Evaluatıon of VEMP fındıngs ın mıgraınous vertıgo, mıgraıne and menıere?s dısease

Objective: Studying the physiopathologic relationship between Meniere?s disease and migrainous vertigo, subclinic vestibular exposure in the asymptomatic ear of the Meniere?s disease patients and in migraine patients, and the relationship between the hearing of Meniere?s disease and vestibular function by applying vestibular evoked myogenic potentials [VEMP] test to migraine, migrainous vertigo and Meniere?s disease patients who suffer from headache and/or vertigo.Method: 26 migrainous vertigo, 26 Meniere?s disease, 22 migraine cases and 27 healthy cases that didn?t suffer from headache and vertigo were included in the study. Monaural VEMP test was applied on cases with an ICS-CHARTER auditory potential audiometry device with a 500 Hz tone-burst stimulant. Headache stimulation with visual stimulation mechanism was applied on migraine cases and the obtained VEMP responses were recorded separately. In the Meniere?s disease group, early and late Meniere?s disease subgroups were created according to hearing thresholds. In the groups, percentages of cases in which VEMP responses couldn?t be obtained and the average and standard deviations of threshold stimulant intensity, p3 latency period, n23 latency period, interpeak amplitude value and amplitude asymmetry ratio values of cases in which VEMP response was obtain were calculated. Bonferonni corrected Kruskall-Wallis Variance Analysis was used for inter-group evaluation, Mann-Whitney U was used for paired comparison of groups, Wilxocon test was employed for the comparison of dependant groups and chi-square test was used for the evaluation of distribution of those in which no response was obtained. All analysis was conducted within 95% confidence interval and p<0,05 was accepted as statistically significant.Findings: While a VEMP response was obtained from all the cases in the control group, no response could be obtained from 9 ears in migraine group (20,4 %), 5 ears from migrainous vertigo group (9,6 %), 11 ears which were diagnosed with Meniere?s disease (35,5%) and 3 ears in Meniere?s disease group which weren?t diagnosed with Meniere?s disease. There was a statistically significant difference between control group and other groups in terms of distribution of unresponsive ears. Threshold stimulant intensity was found to be higher in ears that were diagnosed with Meniere?s disease than the ears in control group, while no difference was observed in terms of latency periods. Their interpeak amplitude value average was calculated to be lower than control group, but no statistically significant difference was found. While no significant difference was detected in comparison of migrainous vertigo group and the control group in terms of latency periods, the threshold stimulus intensity was found to be higher, interpeak amplitude value decreased and amplitude asymmetry ratio increased. The interpeak amplitude value and latency periods were found to be shorter compared to the control group in the migraine group. When Meniere?s disease is compared to migrainous vertigo group, significant differences were not identified in all parameters. No statistically significant difference was observed between pre and post-headache stimulation VEMP records of migraine cases. No statistically significant difference was detected among healthy and unhealthy ears of Meniere?s disease patients in VEMP parameters and distribution of ears for which VEMP response could not be obtained. While no significant difference was established among subgroups of early and late Meniere?s disease in VEMP parameters, the ratio of cases where VEMP record could not be taken was identified to be higher in late Meniere?s disease subgroup but it was not found to be significant statistically.Conclusion: The findings obtained in migrainous vertigo group were considered in favour of peripheral vestibular exposure. On the other hand, the fact that no difference was detected in comparison of responses obtained in migrainous vertigo and Meniere?s disease groups was considered to support the physiopathologic link they have. While subclinical vestibular exposure was identified in the migraine group, lack of change in post-headache stimulation findings gave rise to the thought that the subclinical exposure identified prior to stimulation does not increase with attack. Nonetheless, it was also thought the reason might be that the migraine stimulation mechanism applied is not effective enough to activate the vestibular system. The distribution of ears for which VEMP response could not be obtained among healthy and unhealthy ears of Meniere?s disease and the fact that no difference was identified in comparison of parameters in those for which VEMP response was received were interpreted as finding of asymptomatic saccular exposure in healthy ears of Meniere?s disease patients. No relation was detected between hearing thresholds of Meniere?s disease patients and VEMP responses and it was shown that hearing function progresses independently from vestibular function. Prognosis of asymptomatic ear and vestibular function can be followed up through VEMP test in patients of Meniere?s disease. At the differential diagnosis stage of patients suffering headache and/or vertigo; it was thought that, in VEMP test, establishment of short latency period can be directive to migraine diagnosis while detection of high threshold and reduced interpeak amplitude values can be directive to diagnosis of migrainous vertigo in the absence of audiological pathological finding and to diagnosis of Meniere?s disease in presence of audiological pathological finding.Key words: VEMP, Migrainous Vertigo, Migraine, Meniere?s Disease