2025 Volume 118 Issue 4 Pages 247-254
It is well known that Ménière’s disease is associated with endolymphatic hydrops (EH). Before the development of delayed contrast-enhanced MRI for the inner ear, EH could not be directly evaluated. Consequently, its presence was inferred using physiological examinations, referred to as endolymphatic hydrops estimation tests.
Among the various tests developed for this purpose, we have proposed the furosemide loading cervical vestibular evoked myogenic potential (FVEMP) test. This is because VEMP reflects the function of the saccule, which is the second most frequent organ in EH. This practical test evaluates changes in cVEMP amplitude before and after furosemide administration. A result is considered positive when there is an improvement rate of ≥14.2% or when no response is observed before administration but a significant response appears afterward.
The sensitivity and specificity of FVEMP for diagnosing Ménière’s disease are 0.706 and 0.810, respectively. This test can assess potential EH in the unaffected ear of unilateral Meniere’s disease (with normal hearing) and evaluate the presence of EH in ears with profound deafness.
The results of FVEMP are not associated with the degree of EH in the cochlea but are correlated with the degree of EH in the vestibule observed on inner ear contrast-enhanced MRI. When EH in either the cochlea or vestibule, or both, is defined as positive on inner ear contrast-enhanced MRI, the concordance with FVEMP demonstrates substantial agreement, with a Kappa coefficient of 0.644.
Inner ear contrast-enhanced MRI is undoubtedly a groundbreaking tool for the diagnosis and management of Meniere’s disease. However, it cannot be performed at all facilities, and contraindications exist for certain cases. FVEMP may serve as a useful and objective method for estimating the presence of endolymphatic hydrops.
