Comparison of caloric and head-impulse tests during the attacks of Meniere's disease.

Objectives/hypothesis: To aid in diagnosis of Meniere's disease (MD) during the attacks using caloric and head-impulse tests (HITs). Study

Design: Retrospective case series review.

Methods: We analyzed the results of bithermal caloric and HITs during the attacks in 16 patients with MD. Quantitative analyses of HITs were conducted using a magnetic search coil technique.

Results: In unilateral MD (14 patients, 42 semicircular canals), the head impulse gain of the vestibulo-ocular reflex (VOR) was either normal (28 of 42, 67%), decreased (8 of 42, 19%), or increased (6 of 42, 14%) for each semicircular canal in the affected ear. Likewise, the head impulse VOR gain was either normal (29 of 42, 69%), increased (11 of 42, 26%), or decreased (2 of 42, 5%) in the intact ear. The VOR gain for the horizontal canal was significantly lower on the affected side (P = 0.013). However, the VOR gains for the anterior and posterior canals did not differ between the sides (P = 0.270, P = 0.282). In bilateral MD (two patients, 12 semicircular canals), the VOR gain was either decreased (6 of 12, 50%) or normal (6 of 12, 50%) in either ear. In contrast, the caloric responses were usually decreased in the affected ear (7 of 11, 64%, including one with bilateral MD).

Conclusion: During the attacks of MD, HITs showed varied results between the ears and among the canals, although the caloric responses were usually decreased in the involved ear. These dissociations suggest a frequency-dependent impairment of canal function or mechanical property of the endolymphatic hydrops during the attacks of MD. Level of evidence: 4. Laryngoscope, 127:702-708, 2017.