Vertical head impulse and caloric are complementary but react opposite to Meniere's disease hydrops
Munehisa Fukushima MD, PhD  Ryohei Oya MD  Kengo Nozaki MD  Hirotaka Eguchi MD  Shiro Akahani MD, PhD  Hidenori Inohara MD, PhD  Noriaki Takeda MD, PhD
First published: 04 December 2018 https://doi.org/10.1002/lary.27580
m.f. conceived and designed the experiments and wrote the article. m.f., r.o., k.n., h.e., and s.a. performed the experiments. m.f., h.i., and n.t. analyzed the data.
This research was supported in part by medical research funds of the Hyogo Medical Association and by research funds to promote the hospital functions of the Japan Organization of Occupational Health and Safety.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objectives/Hypothesis
Meniere's disease (MD) patients can show normal head impulses despite poor caloric test results. This study aimed to investigate the discrepancy in the vestibulo‐ocular reflex (VOR) in MD patients and whether endolymphatic hydrops (EH) influence the VOR.

Study Design
Prospective, cross‐sectional observational study.

Methods
Ninety MD patients were enrolled. Neuro‐otological testing, including a video head impulse test (vHIT) of all semicircular canals (SCs), and gadolinium‐enhanced inner ear magnetic resonance imaging were performed. The vestibular EH volume was quantitatively evaluated by processing magnetic resonance images.

Results
Abnormal vHIT results in MD patients were found most frequently in the posterior (44.4%) SCs, followed by the horizontal (13.3%) and anterior (10%) SCs. Canal paresis (CP) was assessed using the vHIT and the caloric test, and results were not significant when vHIT responses were assessed as CP only using the horizontal SC. The difference in the vestibular EH between the presence and absence of CP was not significant if assessed using the vHIT (P = .5591), but it was statistically different if assessed using the caloric test (P = .0467).

Conclusions
The contradictory reaction of VOR in MD patients may result from the high specificity but low sensitivity of CP in the horizontal vHIT. EH volume in the vestibule affects the caloric response but does not affect the vHIT response.

Level of Evidence
2b

Laryngoscope, 129:1660–1666, 2019