Assessing otolith dysfunction in Meniere's disease: insights from multi-frequency vestibular evoked myogenic potential testing

Objective To investigate the impact of Meniere's Disease (MD) on balance and proprioception by utilising multi-frequency Vestibular Evoked Myogenic Potentials (VEMP) to evaluate otolith function. Design Observational study employing the Otolith Tuning Index (OTI) to quantify vestibular function through analysis of VEMP response rates and tuning ratios. Study Sample A total of 123 participants were included, comprising 94 patients diagnosed with MD and 29 healthy controls. VEMP testing was conducted at frequencies of 500 Hz, 750 Hz, and 1 kHz. Results Among MD patients, 69% reported imbalance, with severe cases predominating in advanced stages. The non-response rate for oVEMP at 500 Hz was 73.3% on the affected side, associated with unpredictable falls. Significant correlations were observed between cVEMP non-responses and both disease severity (p = 0.012) and walking imbalance (p = 0.037). oVEMP responses were lowest at 500 Hz, improving at 1 kHz, whereas cVEMP amplitudes peaked at 500 Hz bilaterally. OTI values indicated significant otolith dysfunction on affected sides compared to contralateral sides and controls (p = 0.026, p = 0.032, p < 0.001), with dysfunction worsening with disease progression and age. Conclusions The Otolith Tuning Index (OTI) effectively measures otolith dysfunction in MD patients, offering valuable insights to enhance diagnostics, patient management, and treatment planning.