Vestibular–autonomic effects of middle ear pressure therapy in refractory Ménière’s disease: A retrospective cohort study

Objective Although middle ear pressure therapy (MEPT) has been used for treating refractory Ménière’s disease (MD), its physiological mechanisms remain unclear. This study aimed to evaluate vestibular and autonomic changes over time in patients with stage 4 MD treated with MEPT (using EFET01®) compared with a non-MEPT control group. Methods This retrospective study included patients who underwent vestibular testing (caloric testing and vestibular evoked myogenic potential [VEMPs]) and autonomic assessment (heart rate variability) and completed questionnaires (e.g., Dizziness Handicap Inventory [DHI]) at baseline and 12 months. Results Although canal function and dynamic balance remained unchanged, cervical VEMP (cVEMP) asymmetry ratios significantly decreased over time (p = 0.018), indicating a time-dependent reduction in asymmetry across the cohort. Notably, autonomic evaluation revealed significant time-dependent changes in the high-frequency component of heart rate variability during standing (p < 0.001), which may be associated with altered autonomic regulation. The group-by-time interaction did not reach statistical significance (p = 0.050), indicating that these changes were not statistically confirmed as MEPT-specific. DHI scores improved in both groups. Conclusions Time-dependent changes in cVEMP asymmetry and high-frequency indices during standing were observed, with no statistically confirmed MEPT-specific effects in this cohort. These findings should be interpreted cautiously as exploratory observations rather than evidence of a causal treatment effect. Combined vestibular–autonomic assessment may serve as a sensitive biomarker for monitoring treatment response.