Evaluation of Vestibular Function in Meniere's Disease

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DESCRIPTION:(provided by applicant) The objective of the proposed research is to understand the pathophysiology of the vestibular disturbances in Meniere's disease and how to treat them. The specific effects (both qualitative and quantitative) on vestibular function of both Meniere's disease itself and of intratympanic gentamicin used to alleviate vertigo are unknown and will be determined in the proposed research. The research strategy is to analyze the vestibuloocular reflex (VOR) in three dimensions from responses to stimuli that activate the semicircular canals or the otoliths. Vestibular function will also be evaluated from measurements of the subjective visual vertical and from vestibular-evoked myogenic potentials. The angular VOR evoked by high-frequency, high-acceleration head thrusts will be studied in order to determine the effects of Meniere's disease and of intratympanic gentamicin on the function of individual semicircular canals. The translational VOR in these patients will be evaluated from the responses to rapid, lateral translations of the head. Through comparisons with findings in subjects with normal vestibular function and those with known surgical unilateral vestibular destruction (UVD), these studies will provide a new understanding of the effects of Meniere's disease itself, and the effects of treatment with gentamicin, on individual vestibular end organs. Recovery of the VOR after intratympanic gentamicin and after surgical UVD will be assessed through analyses of the trajectories of eye velocity. The corrective eye movements that reduce the gaze errors that occur as a consequence of diminished vestibular function in the responses to high acceleration angular and translational head movements will also be analyzed. The information derived from this research will have practical import on which vestibular tests are most useful in Meniere's disease, and on deciding when and with what to treat patients with Meniere's disease.