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This study investigated the role of serum osmolality in Meniere's disease (MD) patients with acute sensorineural hearing loss (SNHL). Retrospective study. Twenty definite MD patients with acute unilateral SNHL were treated with an osmotic diuretic (Isosorbide, 100 mL daily) and assigned to Group A. Another 20 age- and sex-matched definite MD patients with acute SNHL were not given Isosorbide and assigned to Group B. Both groups underwent audiometry and blood examination for serum osmolality before and after treatment. Group A revealed a significant increase in serum osmolality after treatment. The optimal cut-off values for increased serum osmolality in Group A were +1.5 mOSM/L for predicting hearing improvement at frequencies of 250–1000 Hz, and +2.5 mOSM/L at 2000–4000 Hz. Comparing increased levels of serum osmolality (> +2.0 vs. ≤ +2.0 mOSM/L), Isosorbide dosing at 3.0 L vs. 1.0 L, significantly differed in the odds ratio (OR). Isosorbide at a total dosage of 3.0 L thus improves the hearing threshold by >10 dB at frequencies of 250–2000 Hz. The Isosorbide at a total dosage of 3.0 L may increase serum osmolality by > +2.0 mOSM/L, and improve the hearing threshold for hydropic ears at least >10 dB at low- and mid-frequencies. [ABSTRACT FROM AUTHOR]

Conclusion: An inner ear test battery may suggest bilateral involvement and aid in 'grading' of potential disease in a patient with actively symptomatic Meniere's disease (MD). Objectives: This study applied an inner ear test battery in patients with bilateral MD to map the inner ear deficits in each ear. Methods: From 2009 to 2012, 100 (20%) of 498 MD patients were diagnosed with bilateral involvement, which was defined as established MD in one ear, and the opposite ear had inner ear symptoms combined with documented hearing loss. Each patient underwent audiometry, and ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests. Results: Grading of inner ear deficits was based on the number of abnormal results in the inner ear test battery. Of 100 patients with bilateral MD, 54% had the same grade and 46% had different grades in their 2 ears. On the other hand, based on four-tone average, 79% had the same Meniere stage and 21% had different stages in their two ears. The difference between ears with asymmetric grades (46%) and ears with asymmetric stages (21%) accounts for 25% of bilateral MD patients, which may be caused by the saccular hydrops in the opposite ear. [ABSTRACT FROM AUTHOR]

Conclusion: Although the affected territory in the posterior/anterior inferior cerebellar artery (PICA/AICA) infarction could not be meticulously demonstrated by magnetic resonance imaging (MRI), it could be picked up by the results of a vestibular test battery comprising caloric, ocular vestibular evoked myogenic potential (oVEMP), and cervical VEMP (cVEMP) tests. Objectives: This study applied audiometry and caloric, oVEMP, and cVEMP tests to map affected territory in patients with PICA/AICA infarction. Methods: Fourteen patients, including 11 with PICA infarction and 3 with AICA infarction, were enrolled in this study during the last 8 years. Each patient underwent audiometry, caloric test, oVEMP test, and cVEMP test. Results: In the PICA group, 8 (36%) of 22 ears had a mean hearing level >25 dB. All six ears (100%) in the AICA group had abnormal hearing, and thus both groups revealed a significant difference. Conversely, significant differences were not observed in the vestibular test battery between the PICA and AICA groups. MRI demonstrated infarction at the brainstem for six patients, while one patient also had cerebellar involvement, indicated by loss of visual suppression on caloric nystagmus. Six patients showed infarction at the cerebellum, and four of them had brainstem affliction based on abnormal oVEMP/cVEMP test results. [ABSTRACT FROM AUTHOR]

Conclusion: The ocular vestibular-evoked myogenic potential (oVEMP) test with eyes up condition may help differentiate facial paresis with and without vestibular nerve deficit, while the oVEMP test with the eyes closed condition is not reliable for testing patients with facial paresis. Objective: This study investigated the influence of facial paresis on oVEMPs via the eyes up versus eyes closed conditions. Methods: Twenty patients with unilateral facial paresis underwent a battery of audiovestibular function tests. The oVEMP test was performed via bone-conducted vibration stimuli with the eyes up and eyes closed conditions used in a randomized order. Results: Under the eyes up condition, the rate of abnormal oVEMP tests in the lesion ear was 30%, significantly higher than the 0% in the opposite healthy ear, indicating that the lesion ear not the recorded eye is responsible for abnormal oVEMPs. However, abnormal oVEMP test results of lesion ears under the eyes closed condition did not significantly differ from those of opposite healthy ears. Analysis of caloric and oVEMP test results indicated that both tests obtained normal responses from 10 ears, and abnormal responses from 5 ears. The caloric and oVEMP test results were significantly correlated. [ABSTRACT FROM AUTHOR]

Conclusion: The age-related changes in ocular vestibular-evoked myogenic potentials (oVEMPs) elicited by galvanic vestibular stimulation (GVS) and bone-conducted vibration (BCV) might be attributed to the morphological degeneration of the vestibular system. Objective: This study employed GVS and BCV modes for eliciting oVEMPs in healthy subjects to explore the effect of aging on the vestibulo-ocular reflex (VOR) pathway. Methods: Sixty-nine healthy subjects (aged 22-69 years) were divided into 5 groups of 12-19 subjects by decades of age. All subjects underwent oVEMPs using GVS and BCV modes. The prevalence and parameters of oVEMPs, including nI latency, pI latency, nI-pI interval, and nI-pI amplitude were measured and compared. Results: The prevalences of GVS-oVEMPs had nonsignificant differences among all age groups, whereas that of BCV-oVEMPs in the over-60 group was significantly lower than those in the under-60 groups. In GVS-oVEMPs, the group over 60 years had significantly longer nI, pI latencies, and smaller amplitudes when compared with those under 60 years. In BCV-oVEMPs, the nI and pI latencies in the over-60 group were significantly longer than those of the under-60 groups, while the nI-pI amplitudes of groups over 50 years were significantly smaller than those of groups under 50 years. All oVEMP parameters exhibited significant differences between GVS- and BCV-oVEMPs in each age group. [ABSTRACT FROM AUTHOR]

Conclusion: The ocular vestibular evoked myogenic potential (o-VEMP) test results correlate significantly with caloric test results for patients with acoustic neuroma (AN), but not for patients with Meniere's disease (MD), indicating that the o-VEMP test may replace the caloric test for evaluating the vestibular nerve from which the AN arises. Conversely, the caloric, o-VEMP, and cervical VEMP (c-VEMP) tests should be performed to map lesion sites in the vestibular labyrinth. Objective: This study performed caloric, o-VEMP, and c-VEMP tests on patients with central and peripheral vestibular disorders to investigate their relationships. Methods: In all, 66 patients comprising 16 with unilateral AN and 50 with unilateral definiteMD were enrolled. All patients underwent caloric, o-VEMP, and c-VEMP tests. Results: In the AN group, the caloric test identified canal paresis and caloric areflexia in 10 ears, while the o-VEMP and c-VEMP tests identified abnormal (absent or delayed) responses in 12 and 11 ears, respectively. A significant correlation existed between caloric and o-VEMP test results, but not between caloric and c-VEMP test results, or between o-VEMP and c-VEMP test results. For theMDgroup, abnormal caloric, o-VEMP, and c-VEMP test results were obtained for 24%, 44%, and 38% of hydropic ears, respectively. No correlation existed between any two test results [ABSTRACT FROM AUTHOR]