Clin Exp Otorhinolaryngol.  2023 Aug;16(3):236-243. 10.21053/ceo.2023.00129.

Use of Skull Vibration-Induced Nystagmus in the Follow-up of Patients With Ménière Disease Treated With Intratympanic Gentamicin

• Alonso SM
• Ayerve NA
• Roca CM
• Touma GC
• Dios JCdPd
• Gómez HS
• Ruíz SSC
• Caletrío ÁB

• KMID: 2545262
• DOI: http://doi.org/10.21053/ceo.2023.00129

Abstract

Objectives
. Ménière disease (MD) is an idiopathic disorder that affects hearing and inner ear balance. Intratympanic gentamicin (ITG) is recognized as an effective treatment for uncontrolled MD characterized by persistent vertigo attacks despite therapy. The video head impulse test (vHIT) and skull vibration-induced nystagmus (SVIN) are validated methods for evaluating vestibular function. A progressive linear relationship has been identified between the slow-phase velocity (SPV) of SVIN determined using a 100-Hz skull vibrator and the gain difference (healthy ear/affected ear) measured by vHIT. The aim of this study was to ascertain whether the SPV of SVIN was associated with the recovery of vestibular function following ITG treatment. Consequently, we sought to determine whether SVIN could predict the onset of new vertigo attacks in patients with MD who were treated with ITG.
Methods
. A prospective longitudinal case-control study was conducted. Several variables were recorded post-ITG and throughout the follow-up period, followed by statistical analyses. Two groups were compared: patients who experienced vertigo attacks 6 months after ITG and those who did not.
Results
. The sample comprised 88 patients diagnosed with MD who underwent ITG treatment. Of the 18 patients who experienced recurring vertigo attacks, 15 demonstrated gain recovery in the affected ear. However, all 18 patients exhibited a decrease in the SPV of SVIN.
Conclusion
. The SPV of SVIN may be more sensitive than vHIT in identifying the recovery of vestibular function following ITG administration. To our knowledge, this is the first study to illustrate the link between a reduction in SPV and the likelihood of vertigo episodes in patients with MD who have been treated with ITG.

Keyword

Pathologic Nystagmus; Vestibular Disease; Meniere Disease; Gentamicin; Head Impulse Test

Figure

• 

  Fig. 1. Box and whisker plots. In the group that did not experience vertigo attacks after intratympanic gentamicin (“no”, group B), no change was noted in the gain on the affected side over time (A), nor was any change observed in the slow-phase velocity (SPV) (B). The SPV modification percentage remained close to 0% (C). Conversely, among those who did experience subsequent attacks (“yes”, group A, blue), the SPV decreased by 37% (C), the gain on the affected side recovered (A), and the SPV also decreased (B). For all patients in group A, the gain difference decreased because the gain on the affected side recovered in every case. The SPV also decreased in all patients in group A. VIN, vibration-induced nystagmus.

• 

  Fig. 2. Linear regression model. The blue dots denote patients who experienced vertigo attacks following intratympanic gentamicin (ITG) (“yes”, group A), while the green dots represent those who did not (“no”, group B). (A) As the gain in the affected ear increases, the slow-phase velocity (SPV) decreases (as evidenced by the predominance of blue dots in the lower right quadrant). This demonstrates a correlation between the SPV of the diseased side and the gain on that same side during follow-up (post-ITG). The Pearson correlation coefficient was 0.6, with a P-value of 0.000. (B) In the blue group, as the gain in the diseased ear recovered and the disparity in gains between both ears diminished, the SPV exhibited a greater percentage of change. In other words, it slowed down compared to the pre-crisis SPV. However, in the green group, the SPV remained unchanged. The Pearson correlation coefficient was 0.7, with a P-value of 0.000. VIN, vibration-induced nystagmus.

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