Skip to main content

Advertisement

SpringerLink
Log in

Evolution of caloric responses during and between the attacks of Meniere’s disease

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Caloric tests are useful for disease surveillance of Meniere’s disease (MD), although the interpretation of caloric tests remains controversial during the attacks of MD. Therefore, we aimed to characterize the findings of caloric tests during the attacks of MD. We analyzed the results of bithermal caloric tests during and between the attacks in 43 patients with unilateral definite MD. Evaluation was performed during the irritative/recovery phase in 22 and during the paretic phase in 26 patients. During the irritative/recovery phase, less than half of patients (10/22, 45%) showed a caloric asymmetry of more than 25%, lesser responses in the affected ear in six and in the healthy ear in the other four. In contrast, patients usually showed a caloric asymmetry of more than 25% during the paretic phase (19/26, 73%) with a decreased response almost always in the affected ear (18/19, 95%). Between the attacks, caloric asymmetry was found in less than half of the patients (20/43, 47%) with a decreased response almost always in the affected ear (19/20, 95%) when observed. The caloric asymmetry was less during the irritative/recovery phases than between the attacks (p = 0.007). In contrast, the caloric asymmetry was larger during the paretic phase than between the attacks (p = 0.041). The caloric asymmetry decreased during the irritative/recovery phases with an estimated mean difference of 34% (adjusted 95% CI 16–53%, p < 0.001) and 23% (adjusted 95% CI 8–38%, p = 0.002) compared to the paretic and interictal phases. Caloric responses fluctuate during and between the attacks of MD depending on the electrophysiologic status of the vestibular afferents. The results of caloric tests in MD, thus should be interpreted with consideration of each phase when the evaluation was done.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Stahle J, Friberg U, Svedberg A (1991) Long-term progression of Meniere’s disease. Acta Otolaryngol Suppl 111:78–83

    Article  Google Scholar 

  2. Huppert D, Strupp M, Brandt T (2010) Long-term course of Menière’s disease revisited. Acta Otolaryngol 130:644–651

    Article  PubMed  Google Scholar 

  3. Maire R, van Melle G (2008) Vestibulo-ocular reflex characteristics in patients with unilateral Ménière’s disease. Otol Neurotol 29:693–698

    Article  PubMed  Google Scholar 

  4. Dobie RA, Snyder JM, Donaldson JA (1982) Electronystagmographic and audiologic findings in patients with Meniere’s disease. Acta Otolaryngol 94:19–27

    Article  CAS  PubMed  Google Scholar 

  5. Proctor LR (2000) Results of serial vestibular testing in unilateral Meniere’s disease. Otol Neurotol 21:552–558

    CAS  Google Scholar 

  6. Lee SU, Kim HJ, Koo JW, Kim JS (2017) Comparison of caloric and head-impulse tests during the attacks of Meniere’s disease. Laryngoscope 127:702–708

    Article  PubMed  Google Scholar 

  7. Lee SU, Kim HJ, Choi JY, Koo JW, Yang X, Kim JS (2020) Evolution in the findings of head-impulse tests during the attacks of Menière’s disease. Otol Neurotol 41:e744–e750

    Article  PubMed  Google Scholar 

  8. Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F (2015) Diagnostic criteria for Menière’s disease. J Vestib Res 25:1–7

    Article  PubMed  Google Scholar 

  9. Monsell EM, Balkany TA, Gates GA, Goldenberg RA, Meyerhoff WL, House JW (1995) Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. Otolaryngol Head Neck Surg 113:181–185

    Article  Google Scholar 

  10. Lee SU, Kee HJ, Sheen SS, Choi BY, Koo JW, Kim JS (2015) Head-shaking and vibration-induced nystagmus during and between the attacks of unilateral Ménière’s disease. Otol Neurotol 36:865–872

    Article  PubMed  Google Scholar 

  11. Choi KD, Oh SY, Kim HJ, Koo JW, Cho BM, Kim JS (2007) Recovery of vestibular imbalances after vestibular neuritis. Laryngoscope 117:1307–1312

    Article  PubMed  Google Scholar 

  12. Matsuzaki M, Kamei T (1995) Stage-assessment of the progress of continuous vertigo of peripheral origin by means of spontaneous and head-shaking nystagmus findings. Acta Otolaryngol 15:188–190

    Article  Google Scholar 

  13. Bance M, Mai M, Tomlinson D, Rutka J (1991) The changing direction of nystagmus in acute Meniere’s disease: pathophysiological implications. Laryngoscope 101:197–201

    Article  CAS  PubMed  Google Scholar 

  14. Curthoys IS (2000) Vestibular compensation and substitution. Curr Opin Neurol 13:27–30

    Article  CAS  PubMed  Google Scholar 

  15. Baloh RW, Kerber K (2010) Baloh and Honrubia’s clinical neurophysiology of the vestibular system. Oxford University Press, New York

    Google Scholar 

  16. Torok N (1970) The hyperactive vestibular response. Acta Otolaryngol 70:153–162

    Article  CAS  PubMed  Google Scholar 

  17. Jacob RG (1988) Panic disorder and the vestibular system. Psychiatr Psychiatr Clin N Am 11:361–374

    Article  CAS  Google Scholar 

  18. Gonçalves DU, Felipe L, Lima TMA (2008) Interpretation and use of caloric testing. Braz J Otorhinolaryngol 74:440–446

    Article  PubMed  Google Scholar 

  19. Park HJ, Migliaccio AA, Della Santina CC, Minor LB, Carey JP (2005) Search-coil head-thrust and caloric tests in Meniere’s disease. Acta Otolaryngol 125:852–857

    Article  PubMed  PubMed Central  Google Scholar 

  20. Carey JP, Minor LB, Peng GC, Della Santina CC, Cremer PD, Haslwanter T (2002) Changes in the three-dimensional angular vestibulo-ocular reflex following intratympanic gentamicin for Ménière’s disease. J Assoc Res Otolaryngol 3:430–443

    Article  PubMed  PubMed Central  Google Scholar 

  21. Shin JE, Kim CH, Park HJ (2013) Vestibular abnormality in patients with Meniere’s disease and migrainous vertigo. Acta Otolaryngol 133:154–158

    Article  PubMed  Google Scholar 

  22. Paškoniene A, Baltagalviene R, Lengvenis G, Beleškiene V, Ivaška J, Markeviciute V, Mickeviciene V, Lesinskas E (2020) The importance of the temporal bone 3T MR imaging in the diagnosis of Menière’s disease. Otol Neurotol 41:235–241

    Article  PubMed  Google Scholar 

  23. Hulshof J, Baarsma E (1981) Vestibular investigations in Meniere’s disease. Acta Otolaryngol 92:75–81

    Article  CAS  PubMed  Google Scholar 

  24. Huygen P, Nicolasen M, Verhagen W, Theunissen E (1989) Contralateral hyperactive caloric response in unilateral labyrinthine weakness. Acta Otolaryngol 107:1–4

    Article  CAS  PubMed  Google Scholar 

  25. Ikeda M, Watanabe I (1997) Evaluation of hyperactive caloric responses in patients with inner ear diseases. ORL J Otorhinolaryngol Relat Spec 59:326–331

    Article  CAS  PubMed  Google Scholar 

  26. Lee IS, Park HJ, Shin JE, Jeong YS, Kwak HB, Lee YJ (2009) Results of air caloric and other vestibular tests in patients with chronic otitis media. Clin Exp Otorhinolaryngol 2:145–150

    Article  PubMed  PubMed Central  Google Scholar 

  27. Redondo-Martínez J, Bécares-Martínez C, Orts-Alborch M, García-Callejo FJ, Pérez-Carbonell T, Marco-Algarra J (2016) Relationship between video head impulse test (vHIT) and caloric test in patients with vestibular neuritis. Acta Otorrinolaringol Esp (Engl Ed) 67:156–161

    Article  Google Scholar 

  28. Lee SU, Park SH, Kim HJ, Koo JW, Kim JS (2016) Normal caloric responses during acute phase of vestibular neuritis. J Clin Neurol 12:301–307

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tsuji K, Velázquez-Villaseñor L, Rauch SD, Glynn RJ, Wall C, Merchant SN (2000) Temporal bone studies of the human peripheral vestibular system. Meniere’s disease. Ann Otol Rhinol Laryngol Suppl 181:26–31

    Article  CAS  PubMed  Google Scholar 

  30. Leigh RJ, Zee DS (2015) The neurology of eye movements. Oxford University Press, New York

    Book  Google Scholar 

  31. McGarvie LA, Curthoys IS, MacDougall HG, Halmagyi GM (2015) What does the head impulse test versus caloric dissociation reveal about vestibular dysfunction in Ménière’s disease? Ann N Y Acad Sci 1343:58–62

    Article  PubMed  Google Scholar 

  32. McGarvie LA, Curthoys IS, MacDougall HG, Halmagyi GM (2015) What does the dissociation between the results of video head impulse versus caloric testing reveal about the vestibular dysfunction in Ménière’s disease? Acta Otolaryngol 135(9):859–865. https://doi.org/10.3109/00016489.2015.1015606

    Article  PubMed  Google Scholar 

  33. Lee SU, Lee J, Kim HJ, Choi JY, Oh HJ, Kim JS (2019) Vestibular hyperreflexia and opsoclonus in acute hepatitis A virus infection. Cerebellum 18:1151–1153

    Article  PubMed  Google Scholar 

  34. Helmchen C, Livitzis E, Sprenger A, Trillenberg P (2015) Cerebellar ataxia with unilateral high frequency vestibulopathy and caloric disinhibition. J Neurol Sci 358:527–529

    Article  PubMed  Google Scholar 

  35. Huh YE, Kim JS, Kim HJ, Park SH, Jeon BS, Kim JM, Cho JW, Zee DS (2015) Vestibular performance during high-acceleration stimuli correlates with clinical decline in SCA6. Cerebellum 14:284–291

    Article  CAS  PubMed  Google Scholar 

  36. Choi JY, Kim HJ, Kim JS (2018) Recent advances in head impulse test findings in central vestibular disorders. Neurology 90:602–612

    Article  PubMed  Google Scholar 

  37. Clendaniel RA, Lasker DM, Minor LB (2002) Differential adaptation of the linear and nonlinear components of the horizontal vestibuloocular reflex in squirrel monkeys. J Neurophysiol 88:3534–3540

    Article  PubMed  Google Scholar 

  38. Park HK, Kim JS, Strupp M, Zee DS (2013) Isolated floccular infarction: impaired vestibular responses to horizontal head impulse. J Neurol 260:1576–1582

    Article  PubMed  Google Scholar 

  39. Sills AW, Baloh RW, Honrubia V (1977) 2. Results in normal subjects. Ann Otol Rhinol Laryngol Suppl 86:7–23

    Article  CAS  PubMed  Google Scholar 

  40. Spector M (1975) Electronystagmographic findings in central nervous system disease. Ann Otol Rhinol Laryngol 84:374–378

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was supported by 2018 Academic Research Funds of the Korean Society of Clinical Neurophysiology, and Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (No. NRF-2016R1D1A1B04935568).

Author information

Authors and Affiliations

  1. Department of Neurology, Korea University Medical Center, Seoul, South Korea

    Sun-Uk Lee

  2. Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea

    Sun-Uk Lee & Ji-Soo Kim

  3. Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea

    Hyo-Jung Kim

  4. Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea

    Jeong-Yoon Choi & Ji-Soo Kim

  5. Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea

    Ja-Won Koo

Authors
  1. Sun-Uk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyo-Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeong-Yoon Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ja-Won Koo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ji-Soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. S-UL analyzed and interpreted the data, and wrote the manuscript. Drs. H-JK, J-YC, and J-WK analyzed and interpreted the data, and revised the manuscript. Dr. J-SK designed and conceptualized the study, interpreted the data, and revised the manuscript.

Corresponding author

Correspondence to Ji-Soo Kim.

Ethics declarations

Conflicts of interest

Lee, HJ Kim, Choi, and Koo report no disclosure. JS Kim serves as an Associate Editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, Journal of Neurology, Medicine, and Clinical Translational Neuroscience.

Ethical standard

This study followed the tenets of the Declaration of Helsinki and was performed according to the guidelines of Institutional Review Board of Seoul National University Bundang Hospital (B-2009/639-104).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, SU., Kim, HJ., Choi, JY. et al. Evolution of caloric responses during and between the attacks of Meniere’s disease. J Neurol 268, 2913–2921 (2021). https://doi.org/10.1007/s00415-021-10470-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-021-10470-4

Keywords

Search

Navigation