Ménière's Disease
A clinical diagnosis whose histopathological substrate — endolymphatic hydrops — leaves a recognisable VEMP signature: reduced amplitudes and a frequency-tuning shift.
What is Ménière's disease?
Ménière's disease is a clinical syndrome of episodic vertigo, fluctuating low-frequency sensorineural hearing loss, and tinnitus, often accompanied by aural fullness. Its histopathological hallmark is endolymphatic hydrops — distension of the endolymphatic compartment of the inner ear.
VEMP signature
- Reduced amplitude on the affected side — the most common abnormality.
- Frequency-tuning shift — best response frequency moves from 500 Hz toward 1 kHz in hydropic saccules.
- Increased IAR, sometimes with raised threshold.
- Absent responses are seen in advanced disease.
Evidence base
A meta-analysis of cVEMP in Ménière's pooled a diagnostic odds ratio of approximately 40 with an area under the ROC curve of 0.78. The 2017 AAN guideline, however, rated routine VEMP evidence as Level C-negative in Ménière's — useful in some research contexts and for monitoring, but not yet diagnostic by itself.[1,8]
VEMP nevertheless plays a useful role in disease staging — declining amplitudes track progression — and in research on the otolithic involvement of subtypes (delayed endolymphatic hydrops, atypical Ménière's, and the role of saccule vs utricle in drop-attack patients).
Reading the report
A unilateral reduced cVEMP amplitude alongside a fluctuating low-frequency hearing loss is consistent with hydrops but cannot establish Ménière's by itself — vestibular neuritis can produce a similar VEMP pattern. The clinical history of episodic vertigo and the audiometric shape remain the diagnostic anchors.