Perception of verticality during attacks of Ménière’s
Reviewed by Victor Osei-Lah

Ménière’s disease (MD) affects the cochlea and all peripheral vestibular receptors. The perception of verticality, a function of the utricle, is evaluated by the subjective visual vertical (SVV) test. The authors studied SVV in two groups of MD patients: a) first ever documented episode and b) recurrent MD, patients with previously documented episodes. There were nine and 12 patients respectively. In both groups, spontaneous nystagmus, audiogram and SVV were assessed during an acute attack and one week after an attack. Spontaneous nystagmus and SVV were characterised as either irritative or paretic. Caloric test, head impulse and head shaking tests were added at one week. In 78% and 75% of cases, the SVV during the acute attack was pathological in the first and second group respectively but the difference was not statistically significant. In the first group, SVV correlated with the canal abnormality in less than half of cases, the others showing SVV deviation to the healthy ear. In all seven subjects the pathological SVV had normalised at one week. The SVV was found to be persistently abnormal in most patients with recurrent MD. The authors concluded that otolith dysfunction is present in acute MD attacks, including the first ever attack and the deviation of SVV is often irritative (in > 40% of cases) i.e. deviation towards the healthy ear: this they called ‘maculo-canal dissociation’.

The first attack of Ménière’s disease: A study through SVV perception, clinical and pathogenetic implications.
Faralli M, Lapenna R, Mandalà M, et al.
JOURNAL OF VESTIBULAR RESEARCH
2014;24:335-42.