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Ismail NM, Kabil SE, Abdel-Hamid EF. Otolithic functions in patients with residual dizziness after successful repositioning manoeuvres for unilateral posterior canal BPPV. J Int Med Res 2024; 52:3000605241249095. [PMID: 38726874 PMCID: PMC11089943 DOI: 10.1177/03000605241249095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/04/2024] [Indexed: 05/15/2024] Open
Abstract
OBJECTIVE To evaluate otolithic functions in patients with residual dizziness after successful canalith repositioning procedures (CRPs) for unilateral posterior canal benign paroxysmal positional vertigo (BPPV), and to investigate possible risk factors. METHODS This case-control observational study included healthy controls and patients with residual dizziness after improvement following CRP for BPPV. All participants were subjected to full history taking, otoscopy, audiological basic evaluation, Dix-Hallpike test to search for posterior canal BPPV, residual dizziness screening, and vestibular evoked myogenic potential (VEMP) testing. Between-group differences were assessed and possible factors associated with residual dizziness were identified by univariate analysis. RESULTS A total of 50 patients with residual dizziness (mean age, 56.53 ± 7.46 years [29 female: 21 male]) and 50 healthy controls (mean age, 58.13 ± 7.57 years [20 female: 30 male]) were included. A significant difference in VEMP latencies was found between the patient and control group (delayed in the patient group), with no significant between-group difference in amplitude in both ears. Aging, female sex, long duration of BPPV, number of CRPs, cervical VEMP and ocular VEMP abnormalities, and winter onset, were significantly associated with the risk of residual dizziness. CONCLUSIONS Residual dizziness is a frequent sequel of BPPV that may relate to otolithic dysfunction. VEMP changes were revealed in the form of delayed latencies.
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Affiliation(s)
- Naema M Ismail
- ENT Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Shaimaa E Kabil
- ENT Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
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López-Viñas L, Rocío-Martín E, Santiago EDLR, Pendolero JP, Wix-Ramos R. Diagnostic value of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:192-196. [PMID: 38220052 DOI: 10.1016/j.otoeng.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/05/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES Vestibular evoked myogenic potentials (VEMPs) are useful for studying the disturbances along nerve pathways implicated in the transmission of neurological information from otolithic organs related to vestibular function. This study aims to determine the differences in VEMPs in patients affected with benign paroxysmal positional vertigo (BPPV). METHODS We recruited 36 patients, 9 diagnosed with recurrent BPPV (rBPPV), 9 with only one episode of vertigo (iBPPV), and 18 as a control group. We performed cervical and ocular VEMPs (cVEMPs and oVEMPs). RESULTS We observed differences in asymmetry ratio, which was 41.82% in cVEMPs in iBPPV and 68.27% in oVEMPs in rBPPV, while no asymmetry was found in control cases. Also, there was a lack of both VEMP responses in 22.2% of cases and an absence of cVEMP in 11.1% in iBPPV; in rBPPV, 11.1 % presented no responses in cVEMPs or oVEMPs, 22.2% showed no oVEMP, and 11.1% showed no cVEMP. These values were normal in the control group. CONCLUSION The value of VEMPs in BPPV demonstrates the implication of vestibular damage, mainly utricle damage. For better sensitivity in detecting otolith abnormalities, we should perform oVEMPs and cVEMPs in recurrent BPPV and early stages of BPPV.
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Affiliation(s)
- Laura López-Viñas
- Neurophysiology Department, QuirónSalud Málaga Hospital, Málaga, Spain.
| | | | | | | | - Rybel Wix-Ramos
- Neurophysiology Department, La Princesa University Hospital, Madrid, Spain
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Wenyan X, Lifeng Y, Jing W, Hui J. Vestibular function in cases of posterior semicircular canal canalolithiasis and cupulolithiasis. Front Neurol 2024; 15:1369193. [PMID: 38487330 PMCID: PMC10937546 DOI: 10.3389/fneur.2024.1369193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Objective To analyze and compare the vestibular function of posterior canal cupulolithiasis and canalolithiasis. Methods The results of posterior cupulolithiasis in 45 cases, posterior canalolithiasis in 122 cases and 19 healthy controls were analyzed retrospectively. Results The abnormal rates of vHIT in the canalolithiasis group and the cupulolithiasis group were 42.6 and 37.8%, respectively, both higher than those in the control group (both p < 0.05); there was no statistically significant difference between two BPPV groups (p = 0.573). The abnormal vHIT in 76.9% of the canalolithiasis cases and 82.4% of the cupulolithiasis cases showed normal gain with saccades, with no difference between the groups (p = 0.859). The lesion location of vHIT in the two groups did not show a correlation with the affected side of BPPV (both p > 0.05). 84.4% of canalolithiasis and 65.0% of cupulolithiasis had abnormal VEMP results, with no significant differences in abnormality rates or sides (both p > 0.05). Abnormal results of VEMPs did not show any correlation with side (p > 0.05). The results of pc-ca and pc-cu were both abnormal in 14 cases and 7 cases, and there was no correlation between the site and side of the injury (all p > 0.05). Conclusion The results of vHIT and VEMP in pc-cu and pc-ca were partially abnormal, but they did not show any correlation with side of BPPV. It can be considered that there are scattered vestibular peripheral organ damage in both groups.
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Affiliation(s)
- Xu Wenyan
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Lifeng
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wu Jing
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiang Hui
- Department of Otolaryngology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Basaran MM, Sahin L. Climatic variations and pollution on benign paroxysmal positional vertigo in Kars, Türkiye. ENVIRONMENTAL RESEARCH 2023; 237:116985. [PMID: 37625533 DOI: 10.1016/j.envres.2023.116985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023]
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common diagnosis for peripheral vertigo. Although pathophysiological mechanisms remain unclear, BPPV is mostly idiopathic and factors related to BPPV are still being investigated. Knowing these factors can contribute to the prevention and management of BPPV. In this study, we investigated the correlations between climatic variations, pollution, and BPPV retrospectively. 262 patients diagnosed with BPPV between 2019 and 2021 in Kars, Türkiye, were included in our study. Meteorological parameters were obtained from Turkish State Meteorological Service. Horizontal BPPV increased significantly with the humidity (p < 0.05). In addition, carbon monoxide levels significantly increased the potantial of BPPV (p < 0.05). Surprisingly, BPPV increased in the summertime and showed a significant relationship with humidity. We believe this change is related with the city-specific features as it is the coldest place in the country, emigrant province and crowded in the summer times.
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Affiliation(s)
- Mustafa Mert Basaran
- Department of Otorhinolaryngology, Kafkas University, Faculty of Medicine, Kars, 36000, Turkey.
| | - Levent Sahin
- Department of Emergency Medicine, Kafkas University, Faculty of Medicine, Kars, 36000, Turkey
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Kunelskaya NL, Manaenkova EA, Chugunova MA, Zaoeva ZO. [Method of registration of vestibular myogenic evoked potentials in the diagnosis of diseases of the inner ear]. Vestn Otorinolaringol 2023; 88:44-49. [PMID: 37450390 DOI: 10.17116/otorino20228803144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The literature review is devoted to the practical application of the method of recording vestibular evoked myogenic potentials (VEMPs) in the diagnosis of the inner ear diseases: superior semicircular canal dehiscence syndrome, Meniere's disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis. Registration of VMEP is an electrophysiological research method that allows to assess objectively the functional state of the otolith receptors (sacculus and utriculus) and their pathways, which expands the diagnostic capabilities in diagnosis of the inner ear diseases.
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Affiliation(s)
- N L Kunelskaya
- L. I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E A Manaenkova
- L. I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Chugunova
- L. I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - Z O Zaoeva
- L. I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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Aydın C, Önay Ö, Tezcan Eİ, Aşkar Z, Özdek A. Comparison of cervical and ocular vestibular-evoked myogenic potential responses between tone burst versus chirp stimulation. Eur Arch Otorhinolaryngol 2022; 279:2339-2343. [PMID: 34129084 DOI: 10.1007/s00405-021-06936-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/09/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE To compare the effectiveness of chirp and tone burst stimuli in oVEMP and cVEMP testing for healthy adults METHODS: This study was conducted in 56 healthy volunteers (112 ears). Ocular and cervical VEMP (oVEMP, cVEMP) tests were performed for each participant using tone burst and chirp stimuli. VEMP response rates, latency of each peak (p1-n1, n1-p1), peak to peak amplitude (p1-n1 amplitude and n1-p1 amplitude), and rectified amplitudes were measured and compared between these two different stimuli. RESULTS VEMP response rates with chirp stimuli are higher than the tone burst stimuli for both cVEMP and oVEMP tests (The difference was statistically significant for oVEMP, p = 0.001). Chirp stimuli have higher p1n1 amplitude and rectified amplitude and shorter p1and n1 latency then tone burst stimuli for cVEMP (p = 0.015, p = 0.007, p < 0.001, p < 0.001, respectively). Chirp stimuli also have higher n1p1 amplitude and shorter n1and p1 latency then tone burst stimuli for oVEMP (p = 0.006, p < 0.001, p < 0.001, respectively). CONCLUSION The present findings show that the chirp stimulus triggers earlier VEMP responses with higher amplitudes than the tone burst stimulus during cVEMP and oVEMP testing. VEMP response rate with chirp stimulus is also higher than the tone burst. Therefore chirp stimulus can be used in VEMP testing as effectively as, if not more than, tone burst stimulus in clinical practice.
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Affiliation(s)
- Canset Aydın
- ENT Clinic, Medicana International Hospital, Ankara, Turkey.
| | - Övsen Önay
- Faculty of Medicine, Department of ENT, Atilim University, Ankara, Turkey
| | | | - Zuhal Aşkar
- Ankara Otology and Neurotology Private Clinic, Ankara, Turkey
| | - Ali Özdek
- Ankara Otology and Neurotology Private Clinic, Ankara, Turkey
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Yao Y, Zhao Z, Qi X, Jia H, Zhang L. cVEMP and VAT for the diagnosis of vestibular migraine. Eur J Clin Invest 2022; 52:e13657. [PMID: 34293195 DOI: 10.1111/eci.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/18/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the diagnostic criteria of vestibular migraine (VM) have already been defined, various clinical manifestations of VM and the lack of pathognomonic biomarker result in high rate of misdiagnosis and mismanagement. A timely and accurate diagnosis tool for the evaluation of VM is highly needed. OBJECTIVE The current study aims to investigate the potential feasibility of cervical vestibular evoked myogenic potential (cVEMP) and vestibular autorotation test (VAT) as a diagnosis tool for VM. METHODS A total of 211 subjects were recruited into the current study with all subjects meeting the inclusion and exclusion criteria. The subjects were divided into 3 groups: healthy control group, general migraine group and VM group. Test of cVEMP and VAT was conducted in all the groups, and the generated data were statistically compared. RESULTS Compared with the other two groups, cVEMP P13-N23 amplitudes of VM patients showed a significant decline. Mean latency values of the VM group had no significant difference in comparison with other groups. Asymmetry ratios showed increased level in VM patients compared to the control groups, without significant difference. VAT results showed that all the horizontal gain, horizontal phase, vertical gain and vertical phase differ from the other two groups to varying degrees at higher frequency. CONCLUSION cVEMP and VAT have potential usage in the assessment of VM and can serve as powerful tool in diagnosis of VM.
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Affiliation(s)
- Yufang Yao
- Department 7 of Neurology, Cangzhou Central Hospital, Cangzhou, China
| | - Zhiyue Zhao
- College of Mechanical and Electrical Engineering, Cangzhou Normal University, Cangzhou, China
| | - Xiaoyuan Qi
- Department 7 of Neurology, Cangzhou Central Hospital, Cangzhou, China
| | - Hongning Jia
- Department 7 of Neurology, Cangzhou Central Hospital, Cangzhou, China
| | - Lihua Zhang
- Department 4 of Neurology, Cangzhou Central Hospital, Cangzhou, China
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Saidha P, Chandran D, Sima N, D'souza O. A study of vestibular evoked myogenic potential and clinical features in benign paroxysmal positional vertigo: An institutional experience. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_17_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Taylan Cebi I, Karatas A. The assessment of fukuda stepping test results in prognosis of benign paroxysmal postural vertigo. Braz J Otorhinolaryngol 2021; 88 Suppl 1:S142-S146. [PMID: 34158254 PMCID: PMC9734258 DOI: 10.1016/j.bjorl.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Benign paroxysmal postural vertigo originating from the peripheral vestibular system is characterized by brief vertigo spells triggered by the sudden head motion. Usually, vestibular dysfunction in benign paroxysmal postural vertigo is unilateral. Fukuda stepping test which is helpful in the diagnosis of unilateral vestibular dysfunction, may also be valuable in the prediction of prognosis of benign paroxysmal postural vertigo. OBJECTIVE The purpose of this study is to evaluate the relevance of Fukuda stepping test results with resistant and/or recurrent benign paroxysmal postural vertigo cases. METHODS We evaluated 62 patients with unilateral, idiopathic benign paroxysmal postural vertigo of posterior and/or lateral canals. The Fukuda stepping test was performed prior to the Dix-Hallpike and head-roll tests. Two groups were created according to the Fukuda stepping test results. In Group 1 Fukuda stepping test results were positive with a deviation angle >45°, while in Group 2 the results were negative with no apparent deviation. Two groups were compared by the number of canalith repositioning manuevers performed and the frequency of recurrences. RESULTS We found Fukuda stepping test to be invaluable in the diagnosis of benign paroxysmal postural vertigo since the ratio of Fukuda stepping test positivity and negativity were similar in benign paroxysmal postural vertigo patients. However, the need for multiple canalith repositioning manuevers was significantly higher in Group 1 (p = 0.0103). In addition, the recurrence frequency was found significantly lower in the Group 2 (p = 0.0441). CONCLUSION Although the sensitivity of Fukuda stepping test in detecting mild/moderate unilateral vestibular dysfunction is poor, it may be valuable in prediction of the prognosis of benign paroxysmal postural vertigo. We suggest that positive Fukuda stepping test results in benign paroxysmal postural vertigo patients indicate poor prognosis, the need for multipl canalith repositioning manuevers and the higher possibility of recurrences.
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Chen G, Dai X, Ren X, Lin N, Zhang M, Du Z, Zhang E. Ocular vs. Cervical Vestibular Evoked Myogenic Potentials in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:596454. [PMID: 33193065 PMCID: PMC7649758 DOI: 10.3389/fneur.2020.596454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To compare utricular dysfunction with saccular dysfunction in benign paroxysmal positional vertigo (BPPV), based on ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP), respectively. Materials and Methods: We performed a literature search exploring utricular and saccular dysfunction in BPPV patients through June 2020 using oVEMP and cVEMP, respectively. The databases included Pubmed, Embase, CENTRAL, CNKI, Wan Fang Data, and CBM. The literatures were limited to Chinese and English. Inclusion criteria and exclusion criteria were defined. We adopted abnormal rate as the outcome. All statistical processes were conducted through software Review Manager. Considering the air-conducted sound (ACS) and bone conducted vibration (BCV) may have different mechanisms, and three types of diagnostic criteria for abnormal VEMP were available, sub-group analysis was performed simultaneously according to the sound stimuli and the diagnostic criteria of abnormal VEMP. Results: We retrieved 828 potentially relevant literatures, and finally 12 studies were included for meta-analysis of abnormal rate after duplication removal, titles and abstracts screening, and full-text reading. The abnormal rate of oVEMP was not significantly different from cVEMP (OR = 1.59, 95% CI = 0.99–2.57). But the abnormal rate was obviously different between the subgroups adopting ACS oVEMP and BCV oVEMP. In studies adopting ACS oVEMP, the abnormal rate of oVEMP was higher than cVEMP (OR = 1.85, 95% CI = 1.38–2.49). The abnormal rate of oVEMP was also higher than cVEMP when adopting asymmetry ratio (AR) and no response (NR) as diagnostic criteria (OR = 2.16, 95% CI = 1.61–2.89). Conclusion: The meta-analysis reveals that utricular dysfunction may be more predominant in BPPV compared with saccular dysfunction.
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Affiliation(s)
- Gang Chen
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaoyan Dai
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiuping Ren
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Naifen Lin
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Min Zhang
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhaolin Du
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Endong Zhang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Shupak A, Falah R, Kaminer M. Functional Integrity of the Inferior Vestibular Nerve and Posterior Canal BPPV. Front Neurol 2020; 11:894. [PMID: 32982924 PMCID: PMC7479309 DOI: 10.3389/fneur.2020.00894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
The functional integrity of the inferior vestibular nerve (IVN) may be evaluated by the cervical vestibular evoked myogenic potential (cVEMP) response, which requires signal transmission via the nerve. As functional integrity of the IVN innervating the posterior semicircular canal is required to produce the typical positioning vertigo and nystagmus characterizing posterior canal benign paroxysmal positional vertigo (PCBPPV), we hypothesized that normal cVEMPs would be found in most PCBPPV patients. Twenty-four PCBPPV patients participated in a prospective cohort study. All were treated by canal repositioning maneuver and had air-conduction cVEMP and videonystagmography (VNG). Follow-up evaluations including history and otoneurological bedside examination were carried out 1, 3, 6, and 12 months after the initial treatment. At the last follow-up, the patients filled the Dizziness Handicap Inventory (DHI) questionnaire. Normal cVEMPs were recorded in 19 (79%) and were absent in 5 (21%) of the subjects. The average DHI in the patients with normal cVEMP was 16.42 ± 17.99 vs. 0.4 ± 0.89 among those with pathological cVEMP (p < 0.04, Mann-Whitney test). Thirteen (54%) patients experienced recurrent PCBPPV (rPCBPPV). The average DHI score was significantly higher among patients having recurrence (22.15 ± 18.61) when compared to those with complete cure (2.36 ± 5.98; p < 0.003, Mann-Whitney test). Ten (77%) of the subjects with rPCBPPV had normal and 3 (23%) had pathological cVEMP as compared to 9 (82%) and 2 (18%) subjects in the non-recurrent (nrPCBPPV) group (Fisher's exact test-not significant). cVEMP p13 and n23 wave latencies and amplitudes, inter-aural differences in p13-n23 peak-to-peak amplitudes, and response thresholds did not differ between the groups. No differences were found between the rPCBBPV and nrPCBBPV groups in VNG caloric lateralization and directional preponderance values. We have found that in most cases, PCBPPV symptoms and signs are associated with normal cVEMP response supporting the role of IVN functional integrity. The absent cVEMPs in the minority of patients, although having similar clinical presentation, raise the possibility that the ipsilateral saccule is affected by the same pathology causing degeneration of the utricle macula. Alternatively, lacking inhibitory stimuli from the involved ipsilateral utricle or partial degeneration of the IVN and ganglion could explain the diminished cVEMP response. Clinical Trial Registration: The study was registered in ClinicalTrials.gov Internet site (study ID-NCT01004913; https://clinicaltrials.gov/ct2/show/NCT01004913?cond=BPPV&cntry=IL&draw=2&rank=3).
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Affiliation(s)
- Avi Shupak
- Unit of Otoneurology, Lin Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Rohi Falah
- Unit of Otoneurology, Lin Medical Center, Haifa, Israel.,Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
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Gunes A, Karali E, Ural A, Ruzgar F. Evaluation of cervical vestibular evoked myogenic potential measures using different stimulus types in patients with posterior canal benign paroxysmal positional vertigo. Acta Otolaryngol 2020; 140:395-400. [PMID: 32022626 DOI: 10.1080/00016489.2020.1720920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Cervical Vestibular Evoked Myogenic Potential (cVEMP) measurements still do not have standard normative values in posterior canal benign paroxysmal positional vertigo (BPPV).Aim/Objectives: We aimed to compare cVEMP recordings obtained with different stimuli applied in two different intensities in posterior canal BPPV patients.Methods: Thirty-four patients with unilateral posterior canal BPPV were included in the patient group. In cVEMP recordings obtained with different stimulus intensity [95 dB HL and 105 dB HL] and different stimuli[tone-burst cVEMP (T-cVEMP) and click cVEMP (C-cVEMP)].Results: When the C-cVEMP and T-cVEMP findings were compared in the patient group, differences were observed only in peak-to-peak p1-n1 amplitude values in the measurements performed with 95 dB stimulus. However, T-cVEMP measurements performed with 105 dB stimulus showed that both p1 and n1 latency values were longer and peak-to-peak p1-n1 amplitude values were higher than C-cVEMP measurements.Conclusions and significance: We recommend using priorly tone-burst stimulus for measurements with 105 dB HL in cVEMP evaluations we will perform in posterior BPPV patients. Both stimulants can be used when 95 dB HL stimuli is used.
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Affiliation(s)
- Akif Gunes
- Faculty of Medicine, Department of Otorhinolaryngology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Elif Karali
- Faculty of Medicine, Department of Otorhinolaryngology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Ahmet Ural
- Faculty of Medicine, Department of Otorhinolaryngology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Fatih Ruzgar
- Faculty of Medicine, Department of Audiology, Bolu Abant Izzet Baysal University, Bolu, Turkey
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13
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Scarpa A, Gioacchini FM, Cassandro E, Tulli M, Ralli M, Re M, Cassandro C. Clinical application of cVEMPs and oVEMPs in patients affected by Ménière's disease, vestibular neuritis and benign paroxysmal positional vertigo: a systematic review. ACTA ACUST UNITED AC 2020; 39:298-307. [PMID: 31708577 PMCID: PMC6843588 DOI: 10.14639/0392-100x-2104] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 02/23/2019] [Indexed: 11/23/2022]
Affiliation(s)
- A Scarpa
- Department of Medicine and Surgery, University of Salerno, Italy
| | - F M Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - E Cassandro
- Department of Medicine and Surgery, University of Salerno, Italy
| | - M Tulli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - M Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - M Re
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - C Cassandro
- Surgical Sciences Department, University of Turin, Italy
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Yıldız E, Bucak A, Kuzu S. A new and simple test for diagnosis and prognosis in children with otitis media with effusion: cVEMP. Acta Otolaryngol 2019; 139:998-1003. [PMID: 31464535 DOI: 10.1080/00016489.2019.1650199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim/objectives: A typical vestibular stimulated myogenic potential (VEMP) response depends on suitable sound transfer from the middle ear to inner ear. This transfer is degraded at various degrees in otitis media with effusion (OME). In cases where the effusion is reduced by treating the OME, response to VEMP test can be obtained Backgrounds: In this study we aimed to compare preoperative and postoperative VEMP values of children who were applied ventilation tube for OME and to compare these values and VEMP values of healthy children. Materials and methods: Forty healthy and 40 patients with OME aged between 4 and 16 years were used for the study. VEMP test was performed before and after the surgery. Results: Significant decrease was seen in p13 and n23 values of patient group (p < .05). Statistically significant increase was seen in postoperative amplitudes of patient group (p < .05). Conclusions: Increased VEMP responses in children with OME have shown that dysfunction of middle ear caused vestibular dysfunction. We think that VEMP test can be used to follow up children with OME as a test for showing improvement. Significance: The VEMP test can be used a diagnostic and prognostic test in the diagnosis and follow-up of children with OME.
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Affiliation(s)
- Erkan Yıldız
- Department of Otorhinolaryngology, Afyonkarahisar Suhut State Hospital, Afyon, Turkey
| | - Abdulkadir Bucak
- Department of Otorhinolaryngology, Afyonkarahisar Healty Science University Medical School, Afyon, Turkey
| | - Selçuk Kuzu
- Department of Otorhinolaryngology, Afyonkarahisar Emirdağ State Hospital, Afyon, Turkey
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Chen G, Yu G, Li Y, Zhao X, Dai X, Wang G. Cervical Vestibular Evoked Myogenic Potentials in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. Front Neurol 2019; 10:1043. [PMID: 31632337 PMCID: PMC6779767 DOI: 10.3389/fneur.2019.01043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/16/2019] [Indexed: 12/25/2022] Open
Abstract
Objective: The objective of our study was to investigate the potential association between the occurrence of benign paroxysmal positional vertigo (BPPV) and saccular dysfunction using cervical vestibular evoked myogenic potentials (cVEMP) testing. Methods: The databases including Pubmed, Embase, and CENTRAL were systemically searched for case-control literatures investigating saccular dysfunction using cVEMP testing in BPPV patients compared with healthy controls. The literatures were published up to 16 April 2019 and were limited to the English language. All statistical processes were carried out using software Review Manager, version 5.3. Subgroup analysis and sensitive analysis were performed simultaneously. Results: Of the 12 case-control studies confirmed for meta-analysis, p13 latency of cVEMP was assessed in 8 studies, n23 latency in 6 studies, amplitude in 5 studies, asymmetry ratio (AR) in 3 studies, proportion of absent response in 9 studies, and abnormal cVEMP in 8 studies. Compared with healthy controls, the p13 mean latency of cVEMP was longer (MD = 0.88, 95% CI = 0.64-1.12, p < 0.00001), the mean amplitude was lower (SMD = -0.60, 95% CI = -0.80 to -0.41, p < 0.00001), and the proportions of absent response (OR = 8.76, 95% CI = 2.28-33.61, p = 0.002), and abnormal cVEMP (OR = 7.47, 95% CI = 4.65-12.01, p < 0.00001) were higher in BPPV patients. But there was no significant difference in the n23 mean latency (MD = 0.37, 95% CI = -0.23-0.98, p = 0.22) and the AR of cVEMP (MD = 3.95, 95% CI = -4.75-12.65, p = 0.37) between BPPV patients and healthy controls. In the sub-group analysis based on age, only the result of the proportion of absent response of cVEMP indicated a significant difference existed (p = 0.002) between the studies with age-matched controls (OR = 2.78, 95% CI = 1.09-7.10, p = 0.03) and the studies without age-matched controls (OR = 53.85, 95% CI = 10.09-287.13, p < 0.00001). In the sub-group analysis of the proportion of abnormal cVEMP according to the diagnostic criteria of abnormal cVEMP, the result indicated no significant difference existed between the four groups (p = 0.61, I 2 = 0%). In the sensitivity analysis, we obtained the consistent results after removing each study sequentially. Conclusion: The meta-analysis reveals that saccular dysfunction may be associated with BPPV occurrence, and neural degeneration in the saccular macula may be a potential pathogenesis for BPPV.
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Affiliation(s)
- Gang Chen
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Jinan, China
| | - Gang Yu
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Jinan, China
| | - Yun Li
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Jinan, China
| | - Xuening Zhao
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Jinan, China
| | - Xiaoyan Dai
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Jinan, China
| | - Guotao Wang
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Jinan, China
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Oya R, Imai T, Takenaka Y, Sato T, Oshima K, Ohta Y, Inohara H. Clinical significance of cervical and ocular vestibular evoked myogenic potentials in benign paroxysmal positional vertigo: a meta-analysis. Eur Arch Otorhinolaryngol 2019; 276:3257-3265. [PMID: 31605189 DOI: 10.1007/s00405-019-05674-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE As the pathological cause of benign paroxysmal positional vertigo (BPPV), the dislocation or degeneration of otoconia in the utricle and saccule is suggested. Vestibular evoked myogenic potential (VEMP) could reflect otolithic dysfunction due to these etiologies of BPPV. The aim of this study was to validate the clinical significance of cervical (c) and ocular (o) VEMP in BPPV by a meta-analysis of previous articles. METHODS Articles related to BPPV with data on cVEMP and oVEMP were collected. The following keywords were used to search PubMed and Scopus for English language articles: benign paroxysmal positional vertigo or BPPV and vestibular evoked myogenic potential or VEMP. RESULTS The p13 latency in cVEMP and n1 latency in oVEMP were slightly but significantly prolonged in BPPV patients compared to control patients. AR in oVEMP of BPPV patients also showed higher value than that of control patients. However, the n23 latency and AR in cVEMP and p1 latency in oVEMP showed no significant difference between BPPV and control patients. Furthermore, latencies in VEMPs also showed no significant difference between an affected and a non-affected ear in BPPV patients. CONCLUSIONS Our results indicated that otolith dysfunction of BPPVs was detected by latencies in VEMPs, and AR in oVEMP more sensitively reflects the difference between affected and non-affected ears in BPPV patients. The otolith dysfunction of BPPV might be induced by the systemic condition. However, the differences of latencies between BPPV patients and control patients were too small to use VEMPs as a prognostic predictor.
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Affiliation(s)
- Ryohei Oya
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan.
| | - Takao Imai
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology Head and Neck Surgery, Kansai Medical Hospital, 1-7-2 Shinsenrinishimachi, Toyonaka, Osaka, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Kazuo Oshima
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
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Papathanasiou E, Straumann D. Why and when to refer patients for vestibular evoked myogenic potentials: A critical review. Clin Neurophysiol 2019; 130:1539-1556. [DOI: 10.1016/j.clinph.2019.04.719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
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18
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Obeidat FS, Lewis Bell S. Comparing the sensitivity and specificity of cervical vestibular-evoked myogenic potentials and electrocochleography in the diagnosis of Ménière’s disease. Int J Audiol 2019; 58:738-746. [DOI: 10.1080/14992027.2019.1627008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Faten Saeed Obeidat
- Hearing and Speech Sciences, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan
- Faculty of Engineering and the Environment, Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Steven Lewis Bell
- Faculty of Engineering and the Environment, Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
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Papathanasiou ES. Standardizing the way we perform and apply vestibular evoked myogenic potentials (VEMPs). Clin Neurophysiol Pract 2019; 4:37-38. [PMID: 30906907 PMCID: PMC6411592 DOI: 10.1016/j.cnp.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 11/16/2022] Open
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20
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Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2019; 276:711-718. [DOI: 10.1007/s00405-019-05297-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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21
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Oh KH, Suh KD, Lee YH, Lee SY, Chang MY, Mun SK. Clinical utility of cervical vestibular-evoked myogenic potentials in predicting residual dizziness after benign paroxysmal positional vertigo. Clin Neurophysiol 2018; 130:95-100. [PMID: 30497047 DOI: 10.1016/j.clinph.2018.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/06/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In the present study, the value of cervical vestibular-evoked myogenic potential (cVEMP) as a predictive factor for residual dizziness after recovery of benign paroxysmal positional vertigo (BPPV) was evaluated. METHODS The present study included 65 patients who had BPPV and underwent cVEMP testing. Patients were divided into two groups depending on the presence or absence of residual dizziness after recovery of BPPV. Univariate and multivariate analyses were performed to determine the factors associated with residual dizziness using age, gender, affected semicircular canal, affected side, BPPV duration, and cVEMP parameters. RESULTS In univariate analysis, cVEMP-modified interaural amplitude difference (IAD) ratio and p13 latency showed a relatively significant association (p < 0.20) with residual dizziness. Based on multivariate analysis, increased cVEMP-modified interaural amplitude difference (IAD) ratio at the affected side (≥25%; p = 0.018, OR 6.623) remained as an associated factor. CONCLUSIONS Increased cVEMP-modified IAD ratio at the affected side is associated with residual dizziness. BPPV patients with increased cVEMP-modified IAD ratio at the affected side are more likely to have residual dizziness after recovery of BPPV. SIGNIFICANCE cVEMP testing could be used for the prediction of residual dizziness. An increased cVEMP-modified IAD ratio at the affected side may be used as a predictor of residual dizziness.
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Affiliation(s)
- Kyung Hyun Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kang Duk Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yang Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Mun Young Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
| | - Seog-Kyun Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
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Valame DA, Gore GB. Role of Cervical Vestibular Evoked Myogenic Potentials (cVEMP) as Outcome-Measure of Glycerol Test. Indian J Otolaryngol Head Neck Surg 2018; 71:425-433. [PMID: 31741998 DOI: 10.1007/s12070-018-1335-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/28/2018] [Indexed: 12/16/2022] Open
Abstract
Diagnosis of Meniere's disease is mainly clinical although many tests have been studied for efficacy in diagnosis of Meniere's disease. Glycerol test is a functional test to identify hydrops in Meniere's disease and can be done with PTA, Speech audiometry, otoacoustic emission, EcochG and cVEMP as its outcome measures. The study aimed to compare two outcome measures of glycerol test to identify Meniere's disease; to determine whether the stage of Meniere's disease affected glycerol outcomes; and to attempt to identify independent variables that could predict outcomes of glycerol test. 26 ears of 20 Meniere's disease participants were evaluated using PTA-based and cVEMP-based glycerol tests. Each test identified ten of 26 ears with Meniere's disease; and high agreement was noted in the two outcome measures. The stage of Meniere's disease based on four frequency hearing threshold average was not associated with outcome of glycerol test, but staging of Meniere's disease based on symptom duration was associated with glycerol test results. As the duration of symptoms increased there was lesser chance of positive outcomes on glycerol test; but intermediate stages of Meniere's disease showed positive outcomes. Variables such as age, gender, severity of hearing loss, duration of symptoms and pre-glycerol cVEMP measurements could not predict glycerol test outcomes. PTA-based and cVEMP- based glycerol tests hold promise in the test battery for identification of Meniere's disease. Positive findings on the test lead to confirmatory diagnosis but a negative glycerol test does not rule out Meniere's disease.
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Affiliation(s)
- Deepa A Valame
- Department of Audiology and Speech Therapy, T.N. Medical College & B.Y.L. Nair Hospital, Dr A. Nair Road, Mumbai Central, Mumbai, Maharashtra 400008 India
| | - Geeta B Gore
- Department of Audiology and Speech Therapy, T.N. Medical College & B.Y.L. Nair Hospital, Dr A. Nair Road, Mumbai Central, Mumbai, Maharashtra 400008 India
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Biswas A, Barui B. Specific Organ Targeted Vestibular Physiotherapy: The Pivot in the Contemporary Management of Vertigo and Imbalance. Indian J Otolaryngol Head Neck Surg 2017; 69:431-442. [PMID: 29238670 DOI: 10.1007/s12070-017-1236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Advancements in our understanding of vestibular physiology and how it is changes in different diseases have established that of the three therapeutic approaches to treat disorders of the vestibular system viz. pharmacotherapy, surgery and physical therapy, it is the later i.e., physical therapy which is the most efficacious modality in the management of balance disorders. The futility of vestibular sedatives in the correction of vestibular disorders and in the restoration of balance and the very limited role of surgery has now been recognised. Advancements in vestibulometry now enable us to localise any lesion in the vestibular system with utmost precision and also determine the exact cause of the balance disorder. The site of lesion and the specific organ that is defective can now be very precisely identified. Treatment modalities especially that for physical therapy hence have to be organ specific, and if possible, also disease specific. Aims and Objectives The study aims at evaluating the efficacy of physiotherapy in the management of balance disorders and also assesses the efficacy of organ targeted physical therapy, a new concept in restoring balance after vestibulometry has identified the offending organ. Materials and Methods The study was conducted in the specialised physical therapy unit for balance and gait disorder patients which is a part of Vertigo and Deafness Clinic in Kolkata, India. Special instruments for physical therapy devised by the first author were used for stimulation of specific sense organs in the vestibular labyrinth that were found to be defective in vestibulometry. Specially made Virtual reality programs were used in patients suffering from psychogenic balance disorders. The pre and post therapy status was evaluated by different standard scales to assess balance and dizziness. Results Very promising results were obtained. Organ targeted physiotherapy where defective sense organs were specifically stimulated showed remarkable improvement in different measures. Virtual reality exercises too showed very promising results in patients of psychogenic vertigo.
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Affiliation(s)
- Anirban Biswas
- Vertigo & Deafness Clinic, BJ-252, Salt Lake, Kolkata, West Bengal 700091 India
| | - Bibhas Barui
- Vertigo & Deafness Clinic, BJ-252, Salt Lake, Kolkata, West Bengal 700091 India
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Otolith Dysfunction in Persons With Both Diabetes and Benign Paroxysmal Positional Vertigo. Otol Neurotol 2017; 38:379-385. [PMID: 27930443 DOI: 10.1097/mao.0000000000001309] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Vestibular dysfunction is a well-recognized complication of type 2 diabetes (DM) that may contribute to increased fall risk. The prevalence of benign paroxysmal positional vertigo (BPPV) is higher in people with DM. The impact of DM on the otolith organs of the vestibular system in people with BPPV is unknown. The purpose of this study was to analyze otolith function using vestibular-evoked myogenic potential (VEMP) tests in people with DM and concurrent BPPV (BPPV + DM), and to examine the relationships between VEMP variables and diabetes-related variables. STUDY DESIGN Prospective, cross-sectional study. SETTING Tertiary academic medical center. SUBJECTS AND METHODS Participants 40 to 65 years were recruited in four groups: controls (n = 20), people with DM (n = 19), BPPV (n = 18), and BPPV + DM (n = 14). Saccule and utricle function were examined using cervical VEMP (cVEMP) and ocular VEMP (oVEMP), respectively. Diabetes-related variables such as HbA1c, duration of diabetes, and presence of sensory impairment due to diabetes were collected. RESULTS The frequency of abnormal cVEMP responses was higher in the DM (p = 0.005), BPPV (p = 0.003), and BPPV + DM (p <0.001) groups compared with controls. In the participants with diabetes, higher HbA1c levels were correlated with prolonged P1 (p = 0.03) and N1 latencies (p = 0.03). The frequency of abnormal oVEMP responses was not different between groups (p = 0.2). CONCLUSION Although BPPV and DM may independently affect utricle and saccule function, they do not seem to have a distinct cumulative effect.
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Chang MY, Shin JH, Oh KH, Hong YH, Mun SK. Clinical implication of cervical vestibular evoked myogenic potentials in benign paroxysmal positional vertigo. Clin Neurophysiol 2017; 128:351-356. [DOI: 10.1016/j.clinph.2016.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/29/2016] [Accepted: 12/03/2016] [Indexed: 12/13/2022]
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Johnson SA, O’Beirne GA, Lin E, Gourley J, Hornibrook J. oVEMPs and cVEMPs in patients with 'clinically certain' Menière's disease. Acta Otolaryngol 2016; 136:1029-34. [PMID: 27121497 DOI: 10.1080/00016489.2016.1175663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To measure ocular vestibular-evoked myogenic potentials (oVEMPs) and cervical vestibular-evoked myogenic potentials (cVEMPS) in Menière's disease patients with confirmed cochlear hydrops and in the normal ears of volunteers. METHODS oVEMPs and cVEMPs were measured in 18 patients with a symptomatic diagnosis of Menière's disease and tone burst electrocochleographic confirmation of hydrops, and in the ears of 22 volunteers. RESULTS Threshold measures: For cVEMP: no significant differences between Menière's ears and controls; for oVEMP: significantly elevated thresholds in affected ears of Menière's ears compared with their unaffected ears, but not with controls. Latency measures: cVEMP N1 peaks were significantly prolonged compared with the left and right ears of controls, but not with the non-affected ear. Amplitude measures: cVEMP P1N1 and N1P2 measures were significantly reduced compared with the right ear of controls, but not with the non-affected ear; For oVEMP, N2P2 amplitudes were significantly reduced compared with both ears of controls but not with the non-affected ear. CONCLUSION Abnormalities of oVEMPs and cVEMPs were found in 18 Menière's disease patients who had an independent confirmation of cochlear hydrops. The overlap of the results from Menière's patients compared with normal controls limits the use of VEMP abnormalities as a sole reliable diagnostic test for Menière's disease.
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Affiliation(s)
- Sarah-Anne Johnson
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | - Greg A. O’Beirne
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | - Emily Lin
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | - John Gourley
- Department of Otolaryngology-Head and Neck Surgery and Audiology, Christchurch Hospital, Christchurch, New Zealand
| | - Jeremy Hornibrook
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
- Department of Otolaryngology-Head and Neck Surgery and Audiology, Christchurch Hospital, Christchurch, New Zealand
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Murofushi T. Clinical application of vestibular evoked myogenic potential (VEMP). Auris Nasus Larynx 2016; 43:367-76. [DOI: 10.1016/j.anl.2015.12.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/12/2015] [Accepted: 12/07/2015] [Indexed: 01/31/2023]
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Saeed BMN, Omari AF. Climatic variations and benign paroxysmal positional vertigo. J Otol 2016; 11:33-37. [PMID: 29937808 PMCID: PMC6002593 DOI: 10.1016/j.joto.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is probably the most common diagnosis at vertigo clinics. Seasonal cycles of several human illnesses could be attributed variously to changes in atmospheric or weather conditions. In this retrospective study, patients with BPPV from January 2010 to December 2012 were studied, and their charts were reviewed. Statistical analysis revealed a statistically significant difference in patients' numbers among different months of the year. Also there is a significant statistical correlation between the numbers of patients with climatic variations especially the temperature. The present paper discusses the possible explanations for these results which confirms the seasonal variations in BPPV, together with a review of literature to view the possible associations with other disorders that causes such seasonality.
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Affiliation(s)
- Basil M N Saeed
- Department of Surgery, College of Medicine, Mosul University, Duhok, Kurdistan, Iraq
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Xu H, Liang FY, Chen L, Song XC, Tong MCF, Thong JF, Zhang QQ, Sun Y. Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients. J Otolaryngol Head Neck Surg 2016; 45:12. [PMID: 26857819 PMCID: PMC4746908 DOI: 10.1186/s40463-016-0125-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/02/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is well-known that ocular vestibular evoked myogenic potentials (oVEMPs) predominantly reflect utricular function whilst cervical vestibular evoked myogenic potentials (cVEMPs) reflect saccular function. To date, there are no published reports on the systemic evaluation of utricular and saccular function in benign paroxysmal positional vertigo (BPPV), nor are there any reports on the differences in VEMPs between patients with recurrent and non-recurrent BPPV. The aim of this study was to evaluate the difference in cervical and ocular (c/o)VEMPs between patients with BPPV and normal controls, as well as between patients with recurrent and non-recurrent BPPV. METHODS Thirty patients with posterior canal BPPV and 30 healthy subjects (as normal controls) were prospectively enrolled. cVEMP and oVEMP testing using 500 Hz tone-burst stimuli were performed on all. VEMP tests were repeated 3 times on each subject to ensure reliability and reproducibility of responses. VEMPs were defined as present or absent. Abnormal VEMP was defined by lack of VEMP response. RESULTS In the control group, abnormal cVEMPs responses were detected in 6.67% and abnormal oVEMPs responses were detected in 3.34%. In BPPV patients (10 with recurrent BPPV, 20 with non-recurrent BPPV), abnormal cVEMPs responses were detected in 30% and abnormal oVEMPs responses were detected in 56.7%. More patients with BPPV showed abnormal responses in c/oVEMPs as compared to the control group (p < 0.05). oVEMPs was more often abnormal as compared to cVEMPs in BPPV patients (p < 0.05). There was no statistical difference between abnormal cVEMP responses in non-recurrent BPPV patients (25%) and recurrent BPPV patients (40%) (p > 0.05). Differences in abnormal oVEMP responses (non-recurrent BPPV, 40%; recurrent BPPV, 90%) were significant (p < 0.05). CONCLUSION An increased occurrence of abnormal c/oVEMP recordings appeared in BPPV patients, possibly as a result of degeneration of the otolith macula. oVEMPs were more often abnormal in BPPV patients as compared to cVEMPs, suggesting that utricular dysfunction may be more common than saccular dysfunction. Furthermore, oVEMP abnormalities in the recurrent BPPV group were significantly higher than those in the non-recurrent BPPV group. Assessment of c/oVEMPs in BPPV patients may therefore be of prognostic value in predicting likelihood of BPPV recurrence.
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Affiliation(s)
- Hui Xu
- Stomatology Department, Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai City, Shandong Province, China.
| | - Fa-ya Liang
- Otorhinolaryngology Head and Neck Surgery Department, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Liang Chen
- Otorhinolaryngology Head and Neck Surgery Department, Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai City, Shandong Province, China. .,Otology Department, Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai City, Shandong Province, China.
| | - Xi-cheng Song
- Otorhinolaryngology Head and Neck Surgery Department, Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai City, Shandong Province, China.
| | - Michael Chi Fai Tong
- Otorhinolaryngology Head and Neck Surgery Department, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Jiun Fong Thong
- Otorhinolaryngology Head and Neck Surgery Department, Singapore General Hospital, Singapore, Singapore.
| | - Qing-quan Zhang
- Otorhinolaryngology Head and Neck Surgery Department, Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai City, Shandong Province, China.
| | - Yan Sun
- Otorhinolaryngology Head and Neck Surgery Department, Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai City, Shandong Province, China.
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Colebatch JG, Rosengren SM, Welgampola MS. Vestibular-evoked myogenic potentials. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:133-155. [PMID: 27638068 DOI: 10.1016/b978-0-444-63437-5.00010-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The vestibular-evoked myogenic potential (VEMP) is a short-latency potential evoked through activation of vestibular receptors using sound or vibration. It is generated by modulated electromyographic signals either from the sternocleidomastoid muscle for the cervical VEMP (cVEMP) or the inferior oblique muscle for the ocular VEMP (oVEMP). These reflexes appear to originate from the otolith organs and thus complement existing methods of vestibular assessment, which are mainly based upon canal function. This review considers the basis, methodology, and current applications of the cVEMP and oVEMP in the assessment and diagnosis of vestibular disorders, both peripheral and central.
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Affiliation(s)
- J G Colebatch
- Neuroscience Research Australia and Department of Neurology, Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, Australia.
| | - S M Rosengren
- Neurology Department, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney, Australia
| | - M S Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney Australia
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Singh NK, Apeksha K. Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal. Eur Arch Otorhinolaryngol 2015; 273:2523-32. [DOI: 10.1007/s00405-015-3867-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
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Zhang S, Leng Y, Liu B, Shi H, Lu M, Kong W. Diagnostic Value of Vestibular Evoked Myogenic Potentials in Endolymphatic Hydrops: A Meta-Analysis. Sci Rep 2015; 5:14951. [PMID: 26455332 PMCID: PMC4601069 DOI: 10.1038/srep14951] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/10/2015] [Indexed: 12/18/2022] Open
Abstract
In this study, we evaluated the clinical diagnostic value of vestibular evoked myogenic potentials (VEMPs) for endolymphatic hydrops (EH) by systematic review and Meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under summary receiver operating characteristic curves (AUC) were calculated. Subgroup analysis and publication bias assessment were also conducted. The pooled sensitivity and the specificity were 49% (95% CI: 46% to 51%) and 95% (95% CI: 94% to 96%), respectively. The pooled positive likelihood ratio was 18.01 (95% CI: 9.45 to 34.29) and the pooled negative likelihood ratio was 0.54 (95% CI: 0.47 to 0.61). AUC was 0.78 and the pooled diagnostic odds ratio of VEMPs was 39.89 (95% CI: 20.13 to 79.03). In conclusion, our present meta-analysis has demonstrated that VEMPs test alone is not sufficient for Meniere’s disease or delayed endolymphatic hydrops diagnosis, but that it might be an important component of a test battery for diagnosing Meniere’s disease or delayed endolymphatic hydrops. Moreover, VEMPs, due to its high specificity and non-invasive nature, might be used as a screening tool for EH.
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Affiliation(s)
- Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yangming Leng
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hao Shi
- Department of Epidemiology and Biostatistics, and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meixia Lu
- Department of Epidemiology and Biostatistics, and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Erdağ TK, Kurtoğlu G. The 100 Most Cited Turkish Papers in the Otorhinolaryngology Journals of Web of Science. Turk Arch Otorhinolaryngol 2015; 53:112-119. [PMID: 29391992 DOI: 10.5152/tao.2015.1352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of the study was to analyze the 100 most cited publications with Turkish origin in the Web of Science Otorhinolaryngology (ORL) journals. Methods The Web of Science database was searched in terms of citations for publications originating from Turkey in ORL journals since 1983. After the identification of the 100 most cited articles, analysis was performed for the first author, institution, city, publication type, subject related to subspecialty, and journals having the most cited articles. Moreover, the number of ORL publications and citations of countries was determined in descending order using the same database. Results A total of 3948 ORL articles with Turkish origin was identified. The number of citations was 181 for the first and 28 for the last in the 100 most cited articles. As there was more than one article with 28 citations, 101 articles were analyzed. The number of the articles was 76, 22, and 3 for the university, education/research, and state hospitals, respectively. Hacettepe University, Ankara Numune Hospital, and Gazi University were the three leading institutions having the most cited articles, and Ankara was the first city. While 98 of 101 articles were original research, the number of case reports and review articles were 2 and 1, respectively. Thirty-five articles were related to otology, 23 to pediatric ORL, 20 to rhinology and head and neck surgery, and 3 to facial plastic surgery. Laryngoscope, Otolaryngology-Head and Neck Surgery, and International Journal of Pediatric Otorhinolaryngology were the leading 3 journals with the most cited articles coming from Turkey. The evaluation of countries revealed that Turkey was among the first 10 countries in terms of number of ORL articles but fell behind for the number of citations. Conclusion This bibliometric study is the first one regarding the contribution of Turkish authors and institutions to ORL literature. Similar studies might be periodically repeated to determine national development in the field of ORL and place of Turkey in the world.
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Affiliation(s)
- Taner Kemal Erdağ
- Department of Otorhinolaryngology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Gökhan Kurtoğlu
- Department of Otorhinolaryngology, Dokuz Eylül University School of Medicine, İzmir, Turkey
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Mohamed ES, Ahmed MAR, Said EAF. Role of cervical vestibular-evoked myogenic potentials testing in vestibular migraine. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ejenta.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yetiser S, Ince D, Gul M. An Analysis of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo. Ann Otol Rhinol Laryngol 2014; 123:686-95. [DOI: 10.1177/0003489414532778] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Vestibular evoked myogenic potentials (VEMPs) selectively test the vestibular end-organ. The aim of this study was to analyze how the site of the diseased canal, type of particulate deposition, duration of symptoms, severity of nystagmus, recurrence, and age affect the VEMP in patients with benign paroxysmal positional vertigo (BPPV). Methods: One hundred two patients were enrolled in the study between 2009 and 2012. There were 36 men and 66 women with ages ranging from 16 to 71 years (mean age, 42.28 ± 11.29 years). Patients with BPPV were tested with roll-on and head-hanging maneuvers under video-electronystagmography monitoring and with air conduction cervical VEMP testing. Patients were grouped for duration, severity, recurrence, age, site of canal involvement, and so on, and the results were compared in each subgroup. Kruskal–Wallis and Mann–Whitney U tests were used for the comparative analysis. Results: Twenty-four patients (23.5%) had a gross VEMP abnormality (absence of VEMP in 6 and greater than 25% depression of the amplitude in 18). Abnormality of VEMPs was not correlated with factors including age, severity of nystagmus, number of maneuvers applied, and the site of canal involvement ( P < .05). However, persistence or recurrence of symptoms has an effect on VEMP results ( P = .016). Conclusion: Vestibular evoked myogenic potential is a useful tool to study the otolithic function in patients with BPPV and should be included in the test battery.
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Affiliation(s)
- Sertac Yetiser
- Department of Otorhinolaryngology–Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | - Dilay Ince
- Department of Otorhinolaryngology–Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | - Murat Gul
- Department of Statistics, University of Giresun, Giresun, Turkey
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Singh NK, Sinha SK, Govindaswamy R, Kumari A. Are cervical vestibular evoked myogenic potentials sensitive to changes in the vestibular system associated with benign paroxysmal positional vertigo? HEARING BALANCE AND COMMUNICATION 2014. [DOI: 10.3109/21695717.2014.883208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The objective of this cross-sectional study was to investigate the possibility that the saccule may contribute to human hearing. The forty participants included twenty healthy people and twenty other subjects selected from patients who presented with benign paroxysmal positional vertigo to Audiology Department of Hazrat Rasoul Akram hospital (Tehran, Iran). Assessments comprised of audiological evaluations, cervical vestibular evoked myogenic potentials (cVEMPs), recognition of spoken phonemes in white noise (Rsp in wn), and auditory brainstem response to 500 Hz tone burst (ABR(500 HZ)). Twenty affected ears with decreased vestibular excitability as detected by abnormal cVEMPs revealed decreased scores of Rsp in wn and abnormal findings of ABR(500 HZ). Both unaffected and normal ears had normal results. Multiple comparisons of mean values of cVEMPs and ABR(500 HZ) between three groups were significant (P < 0.05, ANOVA). The correlation between RSP in wn and p13 latencies was significant. The peak-to-peak amplitudes showed significant correlation to RSP in wn. The correlation between RSP in wn and the latencies of n23 was significant. In high-level of noisy competing situations, healthy human saccular sensation can mediate the detection of low frequencies and possibly help in cochlear hearing for frequency and intensity discrimination. So, all human hearing is not cochlear.
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Spontaneous plugging of the horizontal semicircular canal with reversible canal dysfunction and recovery of vestibular evoked myogenic potentials. Otol Neurotol 2013; 34:743-7. [PMID: 23632787 DOI: 10.1097/mao.0b013e318287f343] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the clinical pathophysiology of oculomotor changes in a patient presenting with a spontaneous semicircular horizontal canal plug. PATIENT A 42-year-old man with acute spontaneous vertigo with spinning and persistent left-horizontal nystagmus, intensity but not direction dependent on head orientation with respect to gravity, indicating a benign paroxysmal positional vertigo due to otoconia causing a plug in the horizontal semicircular canal. INTERVENTION Electrophysiological and video-oculographic testing; vestibular rehabilitation. MAIN OUTCOME MEASURES Cervical and ocular vestibular evoked myogenic potentials (VEMPs); video head impulse testing. RESULTS The video head-impulse test revealed an eye velocity cutoff at 80°/s in the time interval from 40 to 90 ms after initiation of head impulses to the right. This normalized within 2 days after liberatory maneuvers, documenting for the first time a reversible deficiency of the cupular-endolymph high-frequency system dynamics. Cervical and ocular vestibular myogenic potentials were absent during stimulation of the affected side before the liberatory maneuvers but normalized within 30 to 80 days. CONCLUSION This case is special in 4 respects: 1) nystagmus intensity, but not direction, was dependent on head orientation with respect to gravity, indicating a horizontal canal plug; 2) VEMPs were asymmetrical before liberatory maneuvers; 3) VEMPs recovered after Day 30; and 4) video head-impulse test asymmetry recovered. These observations challenge the common belief that VEMPs are evoked by otolith stimulation only. Instead, the assumption of a reversible canal dysfunction by a plug offers a more plausible explanation for all effects.
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Sound sensitivity of the saccule for low frequencies in healthy adults. ISRN OTOLARYNGOLOGY 2013; 2013:429680. [PMID: 24282646 PMCID: PMC3824401 DOI: 10.1155/2013/429680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/12/2013] [Indexed: 11/18/2022]
Abstract
Approximately 80 years ago John Tait speculated about a possible auditory role for the otolith organs in humans those days, there was no direct evidence for that idea. This time is for us to review and research. Then, the objective of our study was to investigate saccular hearing in healthy adults. We selected twenty healthy controls and twenty-four dizzy cases. Assessment comprised of audiologic evaluations, cervical vestibular evoked myogenic potentials (cVEMPs), and recognition of spoken phonemes in white noise (Rsp in wn). In the case group (a total of 48 ears), the cVEMPs abnormalities were all unilateral (24 affected ears and 24 contralateral unaffected ears). Affected ears with decreased vestibular excitability as detected by abnormal cVEMPs had decreased Rsp in wn (mean = 60.78 ± 8.33), whereas both unaffected (mean = 96.24 ± 2.4) and control ears (mean = 96.24 ± 2.4) presented normal results. The correlation between RSP in wn and p13 latencies was significant (P < 0.05, r = -0.551). The peak-to-peak amplitudes showed significant correlation to RSP in wn (P < 0.05, r = 0.307). The correlation between RSP in wn and the latencies of n23 was significant (P < 0.05, r = -0.493). We concluded in presence of severe competing noise, saccule has a facilitating role for cochlea and can improve to detection of loud low-frequencies.
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Talaat HS, Metwaly MA, Khafagy AH, Abdelraouf HR, Moussa Isak HA. Vestibular evoked myogenic potentials in idiopathic posterior canal benign paroxysmal positional vertigo. HEARING, BALANCE AND COMMUNICATION 2013. [DOI: 10.3109/21695717.2013.834577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Role of cervical vestibular evoked myogenic potential response in identifying vestibular dysfunction. The Journal of Laryngology & Otology 2013; 127:848-53. [DOI: 10.1017/s0022215113001655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractObjectives:To analyse cervical vestibular evoked myogenic potential response parameters in normal volunteers and vertiginous patients.Subjects and methods:A prospective study of 50 normal subjects and 50 patients with vertigo was conducted at Chiang Mai University Hospital, Thailand. Cervical vestibular evoked myogenic potential responses were measured using air-conducted, 500-Hz, tone-burst stimuli with subjects in a sitting position with their head turned toward the contralateral shoulder.Results:The mean ± standard deviation age and male:female ratio in the normal (44.0 ± 9.3 years; 12:38) and vertigo groups (44.7 ± 9.8 years; 17:33) were not significantly different. The prevalence of absent responses in the normal (14 per cent) and vertigo ears (46 per cent) differed significantly (p < 0.0001). Other cervical vestibular evoked myogenic potential parameters (i.e. response threshold, P1 and N1 latency, P1–N1 interlatency and interamplitude, inter-ear difference in P1 threshold, and asymmetry ratio) showed no inter-group differences.Conclusion:The absence of a cervical vestibular evoked myogenic potential response is useful in the identification of vestibular dysfunction. However, patients should undergo a comprehensive battery of other vestibular tests to supplement their cervical vestibular evoked myogenic potential response findings.
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Cervical vestibular evoked myogenic potentials and vestibular migraine. Clin Neurophysiol 2013; 124:642-3. [DOI: 10.1016/j.clinph.2012.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 10/05/2012] [Accepted: 10/09/2012] [Indexed: 11/20/2022]
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Nakahara H, Yoshimura E, Tsuda Y, Murofushi T. Damaged utricular function clarified by oVEMP in patients with benign paroxysmal positional vertigo. Acta Otolaryngol 2013; 133:144-9. [PMID: 22992120 DOI: 10.3109/00016489.2012.720030] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
CONCLUSION Utricular dysfunction in patients with posterior canal benign paroxysmal positional vertigo (pBPPV) was supported by findings for ocular vestibular evoked myogenic potential (oVEMP). OBJECTIVE To evaluate the utricular and saccular function in patients with pBPPV. METHODS This study focused on 12 patients definitively diagnosed with pBPPV showing typical nystagmus by Dix-Hallpike maneuver and 12 controls. In these subjects, oVEMPs and cVEMPs to air-conducted 500 Hz tone burst (125 dB SPL) were measured. The patients also underwent caloric tests. RESULTS More of the patients with pBPPV showed abnormal responses in oVEMPs by stimulation on their affected side than the controls, while the results of cVEMPs showed no significant differences between pBPPV patients and controls. The abnormal results for oVEMPs on the affected side showed a higher percentage than those for cVEMPs and caloric tests in pBPPV patients. There was no significant association between any of the tests. These findings support the possibility that oVEMP reflects the specific abnormal condition in pBPPV, i.e. that the urticular function in pBPPV patients was highly damaged.
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Affiliation(s)
- Haruka Nakahara
- Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan.
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Shih CP, Wang CH. Supine to prolonged lateral position: a novel therapeutic maneuver for posterior canal benign paroxysmal positional vertigo. J Neurol 2012; 260:1375-81. [DOI: 10.1007/s00415-012-6807-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 11/28/2022]
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Wang HM, Tsai SM, Chien CY, Ho KY. Analysis of auditory and vestibular function in patients with unilateral Meniere's disease. Acta Otolaryngol 2012; 132:1246-51. [PMID: 23039188 DOI: 10.3109/00016489.2012.697641] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The percentage of the unilateral weakness of the caloric response also reflects the clinical progress of Meniere's disease (MD), including clinical hearing loss. OBJECTIVE To evaluate the relationship between hearing status and vestibular function in patients with MD. METHODS Seventy-nine patients with unilateral definite MD underwent bithermal air caloric testing, vestibular evoked myogenic potential (VEMP) testing, and pure tone audiometry (PTA). The stages of the disease, clinical hearing level of the diseased ears, and dPTA (the difference in hearing level between ears in each patient) were compared with the percentage of the unilateral weakness of the caloric response and the interaural amplitude difference (IAD) ratio of the VEMP response. RESULTS Twenty ears (25.3%) revealed normal caloric responses and 59 ears (74.7%) showed reduced caloric responses. Testing revealed that the VEMPs were normal in 49 ears (62%), while 30 ears (38%) had abnormal VEMPs. The percentage of the unilateral weakness of the caloric response was positively correlated with the clinical hearing level of the diseased ears (p = 0.006) and the dPTA (p = 0.013).
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Affiliation(s)
- Hsun-Mo Wang
- Department of Otolaryngology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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Cervical vestibular evoked myogenic potentials in primary headache disorders. Clin Neurophysiol 2012; 124:779-84. [PMID: 23122971 DOI: 10.1016/j.clinph.2012.09.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/05/2012] [Accepted: 09/07/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if cervical vestibular evoked myogenic potentials (cVEMPS) differ in patients with migraine without aura (MoA), vestibular migraine (VM) and tension type headache (TTH). METHODS Twenty patients with MoA, 24 patients with VM and 20 patients with TTH were included in the study. Thirty healthy volunteers of comparable age and gender were taken as the control group. The latencies of peaks p13 and n23, peak-to-peak amplitude of p13-n23 divided by a mean prestimulus EMG recorded during cVEMP testing were measured. The amplitude asymmetry between right and left sides was also calculated and taken into consideration. Caloric testing was conducted to check if the results are associated with the results of the cVEMPs. RESULTS Five (one on the right, four on the left side) of the 24 patients with VM (20.8%) displayed a unilateral caloric hypofunction. Normal results were recorded from patients with MoA and TTH. p13, n23 latencies and amplitudes of the patient groups were not statistically different from the results of the healthy controls (p>0.05). An amplitude asymmetry between right and left sides exceeding that of the healthy controls was not also present (p>0.05). CONCLUSIONS Though a hypofunctioning horizontal semicircular canal was detected in 20.8% of the patients with VM, saccular function seemed to be unaffected. Patients with MoA and TTH did not display any vestibular test abnormality. SIGNIFICANCE Primary headache disorders seem to be associated with a normal interictal cVEMP profile.
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Andrade IVS, Santos-Perez S, Diz PG, Caballero TL, Soto-Varela A. Correlation between bithermal caloric test results and vestibular evoked myogenic potentials (VEMPs) in normal subjects. Eur Arch Otorhinolaryngol 2012; 270:1623-8. [PMID: 22948860 DOI: 10.1007/s00405-012-2167-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 08/14/2012] [Indexed: 11/24/2022]
Abstract
UNLABELLED Bithermal caloric testing and vestibular evoked myogenic potentials (VEMPs) are both diagnostic tools for the study of the vestibular system. The first tests the horizontal semicircular canal and the second evaluates the saccule and lower vestibular nerve. The results of these two tests can therefore be expected to be correlated. The aim of this study was to compare bithermal caloric test results with VEMP records in normal subjects to verify whether they are correlated. MATERIAL AND METHOD A prospective study was conducted in 60 healthy subjects (30 men and 30 women) who underwent otoscopy, pure tone audiometry, bithermal caloric testing and VEMPs. From the caloric test, we assessed the presence of possible vestibular hypofunction, whether there was directional preponderance and reflectivity of each ear (all based on both slow phase velocity and nystagmus frequency). The analysed VEMPs variables were: p1 and n1 latency, corrected amplitude, interaural p1 latency difference and p1 interaural amplitude asymmetry. We compared the reflectivity, hypofunction and directional preponderance of the caloric tests with the corrected amplitudes and amplitude asymmetries of the VEMPs. No correlations were found in the different comparisons between bithermal caloric testing results and VEMPs except for a weak correlation (p = 0.039) when comparing preponderance based on the number of nystagmus in the caloric test and amplitude asymmetry with 99 dB tone burst in the VEMPs test. The results indicate that the two diagnostic tests are not comparable, so one of them cannot replace the other, but the use of both increases diagnostic success in some conditions.
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Affiliation(s)
- Isabel Vaamonde Sanchez Andrade
- Division of Neurotology, Servicio de Otorrinolaringología, Complejo Hospitario Universitario de Santiago, Travesía DA Choupana, Postal Code 15706, Santiago de Compostela, Spain.
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Serra AP, Dorigueto RS, de Almeida RR, Ganança FF. Vestibular evoked myogenic potential in unilateral vestibular hypofunction. Acta Otolaryngol 2012; 132:732-8. [PMID: 22404258 DOI: 10.3109/00016489.2012.659283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The patients with unilateral chronic vestibular hypofunction detected by caloric test demonstrated at least some sort of altered vestibular evoked myogenic potential (VEMP) in 63.63% of the cases. The VEMP altered side was the same as the unilateral vestibular hypofunction side in 54.54% of the cases and was the opposite side in 24.24%. The VEMP test improved functional vestibular assessment in patients with unilateral caloric hypofunction. OBJECTIVES To analyze VEMP in patients with chronic dizziness and unilateral vestibular hypofunction and verify findings according to the side and structures involved. METHODS This was an observational study. In all, 66 subjects were evaluated by VEMP (tone bursts/1000 Hz/100 dBnHL/bandpass filtered 10-1500 Hz/4.3 Hz rate), 33 with unilateral vestibular hypofunction, detected by caloric test and clinical data, and 33 control subjects, matched by gender and age. Amplitude of the p13-n23, asymmetry index of the amplitude, p13 and n23 latencies, p13 and n23 interaural difference and threshold were analyzed. Simple descriptive analysis was carried out using the t test, Shapiro-Wilks test, and Mann-Whitney test, p < 0.05. RESULTS VEMP was altered in patients with unilateral vestibular hypofunction in 63.63% of cases. Thirteen of them were ipsilateral to the vestibular hypofunction and three were contralateral to the vestibular hypofunction. In five cases, VEMP were bilaterally altered.
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Affiliation(s)
- Ana Paula Serra
- Department of Otolaryngology and Head Neck Surgery, Federal University of São Paulo, Brazil.
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Longo G, Onofri M, Pellicciari T, Quaranta N. Benign paroxysmal positional vertigo: is vestibular evoked myogenic potential testing useful? Acta Otolaryngol 2012; 132:39-43. [PMID: 22103311 DOI: 10.3109/00016489.2011.619570] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS In benign paroxysmal positional vertigo (BPPV), vestibular evoked myogenic potentials (VEMPs) help to better define the extent of saccular damage and the patient's prognosis. OBJECTIVES To report the results of VEMPs in patients affected by BPPV of the posterior semicircular canal (PSC) in order to evaluate the presence of signs of saccular dysfunction compared to the normal population and to correlate them with the clinical picture. METHODS This was a prospective study in a tertiary referral center; 23 patients affected by BPPV of the PSC and 24 controls were evaluated. All patients underwent complete clinical history and otoneurologic and audiovestibular evaluation consisting of pure-tone audiometry, caloric testing, and registration of VEMPs. RESULTS VEMP thresholds and latencies were not different between patients and controls. As a group BPPV patients presented significantly higher abnormal VEMPs compared with controls (p < 0.001). Age positively correlated with VEMP threshold in the affected ear of patients and in controls; the number of BPPV attacks positively correlated with threshold and negatively with amplitude of VEMPs in the affected ear; duration of the last attack was negatively correlated with the effect of the maneuver performed.
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Affiliation(s)
- Giovanni Longo
- Otolaryngology Unit, University of Bari "A. Moro", Italy
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Ocular Vestibular Evoked Myogenic Potentials in Response to Air-Conducted Sound in Ménière's Disease. Otol Neurotol 2011; 32:1273-80. [DOI: 10.1097/mao.0b013e31822e5ac9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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