Results of video head impulse test, caloric test, and ocular vestibular evoked myogenic potential findings in Meniere’s disease

Abstract Background Meniere’s disease (MD) is marked by fluctuating hearing loss, episodic vertigo, aural fullness, and tinnitus. Vestibulo-ocular reflex (VOR) assessment through video head impulse test (vHIT), caloric testing, and ocular vestibular evoked myogenic potentials (oVEMP) may provide complementary diagnostic insights. Objective To evaluate the sensitivity, compatibility, and diagnostic value of oVEMP, caloric testing, and vHIT in cases with MD. Methods This cross-sectional analytical study was conducted on 28 subjects with dizziness and/or vertigo in the Audiology unit outpatient clinic of the ENT department, during the period from March 2021 to August 2023. All participants underwent full history taking, dizziness analysis, audiological assessment, caloric testing, vHIT, and oVEMP recording. Results oVEMP abnormalities were detected in 68% of patients, most commonly delayed latency with abnormal inter-aural amplitude difference (IAAD). Caloric testing revealed abnormalities in 53.6%, predominantly unilateral weakness. vHIT showed the lowest sensitivity, with no patients demonstrating abnormal gain. Significant correlations were found between pure tone audiometry thresholds and oVEMP IAAD, caloric weakness percentage, and vHIT gain asymmetry. Sensitivity was highest for oVEMP (67.9%), followed by caloric testing (53.6%), while vHIT was least sensitive (7.1%). Specificity was highest for caloric testing (76.6%), moderate for vHIT (71.2%), and lowest for oVEMP (20.3%). Conclusion oVEMP demonstrated the greatest sensitivity for detecting vestibular dysfunction in MD, whereas caloric testing was more specific and superior to vHIT across disease stages. Dissociation between caloric and video head impulse test outcomes may represent a diagnostic indicator of Meniere’s disease.