Singh Niraj Kumar, Kumar Prawin, Jagadish Nirmala, Mendhakar Akshay, Mahajan Yatin
Department of Audiology, All India Institute of Speech and Hearing (AIISH), University of Mysore, Mysore, India.
The MARCS Institute for Brain, Behaviour, and Development, Sydney, Australia.
Ear Hear. 2023;44(5):940-948. doi: 10.1097/AUD.0000000000001343. Epub 2023 Mar 2.
A recently devised parameter of vestibular-evoked myogenic potential (VEMP) based on the principles of frequency tuning is the inter-frequency amplitude ratio (IFAR). It refers to the ratio of the amplitude of 1000 Hz tone burst evoked VEMP to 500 Hz evoked tone burst. A pathology like Meniere's disease changes the frequency response and alters the frequency tuning of the otolith organs. Because IFAR is based on the principle of frequency tuning of VEMP, it is likely to help identify Meniere's disease. Few studies in the last decade have investigated the utility of IFAR in identifying Meniere's disease. However, a systematic review and a meta-analysis on IFAR in Meniere's disease are lacking. The present study investigates whether the IFAR of VEMP helps identify Meniere's disease and differentiates it from healthy ears and other vestibular pathologies.
The present study is a systematic review and a meta-analysis. The studies investigating the IFAR of cervical and ocular VEMPs in Meniere's disease, healthy controls, and other vestibular pathologies were searched across research databases such as PubMed, Science Direct, and Scopus. The search strategy was developed using the PICO (population, intervention, comparison, and outcomes) format, and Medical Subject Headings (MeSH) terms and Boolean operators were employed. The systematic review was performed using the Rayyan software, whereas the Review Manager software was used to carry out the meta-analysis. A total of 16,605 articles were retrieved from the databases. After the duplicate removal, 2472 articles remained. These were eliminated using title screening, abstract screening, and full-length inspections. A total of nine articles were found eligible for quality assessment and meta-analysis, and the New Castle-Ottawa Scale was used for quality assessment. After the data extraction, 24 six articles were found to have the desired data format for the meta-analysis.
The results showed significantly higher IFAR in the affected ears of individuals in the Meniere's disease group than in the control group's unaffected ears. There was no significant difference between the unaffected ears of individuals in the Meniere's disease group and the ears of the control group. The only study on Meniere's disease and benign paroxysmal positional vertigo found significantly larger ocular VEMP IFAR in ears with Meniere's disease than in benign paroxysmal positional vertigo.
This systematic review and meta-analysis found IFAR efficient in differentiating Meniere's disease from healthy controls. We also found an enhanced IFAR as a potential marker for Meniere's disease. However, more investigations are needed to confirm the utility of an enhanced IFAR value in the exclusive identification of Meniere's disease.
基于频率调谐原理最近设计的一种前庭诱发肌源性电位（VEMP）参数是频率间振幅比（IFAR）。它指的是1000Hz短纯音诱发的VEMP振幅与500Hz诱发短纯音振幅的比值。梅尼埃病等病理情况会改变频率响应并改变耳石器官的频率调谐。由于IFAR基于VEMP的频率调谐原理，它可能有助于识别梅尼埃病。在过去十年中，很少有研究探讨IFAR在识别梅尼埃病方面的效用。然而，目前缺乏关于梅尼埃病中IFAR的系统评价和荟萃分析。本研究调查VEMP的IFAR是否有助于识别梅尼埃病，并将其与健康耳朵及其他前庭疾病区分开来。
本研究是一项系统评价和荟萃分析。在PubMed、Science Direct和Scopus等研究数据库中搜索了关于梅尼埃病、健康对照和其他前庭疾病中颈性和眼性VEMP的IFAR的研究。使用PICO（人群、干预、对照和结局）格式制定搜索策略，并使用医学主题词（MeSH）术语和布尔运算符。使用Rayyan软件进行系统评价，而使用Review Manager软件进行荟萃分析。从数据库中检索到总共16605篇文章。在去除重复项后，剩下2472篇文章。通过标题筛选、摘要筛选和全文检查对这些文章进行筛选。总共发现9篇文章符合质量评估和荟萃分析的要求，并使用纽卡斯尔-渥太华量表进行质量评估。在数据提取后，发现有24篇文章具有荟萃分析所需的数据格式。
结果显示，梅尼埃病组个体患侧耳朵的IFAR显著高于对照组未患侧耳朵。梅尼埃病组个体的未患侧耳朵与对照组的耳朵之间没有显著差异。关于梅尼埃病和良性阵发性位置性眩晕的唯一一项研究发现，梅尼埃病耳朵的眼性VEMP的IFAR显著大于良性阵发性位置性眩晕。
这项系统评价和荟萃分析发现IFAR在区分梅尼埃病与健康对照方面是有效的。我们还发现IFAR升高是梅尼埃病的一个潜在标志物。然而，需要更多的研究来证实升高的IFAR值在梅尼埃病的特异性识别中的效用。
