In Ménière’s disease (MD), several factors can create postural instability. In a recent study, 54 definite MD patients were compared to 66 controls. Several tasks were tested: two-legged stance tasks were performed in 4 conditions: eyes open with and without foam rubber and eyes closed with and without foam rubber (also called sensory organization testing). Six variables in the manner of attempting these tasks were evaluated. For Ménière’s disease patients, statistical analyses were performed to explore the relationship between the 6 variables and the following independent variables: gender, age, the presence of abnormal caloric (abnormal in about half of Ménière’s disease patients) and/or cervical vestibular evoked myogenic potential (cVEMP) responses (neck muscle response to a click sound placed in the ear, also abnormal in about half of Ménière’s disease patients), the time elapsed since the last vertigo attack, and duration of the Ménière’s disease.
Since MD patients might have diminished postural stability because of other factors, such as age and the degree of balance organ dysfunction at the time of testing, the purpose of this study was to assess the influence of various factors that can affect postural stability in MD patients, comparing MD patients with normal persons.
To assess postural control, the research used a foam cushion posturography analysis system originally established by their team for improving diagnostic accuracy of peripheral vestibular disorders in accordance with the guidelines from the Standards for Reporting of Diagnostic Accuracy.
Results: The presence of MD was significantly associated with abnormalities of all 6 of the variables. The presence of abnormal ear responses to warm and cool irrigations of the ear and cVEMP responses also correlated strongly with difficulty standing eyes closed, feet close together and the rate of leaning in that condition. The shorter time interval from last vertigo attack to measurement, the more likely patients with Ménière’s disease were to have trouble standing on a foam cushion with eyes closed.
These results indicate that MD patients with abnormal caloric and/or cVEMP responses have a greater dependence on visual and somato-sensory inputs (joint position sensors in the back, hips, knees, and ankles) to maintain an upright posture than those subjects with normal caloric and cVEMP responses.
Conclusion. Ménière’s disease patients show poor postural performance, which is affected by the existence of their peripheral vestibular function and the shorter time interval from last vertigo attack to measurement.
Comment: While Ménière’s disease patients complain more about the abruptly disruptive spells of vertigo that they suffer, they also have chronic balance problems of variable severity that fluctuates in its distracting features with the frequency and severity of the Ménière’s disease episodes.
- Factors affecting postural instability in Meniere’s disease., , Otolaryngol Head Neck Surg, 2013 Nov, Volume 149, Issue 5, p.759-65, (2013)