A 55-year-old woman presents with episodic vertigo lasting 20–30 minutes, fluctuating low-frequency sensorineural hearing loss, tinnitus, and aural fullness. The vestibular function test most likely to show enhanced amplitude is:
- A cVEMP (showing enhanced amplitude and lowered threshold) ✓
- B Caloric test (showing canal paresis)
- C Rotary chair test (showing reduced gain)
- D Video head impulse test (showing corrective saccades)
Correct answer: A. cVEMP (showing enhanced amplitude and lowered threshold)
Explanation
In Meniere's disease with endolymphatic hydrops, elevated endolymph pressure in the saccule lowers the threshold for saccular activation. cVEMP testing characteristically shows enhanced (increased) amplitude and a reduced threshold to sound stimulation, reflecting the distended, pressure-loaded saccule. Caloric test may show canal paresis (reduced response) in advanced disease but not early. Video HIT and rotary chair may be normal in early Meniere's, making cVEMP the most sensitive early functional test.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.