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Reappraisal of the glycerol test in patients with suspected Meniere's disease.

ABSTRACT: BACKGROUND:Recent advances in magnetic resonance imaging make it possible to visualize the presumed pathophysiologic correlate of Menière's disease: endolymphatic hydrops. As traditional diagnostic tests can provide only indirect evidence, they are hardly competitive in this respect and need to be rethought. This is done here for the glycerol test. METHODS:The data of a previous retrospective analysis of the glycerol test in patients with suspected Menière's disease are reinterpreted using a simple model. The mean threshold reduction (MTR) in the frequency range from 125 to 1500 Hz (calculated from audiograms obtained immediately before and four hours after the glycerol intake) is used as the test statistic. The proposed model explains the frequency distribution of the observed MTR by the convolution of a Gaussian probability density function (representing measurement errors) with a template representing the frequency distribution of the true MTR. The latter is defined in terms of two adjustable parameters. After fitting the model to the data, the performance of the test is evaluated using receiver operating characteristic (ROC) analysis. RESULTS:The cumulative frequency distribution of the observed MTR can be explained almost perfectly by the model. According to the ROC analysis performed, the capability of the currently used audiometric procedure to detect a glycerol-induced threshold reduction corresponds to a diagnostic test of rather high accuracy (area under the ROC curve greater than 0.9). Simulations show that methodological improvements could further enhance the performance. CONCLUSIONS:Owing to their ability to reveal functional aspects without an obvious morphological correlate, traditional test for Menière's disease could be decisive for defining the stage of the disease. A distinctive feature of the glycerol test is that it is capable of determining, with high accuracy, whether the pathophysiologic condition of the inner ear is partially reversible. Prospectively, this could help to estimate the chances of specific therapies.

SUBMITTER: Lutkenhoner B

PROVIDER: S-EPMC4392460 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Reappraisal of the glycerol test in patients with suspected Menière's disease.

Lütkenhöner Bernd B Basel Türker T

BMC ear, nose, and throat disorders 20141124

<h4>Background</h4>Recent advances in magnetic resonance imaging make it possible to visualize the presumed pathophysiologic correlate of Menière's disease: endolymphatic hydrops. As traditional diagnostic tests can provide only indirect evidence, they are hardly competitive in this respect and need to be rethought. This is done here for the glycerol test.<h4>Methods</h4>The data of a previous retrospective analysis of the glycerol test in patients with suspected Menière's disease are reinterpre ...[more]

PMID: 25866475

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Project description:Objective: Intravenous contrast agent enhanced, high-resolution magnetic resonance imaging of the inner ear (iMRI) confirmed that patients with Menière's disease (MD) and vestibular migraine (VM) could present with endolymphatic hydrops (EH). The present study aimed to investigate EH characteristics and their interrelation to neurotologic testing in patients with VM, MD, or VM with concurrent MD (VM-MD). Methods: Sixty-two patients (45 females, aged 23-81 years) with definite or probable VM (n = 25, 19 definite), MD (n = 29, 17 definite), or showing characteristics of both diseases (n = 8) were included in this study. Diagnostic workup included neurotologic assessments including video-oculography (VOG) during caloric stimulation and head-impulse test (HIT), ocular and cervical vestibular evoked myogenic potentials (o/cVEMP), pure tone audiometry (PTA), as well as iMRI. EH's degree was assessed visually and via volumetric quantification using a probabilistic atlas-based segmentation of the bony labyrinth and volumetric local thresholding (VOLT). Results: Although a relevant number of VM patients reported varying auditory symptoms (13 of 25, 52.0%), EH in VM was only observed twice. In contrast, EH in VM-MD was prevalent (2/8, 25%) and in MD frequent [23/29, 79.3%; χ2(2) = 29.1, p < 0.001, φ = 0.7]. Location and laterality of EH and neurophysiological testing classifications were highly associated (Fisher exact test, p < 0.005). In MD, visual semi-quantitative grading and volumetric quantification correlated highly to each other (r S = 0.8, p < 0.005, two-sided) and to side differences in VOG during caloric irrigation (vestibular EH ipsilateral: r S = 0.6, p < 0.05, two-sided). In VM, correlations were less pronounced. VM-MD assumed an intermediate position between VM and MD. Conclusion: Cochlear and vestibular hydrops can occur in MD and VM patients with auditory symptoms; this suggests inner ear damage irrespective of the diagnosis of MD or VM. The EH grades often correlated with auditory symptoms such as hearing impairment and tinnitus. Further research is required to uncover whether migraine is one causative factor of EH or whether EH in VM patients with auditory symptoms suggests an additional pathology due to MD.

Dataset Information

Reappraisal of the glycerol test in patients with suspected Meniere's disease.

Publications

Reappraisal of the glycerol test in patients with suspected Menière's disease.

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