. A quantitative analysis of the normalized radiomic image features was performed in Mathematica 10. The image features of the two groups were statistically compared. Results For numerous image features, there was a statistically significant difference (p-value