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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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Kirovakov Z, Kutsarov A, Todorov S, Penchev P. Vertigo During Pregnancy: A Narrative Review of the Etiology, Pathophysiology, and Treatment. Cureus 2024; 16:e55657. [PMID: 38495964 PMCID: PMC10944550 DOI: 10.7759/cureus.55657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
From the time of conception until the time of labor, a woman's body and mind undergo a variety of hormonal and other changes. Patients may also experience vertigo and a lack of balance during this period. Disabling and physically painful, these symptoms may strike at any moment. Pregnancy-related vertigo has been the focus of several studies. We looked at the research on vertigo in pregnant women in detail. This narrative review aims to examine the causes, pathophysiology, and current treatments for vertigo during pregnancy. Vertigo during pregnancy has a diverse etiology, with typical causes including hormonal changes and modifications in vascular dynamics. Vertigo may start to appear due to pathophysiological mechanisms involving vestibular and central nervous system adaptations. Numerous alternatives for treatment are available, including dietary changes, vestibular therapy, medicines, and surgical procedures. The thorough assessment of the current research on vertigo during pregnancy provided by this narrative review will help medical practitioners make wise clinical decisions.
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Affiliation(s)
- Zlatko Kirovakov
- Department of Obstetrics and Gynaecology, University Hospital for Active Treatment - Burgas, Burgas, BGR
- Faculty of Public Health and Health Care, Prof. Asen Zlatarov University, Burgas, BGR
| | - Asen Kutsarov
- Department of Health Care, Medical University Varna, Affiliate Veliko Tarnovo, Veliko Tarnovo, BGR
| | - Svetoslav Todorov
- Department of Neurological Surgery, University Hospital for Active Treatment - Burgas, Burgas, BGR
- Faculty of Medicine, Prof. Asen Zlatarov University, Burgas, BGR
| | - Plamen Penchev
- Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR
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Dietz V, Holliger NS, Christen A, Geissmann M, Filli L. Neural coordination of bilateral hand movements: evidence for an involvement of brainstem motor centres. J Physiol 2024; 602:397-412. [PMID: 38178603 DOI: 10.1113/jp285403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
Bilateral hand movements are assumed to be coordinated by a neural coupling mechanism. Neural coupling is experimentally reflected in complex electromyographic (EMG) responses in the forearm muscles of both sides to unilateral electrical arm nerve stimulation (ES). The aim of this study was to examine a potential involvement of the reticulospinal system in neural coupling by the application of loud acoustic stimuli (LAS) known to activate neurons of this system. LAS, ES and combined LAS/ES were applied to healthy subjects during visually guided bilateral hand flexion-extension movements. Muscle responses to the different stimuli were evaluated by electrophysiological recordings. Unilateral electrical ulnar nerve stimulation resulted in neural coupling responses in the forearm extensors (FE) of both sides. Interestingly, LAS evoked bilateral EMG responses that were similar in their configuration to those induced by ES. The presence of startles was associated with a shift of the onset and enhanced amplitude of LAS-induced coupling-like responses. Upon combined LAS/ES application, ES facilitated ipsilateral startles and coupling-like responses. Modulation of coupling-like responses by startles, the similarity of the responses to ES and LAS, and their interaction following combined stimulation suggests that both responses are mediated by the reticulospinal system. Our findings provide novel indirect evidence that the reticulospinal system is involved in the neural coupling of hand movements. This becomes clinically relevant in subjects with a damaged corticospinal system where a dominant reticulospinal system leads to involuntary limb coupling, referred to as associated movements. KEY POINTS: Automatic coordination of hand movements is assumed to be mediated by a neural coupling mechanism reflected by bilateral reflex responses in forearm muscles to unilateral electrical arm nerve stimulation (ES). Loud acoustic stimuli (LAS) were applied to assess a potential involvement of the reticulospinal system in the neural coupling mechanism. LAS evoked a bilateral reflex response in the forearm extensors that was similar to the neural coupling response to ES, and which could be separated from the acoustic startle response. Combined application of LAS and ES resulted in a facilitation of startle and coupling-like responses ipsilateral to ES, thus indicating an interaction of afferences from both stimuli. These novel findings provide indirect evidence that the reticulospinal system is a key motor structure for the coupling of bilateral hand movements.
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Affiliation(s)
- Volker Dietz
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicole Sarah Holliger
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrin Christen
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marina Geissmann
- Swiss Center for Movement Analysis (SCMA), Balgrist Campus AG, Zurich, Switzerland
| | - Linard Filli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Swiss Center for Movement Analysis (SCMA), Balgrist Campus AG, Zurich, Switzerland
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Raciti FM, Morales Y, Snapp HA, Rajguru SM. A reliable and reproducible protocol for sound-evoked vestibular myogenic potentials in rattus norvegicus. Front Integr Neurosci 2023; 17:1236642. [PMID: 37731913 PMCID: PMC10508189 DOI: 10.3389/fnint.2023.1236642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Cervical vestibular evoked myogenic potentials (cVEMPs) provide an objective measure of the integrity of the sacculo-collic pathway leading to their widespread use as a clinical tool in the diagnostic vestibular test battery. Though the application of cVEMPs in preclinical models to assess vestibular function, as performed in relevant clinical populations, remains limited. The present study aimed to establish a rodent model of cVEMP with standardized methods and protocols, examine the neural basis of the responses, and characterize and validate important features for interpretation and assessment of vestibular function. Methods We compared air-conducted sound (ACS)-evoked VEMPs from the sternocleidomastoid muscles in naïve Brown Norway rats. A custom setup facilitated repeatable and reliable measurements which were carried out at multiple intensities with ACS between 1 and 16 kHz and over 7 days. The myogenic potentials were identified by the presence of a positive (P1)-negative (N1) waveform at 3-5 ms from the stimulus onset. Threshold, amplitude, and latency were compared with intensity- and frequency-matched responses within and between animals. Results cVEMP responses were repeatedly evoked with stimulus intensities between 50-100 dB SPL with excellent test-retest reliability and across multiple measurements over 7 days for all frequencies tested. Suprathreshold, cVEMP responses at 90 dB SPL for 6-10 kHz stimuli demonstrated significantly larger amplitudes (p < 0.01) and shorter latencies (p < 0.001) compared to cVEMP responses for 1-4 kHz stimuli. Latency of cVEMP showed sex-dependent variability, but no significant differences in threshold or amplitude between males and females was observed. Discussion The results provide a replicable and reliable setup, test protocol, and comprehensive characterization of cVEMP responses in a preclinical model which can be used in future studies to elucidate pathophysiological characteristics of vestibular dysfunctions or test efficacy of therapeutics.
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Affiliation(s)
- Federica M. Raciti
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Yasniary Morales
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Hillary A. Snapp
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Suhrud M. Rajguru
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, United States
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Mat Q, Deggouj N, Duterme JP, Tainmont S, Lelubre C, Manto M. Influence of the Electrode Montage to Detect Ocular Vestibular Evoked Myogenic Potentials. Otol Neurotol 2023; 44:e412-e418. [PMID: 37231530 PMCID: PMC10289211 DOI: 10.1097/mao.0000000000003897] [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: 05/27/2023]
Abstract
OBJECTIVE To compare ocular vestibular evoked myogenic potentials (oVEMPs) obtained with three different electrode montages (infra-orbital vs belly-tendon vs chin) in a group of healthy subjects. To assess the electrical activity recorded at the level of the reference electrode in the belly-tendon and chin montages. STUDY DESIGN Prospective study. SETTING Tertiary referral center. PATIENTS Twenty-five healthy adult volunteers. INTERVENTIONS Each ear was tested separately via air-conducted sound (500 Hz Narrow Band CE-Chirps at 100 dB nHL) for recording contralateral myogenic responses. Recording conditions were randomized. MAIN OUTCOME MEASURES n1-p1 amplitudes values, interaural amplitude asymmetry ratios (ARs) and response rates. RESULTS The belly-tendon electrode montage (BTEM) produced larger amplitudes than the chin ( p = 0.008) and the IOEM (infra-orbital electrode montage; p < 0.001). The chin montage displayed larger amplitudes than the IOEM ( p < 0.001). The interaural amplitude asymmetry ratios (ARs) were not affected by the different electrode montages ( p = 0.549). In 100% of cases, oVEMPs were detected bilaterally with the BTEM which is higher than with the chin and the IOEM ( p < 0.001; p = 0.020, respectively). We did not record any VEMP when placing the active electrode on the contralateral internal canthus or the chin and the reference electrode on the dorsum of the hand. CONCLUSIONS The BTEM increased the amplitudes recorded and response rate in healthy subjects. No positive or negative reference contamination was observed with the belly-tendon or chin montages.
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Affiliation(s)
- Quentin Mat
- Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi 6042, Belgium
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons 7000, Belgium
| | - Naïma Deggouj
- Department of Otorhinolaryngology and Head and Neck Surgery, Cliniques Universitaires Saint-Luc, UCLouvain (UCL), Brussels 1200, Belgium
| | - Jean-Pierre Duterme
- Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi 6042, Belgium
| | - Sophie Tainmont
- Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi 6042, Belgium
| | - Christophe Lelubre
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons 7000, Belgium
- Department of Internal Medicine, C.H.U. Charleroi, Charleroi 6042, Belgium
| | - Mario Manto
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons 7000, Belgium
- Department of Neurology, Médiathèque Jean Jacquy, C.H.U. Charleroi, Charleroi 6042, Belgium
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Pastras CJ, Gholami N, Jennings S, Zhu H, Zhou W, Brown DJ, Curthoys IS, Rabbitt RD. A mathematical model for mechanical activation and compound action potential generation by the utricle in response to sound and vibration. Front Neurol 2023; 14:1109506. [PMID: 37051057 PMCID: PMC10083375 DOI: 10.3389/fneur.2023.1109506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/01/2023] [Indexed: 03/28/2023] Open
Abstract
Introduction Calyx bearing vestibular afferent neurons innervating type I hair cells in the striolar region of the utricle are exquisitely sensitive to auditory-frequency air conducted sound (ACS) and bone conducted vibration (BCV). Here, we present experimental data and a mathematical model of utricular mechanics and vestibular compound action potential generation (vCAP) in response to clinically relevant levels of ACS and BCV. Vibration of the otoconial layer relative to the sensory epithelium was simulated using a Newtonian two-degree-of-freedom spring-mass-damper system, action potential timing was simulated using an empirical model, and vCAPs were simulated by convolving responses of the population of sensitive neurons with an empirical extracellular voltage kernel. The model was validated by comparison to macular vibration and vCAPs recorded in the guinea pig, in vivo. Results Transient stimuli evoked short-latency vCAPs that scaled in magnitude and timing with hair bundle mechanical shear rate for both ACS and BCV. For pulse BCV stimuli with durations <0.8 ms, the vCAP magnitude increased in proportion to temporal bone acceleration, but for pulse durations >0.9 ms the magnitude increased in proportion to temporal bone jerk. Once validated using ACS and BCV data, the model was applied to predict blast-induced hair bundle shear, with results predicting acute mechanical damage to bundles immediately upon exposure. Discussion Results demonstrate the switch from linear acceleration to linear jerk as the adequate stimulus arises entirely from mechanical factors controlling the dynamics of sensory hair bundle deflection. The model describes the switch in terms of the mechanical natural frequencies of vibration, which vary between species based on morphology and mechanical factors.
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Affiliation(s)
- Christopher J. Pastras
- Faculty of Science and Engineering, School of Engineering, Macquarie University, Sydney, NSW, Australia
| | - Nastaran Gholami
- Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Skyler Jennings
- Communication Sciences and Neuroscience Program, University of Utah, Salt Lake City, UT, United States
| | - Hong Zhu
- University of Mississippi Medical Center, Jackson, MS, United States
| | - Wu Zhou
- University of Mississippi Medical Center, Jackson, MS, United States
| | - Daniel J. Brown
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia
| | - Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Richard D. Rabbitt
- Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Otolaryngology and Neuroscience Program, University of Utah, Salt Lake City, UT, United States
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Premkumar PK, Krishnamurthy R, Kumar K, Yerraguntla K, Narayan A, Roushan R. Cervical Vestibular-Evoked Myogenic Potentials in Individuals with Diabetes Mellitus: A Systematic Review and Meta-Analysis. Crit Rev Biomed Eng 2023; 51:45-56. [PMID: 37551908 DOI: 10.1615/critrevbiomedeng.2023047273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Vestibular evoked myogenic potentials (VEMPs) in individuals with diabetes mellitus (DM) provide evidence as how diabetes can bring about changes in the peripheral nervous system. Cervical VEMP (cVEMP) evaluates the function and integrity of the sacullo- collic pathway and ocular VEMP (oVEMP) evaluates the utriculo-collic pathway. cVEMP is an ipsilateral inhibitory response of the sternocleidomastoid muscle. cVEMP is recorded at higher intensity above 80-85 dBnHL with biphasic waveforms having initial peak positivity P13 followed by a negativity N23. We performed a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to evaluate cVEMP in diabetes mellitus. The search was conducted in the databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Cochrane library using the keywords "diabetes mellitus" and "vestibular evoked myogenic potential" or "cVEMP." A two-phase selection process was used for the final inclusion of studies, and the methodological quality of these studies was assessed using the Newcastle Ottawa scale (NCOS). Meta-analysis was performed using a random-effects model. For comparisons between DM and healthy controls, a significant difference was observed for cVEMP amplitude (P = 0.01). Our meta-analysis's results suggest peripheral vestibular dysfunction can be observed in DM. It appears that cVEMPs may be useful in the early detection of neuropathy in DM.
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Affiliation(s)
| | - Rahul Krishnamurthy
- Department of Special Education and Communication Disorders, University of Nebraska - Lincoln, NE 68503, USA
| | - Kaushlendra Kumar
- Department of Audiology and Speech language pathology, Kastruba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Krishna Yerraguntla
- Department of Medical Rehabilitation Science, Audiology Program, College of Applied Medical Sciences, King Khalid University, Guraiger, Abha, Kingdom of Saudi Arabia
| | - Amitesh Narayan
- Professor, Department of Physiotherapy Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India-575001
| | - Ritik Roushan
- Department of Audiology and Speech Language Pathology, Kastruba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Lodha V, Neupane AK. Multifrequency Narrowband Chirp Evoked Cervical Vestibular Myogenic Potentials: Evaluation of Responses in Normal-Hearing Young Adults. Am J Audiol 2022; 31:1191-1201. [DOI: 10.1044/2022_aja-22-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose:
The study aimed to explore the various parameters of multifrequency narrowband Claus Elberling chirp (NB CE-chirp) evoked cervical vestibular evoked myogenic potentials (cVEMPs) in normal-hearing healthy young adults. The study also attempted to define the optimal frequency tuning characteristic of NB CE-chirp evoked cVEMPs.
Method:
cVEMP was performed on 26 young healthy adults using four different NB CE-chirps centered at 500, 1000, 2000, and 4000 Hz. The neck torsion method was applied for electrode placement. To have the acute recording, visual feedback of sternocleidomastoid muscle contraction was provided, and electromyography (EMG) scaling was done.
Results:
cVEMPs were present for 100% across all frequencies except at 4000 Hz. Amplitudes between each pair of frequencies were significantly different for EMG scaled and unscaled conditions. Frequency tuning was observed at 500 Hz regardless of scaling done. Positive peak 1 of cVEMP (P1) latencies showed no differences between frequencies while both negative peak 1 of cVEMP and the complex of positive peak 1 and negative peak 1 of cVEMP (P1N1) interpeak latency values decreased with increasing frequency. Interaural amplitude asymmetry ratio showed no difference between scaled and unscaled amplitudes. Intraclass correlation revealed a range of test–retest reliability across frequencies. EMG unscaled amplitude were having relatively lower test–retest reliability consistently across frequencies
Conclusions:
Differences in amplitudes between frequencies with a maximum at 500 Hz can be attributed to the low frequency centered saccular response. No differences in P1 were observed. Yet, N1 latency and P1N1 interpeak latency difference gradually shortened with the decrement in the stimulus duration as the stimulation frequency increased. The lower reliability of EMG unscaled amplitude across frequencies supports the need to use EMG scaling to avoid confounding variables related to muscle contraction.
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Affiliation(s)
- Vidhi Lodha
- School of Audiology & Speech-Language Pathology, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Anuj Kumar Neupane
- School of Audiology & Speech-Language Pathology, Bharati Vidyapeeth (Deemed to be University), Pune, India
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Xiao Q, Zhang Q, Wu Q, Shen J, Wang L, Chen Y, Lv J, Yang J, Jin Y, Zhang Q. Effects of acoustic stimulation intensity on air-conducted vestibular evoked myogenic potential in children. Front Neurol 2022; 13:996246. [PMID: 36303562 PMCID: PMC9592712 DOI: 10.3389/fneur.2022.996246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the effects of acoustic stimulation intensity on ocular and cervical vestibular evoked myogenic potential (oVEMP and cVEMP) responses elicited by air-conducted sound (ACS) in healthy children. Methods Thirteen healthy children aged 4–10 years and 20 healthy adults aged 20-40 years with normal hearing and tympanometry were enrolled in this study. All subjects received oVEMP and cVEMP tests under different acoustic stimulation intensities (131, 126, 121, 116, 111 and 106 dB SPL). Mean n1 latency, p1 latency, interpeak latency, amplitude and response rate were investigated and analyzed. Results As the acoustic stimulation intensity decreased, for oVEMP, the response rate of children decreased from 100% (131, 126 and 121 dB SPL) to 57.69% (116 dB SPL), 26.92% (111 dB SPL) and 11.54% (106 dB SPL). The response rate of adults decreased from 100% (131 and 126 dB SPL) to 95% (121 dB SPL), 55% (116 dB SPL), 12.5% (111 dB SPL) and 2.5% (106 dB SPL). There were lower n1 latency, p1 latency and higher amplitude in children when comparing by acoustic stimulation intensities (p < 0.05). Regarding cVEMP, the response rate of children decreased from 100% (131, 126 and 121 dB SPL) to 88.46% (116 dB SPL), 53.85% (111 dB SPL) and 26.92% (106 dB SPL). The response rate of adults decreased from 100% (131 and 126 dB SPL) to 95% (121 dB SPL), 85% (116 dB SPL), 37.5% (111 dB SPL) and 7.5% (106 dB SPL). A statistically significant difference was found in amplitude at different acoustic stimulation intensities in both children and adults (p < 0.05). When stimulated by 131 dB SPL acoustic stimulation, there were lower n1 latency, p1 latency and higher amplitude in children in oVEMP and cVEMP compared with adults (p < 0.05). Conclusion The response rate and amplitude of oVEMP and cVEMP in children and adults presented significant differences with a decrease in acoustic stimulation intensity. In this study, using 121 dB SPL for children and 126 dB SPL for adults during VEMP test could be regarded as safer stimulation intensities and thus reduced sound exposure.
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Affiliation(s)
- Qianwen Xiao
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qin Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qiong Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Lu Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yanfei Chen
- Department of Otolaryngology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingrong Lv
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Jun Yang
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Yulian Jin
| | - Qing Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Department of Otolaryngology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Qing Zhang
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Shen J, Wang L, Ma X, Chen Z, Chen J, Wang X, He K, Wang W, Sun J, Zhang Q, Shen M, Chen X, Zhang Q, Kaga K, Duan M, Yang J, Jin Y. Cervical vestibular evoked myogenic potentials in 3-month-old infants: Comparative characteristics and feasibility for infant vestibular screening. Front Neurol 2022; 13:992392. [PMID: 36247765 PMCID: PMC9557108 DOI: 10.3389/fneur.2022.992392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveWe compared the characteristics of air-conducted sound cervical vestibular evoked myogenic potential (ACS-cVEMP) and bone-conducted vibration cVEMP (BCV-cVEMP) among 3-month-old infants with normal hearing and sensorineural hearing loss (SNHL), and healthy adults to explore the feasibility and optimal strategies for infant vestibular screening.Methods29 infants (58 ears) were divided into two groups according to hearing (group I: normal hearing ears; group II: SNHL ears), 20 healthy adults were defined as group III. The results of response rate, P13 and N23 latency, P13-N23 interval, amplitudes, and corrected interaural asymmetry ratio (IAR) were recorded and compared among three groups.ResultsThe response rates of ACS-cVEMP in three groups were 88.89, 62.00, 100%, respectively. The P13 and N23 latencies, and P13-N23 interval did not differ significantly between group I and II (p = 0.866, p = 0.190, p = 0.252). A significant difference was found between group I and III (p = 0.016, p < 0.001, p < 0.001). No significant difference was observed in raw or corrected amplitude between group I and II (p = 0.741, p = 0.525), while raw and corrected amplitudes in group III were significantly larger than group I (p < 0.001, p < 0.001). For BCV-cVEMP, the response rates in three groups were 100, 86.36, 100%, respectively, No significant difference existed in the P13 and N23 latency, or P13-N23 interval between group I and II (p = 0.665, p = 0.925, p = 0.806), however, P13 and N23 latencies were significantly longer in group III than group I (p < 0.001, p = 0.018), but not in P13-N23 interval (p = 0.110). There was no significant difference in raw or corrected amplitude between group I and II (p = 0.771, p = 0.155) or in raw amplitude between group I and III (p = 0.093), however, a significant difference existed in corrected amplitude between group I and III (p < 0.001).ConclusionsCompared with adults, 3-month-old infants with normal hearing presented with equivalent response rates, shorter P13 and N23 latencies, smaller corrected amplitudes, and a wider IAR range for both ACS and BCV-cVEMP. SNHL infants had equivalent response rates of BCV-cVEMP, lower response rates of ACS-cVEMP than normal hearing infants. When responses were present, characteristics of ACS and BCV-cVEMP in SNHL infants were similar with normal hearing infants. ACS combined with BCV-cVEMP are recommended to improve the accuracy of vestibular screening.
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Affiliation(s)
- Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Lu Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Xiaobao Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Zichen Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Jianyong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Xueyan Wang
- Department of Otolaryngology-Head and Neck Surgery, Yanbian University Hospital, Yanji, China
| | - Kuan He
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Wei Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qin Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Min Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Xiangping Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qing Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Kimitaka Kaga
- National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Maoli Duan
- Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Division of Ear, Nose, and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Maoli Duan
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Jun Yang
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- *Correspondence: Yulian Jin
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Assessment of Vestibular-Evoked Myogenic Potentials in Parkinson’s Disease: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12070956. [PMID: 35884762 PMCID: PMC9313211 DOI: 10.3390/brainsci12070956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/03/2022] [Accepted: 07/19/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The brainstem plays an essential role in the early stage of Parkinson’s disease (PD), but it is not widely tested in clinical examinations of PD. Vestibular-evoked myogenic potentials (VEMPs) are recognized as fundamental tools in the assessment of brainstem function. The aim of our meta-analysis was to assess the abnormal findings of VEMPs in patients with PD. (2) Methods: Up to 14 February 2022, PubMed, Embase, and Web of Science were searched to evaluate VEMPs in patients with PD in comparison with respective controls. The study protocol was registered at PROSPERO (CRD42022311103). (3) Results: A total of 15 studies were finally included in our meta-analysis. The absence rates of VEMPs in patients with PD were significantly higher than those of control groups (cVEMP: OR = 6.77; oVEMP: OR = 13.9; mVEMP: OR = 7.52). A delayed P13 latency, a decreased peak-to-peak amplitude, and an increased AAR of cVEMP, and a delayed oVEMP P15 latency were also found in patients with PD. (4) Conclusions: Our meta-analysis indicates abnormal VEMP findings in patients with PD, revealing the dysfunction of the brainstem in PD. VEMP tests, especially cVEMP tests, could be a helpful method for the early detection of PD.
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Margani V, Talamonti R, Benincasa AT, Gorla A, Covelli E, Elfarargy HH, Barbara M. Inner ear impairment after stapedotomy: do the cervical vestibular evoked myogenic potentials play a diagnostic role? Acta Otolaryngol 2022; 142:463-469. [PMID: 35732026 DOI: 10.1080/00016489.2022.2087902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Otosclerosis is characterized by a bony remodeling process that ends up with stapes fixation. The hearing impairment can be recovered by surgery by replacing the stapes superstructure. Due to the surgical management of the vestibule, the vestibular examination could provide an insight into the correlation between this kind of surgery and vestibular changes. OBJECTIVES To evaluate the impact of the stapedotomy on the inner ear. METHODS We evaluated pure tone audiometry and the presence of vestibular evoked myogenic potentials (VEMPs) in 41 patients with otosclerosis before and after the stapedotomy operation. RESULTS Air conduction (Ac)-VEMPs were present in 18 cases preoperatively and 31 cases postoperatively. Bone conduction (Bc)-VEMPs were present in 23 cases preoperatively and 33 cases postoperatively. ABG was closed to less than 20 dB in all cases after the operation. CONCLUSIONS The preoperative Bc-VEMPS had an outstanding capability to predict the type of hearing loss. The postoperative absence of VEMPS despite the closure of ABG indicated the impact of otosclerosis on the saccular cells. The use of Thulium Laser in stapedotomy didn't affect significantly the saccular cells. SIGNIFICANCE Integrated use of audiometry and VEMPs was effective to evaluate the changes associated with otosclerosis and the stapedotomy operation.
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Affiliation(s)
- Valerio Margani
- ENT Clinic, NESMOS Department, Sant 'Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Rita Talamonti
- ENT Clinic, NESMOS Department, Sant 'Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Anna Teresa Benincasa
- ENT Clinic, NESMOS Department, Sant 'Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Alessia Gorla
- ENT Clinic, NESMOS Department, Sant 'Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Edoardo Covelli
- ENT Clinic, NESMOS Department, Sant 'Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Haitham H Elfarargy
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Maurizio Barbara
- ENT Clinic, NESMOS Department, Sant 'Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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Mehrem ES, Fergany LA, Mohamed SA, Fares HM, Kamel RM. Efficacy of fine motor and balance exercises on fine motor skills in children with sensorineural hearing loss. Restor Neurol Neurosci 2021; 40:43-52. [PMID: 34974444 DOI: 10.3233/rnn-211156] [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: 11/15/2022]
Abstract
BACKGROUND Childhood hearing impairment is a major disability associated with delayed motor development. The affected Fine motor performance in children with sensorineural hearing loss (SNHL) could be due to dynamic balance deficits and visual-motor incoordination. OBJECTIVE This study was designed to investigate the effects of fine motor exercises with or without balancing exercises on fine motor skills in children with SNHL. METHODS One hundred and eighty (180) children their age ranged from 8 to 18 years old diagnosed with SNHL were selected. They were divided into three groups, 60 children (control group) practiced only their ordinary activities of daily living, 60 children (fine motor exercises group) practiced fine motor exercises, and 60 children (fine motor and balance exercise) group practiced fine motor and balance exercises. The outcomes were assessed by the Bruininks Oseretsky Test of the motor proficiency second edition scale (BOT-2). RESULTS Generally, there was a statistically significant difference between control group and fine motor exercises group where (p < 0.05), besides, there was a statistically significant difference between control group and fine motor and balance exercises group where (p < 0.05). But, there was no statistically significant difference between fine motor exercises group and fine motor and balance exercises group where (p > 0.05). CONCLUSIONS The Fine Motor performance of children with SNHL has been improved by Fine motor with or without balancing exercises according to (BOT-2).
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Affiliation(s)
- Elsayed S Mehrem
- Department of Pediatrics Physical Therapy, Faculty of Physical Therapy, Deraya University, Egypt
| | - Lamyaa A Fergany
- Department of Neurological and Neurosurgical, Faculty of Physical Therapy, Deraya University, Egypt
| | - Said A Mohamed
- Woman Health Department, Faculty of Physical Therapy, Deraya University, Egypt
| | - Hany M Fares
- Department of Physical Therapy for Internal Medicine and surgery, Faculty of Physical Therapy, Ahram Canadian University, Egypt
| | - Roshdy M Kamel
- Basic Science Department, Faculty of Physical Therapy, Benha University, Egypt
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Kabel AEMH, Afifi KH, ElFakhrany SM, Moaty AS. Cervical and ocular vestibular evoked myogenic potentials in epileptic patients. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2021; 37:51. [DOI: 10.1186/s43163-021-00114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/06/2021] [Indexed: 09/02/2023]
Abstract
Abstract
Background
Vertigo and dizziness are very common complaints that may be related to epilepsy. The purpose of this study was to assess vestibulo-spinal and linear vestibulo-ocular function in epileptic patients in the inter ictal period. The current observational study was carried out in audio-vestibular unit Menoufia University. Subjects in the current study were divided into two groups: The control group included 30 normal individuals not complaining from any dizzy symptoms and the epileptic cases group included 30 epileptic patients. All subjects in the study were submitted to cervical and ocular vestibular evoked myogenic potential.
Results
There was no significant difference between the control and epileptic group regarding the age and sex distribution. Sixty-seven percent of epileptic cases had dizzy symptoms. There was statistically significant difference in the latency and amplitude of c and o VEMP between the control and the epileptic group, 39/60 ears (65%) in the study group had cVEMP abnormalities, 32/60 ears (53%) had oVEMP abnormalities. Abnormal c and o VEMP were reported in 28/60 ears (46.7%). There was statistically significant relationship between VEMP abnormalities and duration of seizures, frequency of epileptic attacks, and type of therapy.
Conclusion
Vestibular abnormalities were frequently reported in epileptic patients in the current study which may be related to the severity and control of epilepsy.
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Mat Q, Deggouj N, Duterme JP, Tainmont S, Lelubre C, Manto M. Using Narrow Band CE-Chirps to Elicit Cervical Vestibular Evoked Myogenic Potentials. Ear Hear 2021; 43:941-948. [PMID: 34611119 PMCID: PMC9007088 DOI: 10.1097/aud.0000000000001146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: To compare the effects of Narrow band CE-Chirps (NB CE-Chirps) and tone bursts (TBs) at 500 Hz and 1000 Hz on the amplitudes and latencies in cervical vestibular evoked myogenic potentials (cVEMPs). Design: Thirty-one healthy adult volunteers of varying ages were tested by air conduction at 95 dB nHL. Recording conditions were randomized for each participant and each modality was tested twice. Results: NB CE-Chirps showed larger corrected amplitudes than TBs at 500 Hz (p < 0.001) which were themselves larger than NB CE-Chirps and TBs at 1000 Hz (p < 0.001). In older volunteers, NB CE-Chirps 500 and 1000 Hz had significantly higher response rates than TBs 500 Hz (p = 0.039). A negative correlation was observed between the corrected amplitudes and the age of the participants regardless of the stimulus and the frequency studied. The p13 and n23 latencies were not correlated with the age of the subjects. Conclusions: NB CE-Chirps at 500 Hz improved the corrected amplitudes of waveforms in cVEMPs as a result of a better frequency specificity compared with TBs. In the elderly, eliciting cVEMPs at a frequency of 1000 Hz might not be necessary to improve response rates with NB CE-Chirps. Additional studies including a higher number of healthy participants and patients with vestibular disorders are required to confirm these observations.
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Affiliation(s)
- Quentin Mat
- Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi, Belgium Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium Department of Otorhinolaryngology and Head and Neck Surgery, Cliniques Universitaires Saint-Luc, UCLouvain (UCL), Brussels, Belgium Department of Internal Medicine, C.H.U. Charleroi, Charleroi, Belgium Department of Neurology, Médiathèque Jean Jacquy, C.H.U. Charleroi, Charleroi, Belgium
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Nakul E, Bartolomei F, Lopez C. Vestibular-Evoked Cerebral Potentials. Front Neurol 2021; 12:674100. [PMID: 34621231 PMCID: PMC8490637 DOI: 10.3389/fneur.2021.674100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
The human vestibular cortex has mostly been approached using functional magnetic resonance imaging and positron emission tomography combined with artificial stimulation of the vestibular receptors or nerve. Few studies have used electroencephalography and benefited from its high temporal resolution to describe the spatiotemporal dynamics of vestibular information processing from the first milliseconds following vestibular stimulation. Evoked potentials (EPs) are largely used to describe neural processing of other sensory signals, but they remain poorly developed and standardized in vestibular neuroscience and neuro-otology. Yet, vestibular EPs of brainstem, cerebellar, and cortical origin have been reported as early as the 1960s. This review article summarizes and compares results from studies that have used a large range of vestibular stimulation, including natural vestibular stimulation on rotating chairs and motion platforms, as well as artificial vestibular stimulation (e.g., sounds, impulsive acceleration stimulation, galvanic stimulation). These studies identified vestibular EPs with short latency (<20 ms), middle latency (from 20 to 50 ms), and late latency (>50 ms). Analysis of the generators (source analysis) of these responses offers new insights into the neuroimaging of the vestibular system. Generators were consistently found in the parieto-insular and temporo-parietal junction-the core of the vestibular cortex-as well as in the prefrontal and frontal areas, superior parietal, and temporal areas. We discuss the relevance of vestibular EPs for basic research and clinical neuroscience and highlight their limitations.
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Affiliation(s)
- Estelle Nakul
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Neurosciences Cognitives (LNC), FR3C, Aix Marseille Univ, Marseille, France
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, Inserm, Aix Marseille Univ, Marseille, France
- Service de Neurophysiologie Clinique, Hôpital Timone, Aix Marseille Univ, Marseille, France
| | - Christophe Lopez
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Neurosciences Cognitives (LNC), FR3C, Aix Marseille Univ, Marseille, France
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Bayramoglu B, Emre U, Erdal Y, Demirhan H, Yasak I, Yalin OO. Cervical vestibular-evoked myogenic potentials in patients with essential tremor. J Clin Neurosci 2021; 91:365-368. [PMID: 34373053 DOI: 10.1016/j.jocn.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
Although different neuroanatomical structures and pathways are emphasized as possible explanations for essential tremor (ET), there is still an ongoing debate. This study aimed to assess the role of brainstem and reflex pathways with cervical vestibular-evoked myogenic potentials (VEMP) in patients with ET. This prospective study included 34 patients with ET and 25 healthy controls. Cervical VEMP was performed in both groups and latencies, inter-peak latency intervals, peak-to-peak amplitudes and asymmetry ratios were recorded. There was statistically no significant difference between the groups in terms of age (38.9 ± 14.9 years vs. 38.9 ± 14.9 years, p = 0.673) and gender (female to male ratio: 14/11 vs. 20/14, p = 0.828). Right N1 latency and right N1-P1 interval were significantly longer in the patient group (p < 0.05). There was a significant positive correlation between the duration of disease and the right N1-P1 interval (p < 0.05). There was no significant difference between the patient and control groups in terms of bilateral P1 latency, left N1 latency, left N1-P1 interval, and bilateral N1 and P1 amplitudes (p˃0.05). Cervical VEMP may reveal the involvement of brainstem and associated reflex pathways in ET.
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Affiliation(s)
- Banu Bayramoglu
- Health Sciences University, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric and Neurologic Diseases, Neurology Department, Istanbul, Turkey.
| | - Ufuk Emre
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Yuksel Erdal
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Hasan Demirhan
- Istanbul Medipol University, Otorhinolaryngology Department, Istanbul, Turkey
| | - Ilknur Yasak
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Osman Ozgur Yalin
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
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Abstract
OBJECTIVES To evaluate the effects of narrow band CE-Chirp (NB CE-Chirp) on the amplitudes and latencies in ocular vestibular evoked myogenic potentials (oVEMPs) at 500 and 1000 Hz in comparison with tone burst (TB). DESIGN Twenty-one healthy volunteers were included in the study and tested in air conduction with a "belly-tendon" montage. Recording conditions were randomized for each participant and each modality was tested twice to check the reproducibility of the procedure. RESULTS NB CE-Chirps at 500 Hz revealed larger n1-p1 amplitudes than 500 Hz TBs (p = .001), which were also larger than NB CE-Chirps and TBs at 1000 Hz (p = .022, p < .001, respectively). Besides, n1 and p1 latencies were shorter in NB CE-Chirp than in TB at 500 Hz (p < .001) and 1000 Hz (p < .001). The older the participants, the lower the amplitudes (p = .021, p = .031) and the longer the n1 (p = .030, p = .025) and p1 latencies (p < .001, p < .001) in 500 Hz NB CE-Chirps and 500 Hz TBs. Interaural asymmetry ratios were slightly higher in 500 Hz NB CE-Chirps as compared to 500 Hz TBs (p = .013). CONCLUSIONS NB CE-Chirps at 500 Hz improved the amplitudes of waveforms in oVEMPs. As for TBs with clicks before, enhancing oVEMPs amplitudes is an essential step to distinguish a healthy person from a patient with either utricular or its related pathways disorder and potentially minimize the risk of cochlear damages. Additional studies including a higher number of healthy participants and patients with vestibular disorders are required to confirm this hypothesis. The large interindividual variability of interaural asymmetry ratios in NB CE-Chirp and in TB at 500 Hz could be explained by the selected montage.
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Hawkins KE, Chiarovano E, Paul SS, MacDougall HG, Curthoys IS. Static and dynamic otolith reflex function in people with Parkinson's disease. Eur Arch Otorhinolaryngol 2020; 278:2057-2065. [PMID: 33112983 DOI: 10.1007/s00405-020-06446-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Parkinson's disease (PD) is a neurodegenerative disorder with possible vestibular system dysfunction. This study reports the transient and sustained functions of the otoliths and their reflex pathways in PD compared to healthy controls (HC) and determines if otolith function relates to previous fall history. METHODS Forty participants with PD and 40 HC had their otolith function assessed. Transient saccular and utricular-mediated reflexes were assessed by cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs, respectively) elicited by air-conducted stimulus (clicks) and bone-conducted vibration (light tendon hammer taps). Static otolith function was assessed by the Curator Subjective Visual Vertical (SVV) test. RESULTS Compared to HC, the PD group had significantly more absent cVEMP responses to both clicks (47.5% vs. 30%, respectively, p = 0.03) and taps (21.8% vs. 5%, respectively, p = 0.002). Only the PD group had bilaterally absent tap cVEMPs, this was related to previous falls history (p < 0. 001). In both groups, click oVEMPs were predominantly absent, and tap oVEMPs were predominantly present. The PD group had smaller tap oVEMP amplitudes (p = 0.03) and recorded more abnormal SVV responses (p = 0.01) and greater error on SVV compared to HC, p < 0.001. SVV had no relationship with VEMP responses (p = 0.14). CONCLUSIONS PD impacts on cVEMP reflex pathways but not tap oVEMP reflex pathways. Bone-conducted otolith stimuli (taps) are more robust than air-conducted sound stimuli (clicks) for both o and cVEMPs. A lack of association between SVV and VEMP responses suggest that static and dynamic otolith functions are differentially affected in PD.
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Affiliation(s)
- Kim E Hawkins
- Vestibular Research Laboratory, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia.
| | - Elodie Chiarovano
- Sydney Human Factors Research, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Serene S Paul
- Discipline of Physiotherapy, Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, Australia
| | - Hamish G MacDougall
- Sydney Human Factors Research, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
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Hao W, Zhao L, Yu H, Li H. Vestibular prognosis in idiopathic sudden sensorineural hearing loss with vestibular dysfunction treated with oral or intratympanic glucocorticoids: a protocol for randomized controlled trial. Trials 2020; 21:669. [PMID: 32698830 PMCID: PMC7477872 DOI: 10.1186/s13063-020-04579-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background Idiopathic sudden sensorineural hearing loss (ISSNHL) is a rapid-onset sensorineural hearing impairment with unclear etiology and unsatisfying treatment effects. Vestibular dysfunction has been considered as a poor indicator in the clinical manifestations and prognosis of ISSNHL, which occurred in approximately 28–57% cases. Glucocorticoids, administered through oral or intratympanic way, are currently regularly and standardly applied for ISSNHL to improve the hearing outcome. However, the vestibular prognosis of ISSNHL after routine treatments remains seldom explored. This study aims to compare the effectiveness of oral and intratympanic glucocorticoids in ISSNHL with vestibular dysfunction in terms of the pattern and trajectory of possible process of vestibular function recovery. Methods/design A randomized, outcome-assessor- and analyst-blinded, controlled, clinical trial (RCT) will be carried out. Seventy-two patients with ISSNHL complaining of vestibular dysfunction appearing as vertigo or imbalance will be recruited and randomized into either oral or intratympanic glucocorticoid therapy group with a 1:1 allocation ratio. The primary outcomes will be vestibular function outcomes assessed by sensory organization test, caloric test, video head impulse test, cervical vestibular evoked myogenic potential, and ocular vestibular evoked myogenic potential; the secondary outcomes include self-reported vestibular dysfunction symptoms; dizziness-related handicap, visual analogue scale for vertigo and tinnitus; and pure tone audiometry. Assessments of primary outcomes will be performed at baseline and at 4 and 8 weeks post-randomization, while assessments of secondary outcomes will be performed at baseline and 1, 2, 4, and 8 weeks post-randomization. Discussion Previous intervention studies of ISSNHL included only hearing outcomes, with little attention paid on the prognosis of vestibular dysfunction. This trial will be the first RCT study focusing on the progress and prognosis of vestibular dysfunction in ISSNHL. The efficacy of two commonly used therapies of glucocorticoids will be compared in both auditory and vestibular function fields, rather than in the hearing outcome alone. Trial registration ClinicalTrials.gov NCT03974867. Registered on 23 July 2019
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Affiliation(s)
- Weiming Hao
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Liping Zhao
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China
| | - Huiqian Yu
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China. .,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China.
| | - Huawei Li
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China. .,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, People's Republic of China. .,Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, People's Republic of China. .,The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China.
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21
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Noij KS, Rauch SD. Vestibular Evoked Myogenic Potential (VEMP) Testing for Diagnosis of Superior Semicircular Canal Dehiscence. Front Neurol 2020; 11:695. [PMID: 32793102 PMCID: PMC7385271 DOI: 10.3389/fneur.2020.00695] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 01/31/2023] Open
Abstract
Superior semicircular canal dehiscence is a bony defect of the superior semicircular canal, which can lead to a variety of auditory and vestibular symptoms. The diagnosis of superior semicircular canal dehiscence (SCD) can be challenging, time consuming, and costly. The clinical presentation of SCD patients resembles that of other otologic disease, necessitating objective diagnostics. Although temporal bone CT imaging provides excellent sensitivity for SCD detection, it lacks specificity. Because the treatment of SCD is surgical, it is crucial to use a highly specific test to confirm the diagnosis and avoid false positives and subsequent unnecessary surgery. This review provides an update on recent improvements in vestibular evoked myogenic potential (VEMP) testing for SCD diagnosis. Combining audiometric and conventional cervical VEMP results improves SCD diagnostic accuracy. High frequency VEMP testing is superior to all other methods described to date. It is highly specific for the detection of SCD and may be used to guide decision-making regarding the need for subsequent CT imaging. This algorithmic sequential use of testing can substantially reduce radiation exposure as well as cost associated with SCD diagnosis.
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Affiliation(s)
- Kimberley S. Noij
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, United States
| | - Steven D. Rauch
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, United States
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
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22
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Puligheddu M, Figorilli M, Serra A, Laccu I, Congiu P, Tamburrino L, de Natale ER, Ginatempo F, Deriu F, Loi G, Fantini ML, Schenck CH, Ferri R. REM Sleep without atonia correlates with abnormal vestibular-evoked myogenic potentials in isolated REM sleep behavior disorder. Sleep 2020; 42:5532726. [PMID: 31310647 DOI: 10.1093/sleep/zsz128] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/14/2019] [Indexed: 01/09/2023] Open
Abstract
STUDY OBJECTIVES The neurophysiological hallmark of REM sleep behavior disorder (RBD) is loss of atonia during REM sleep. Indeed, signs and symptoms of neurodegeneration can occur after years, even decades, from its beginning. This study aimed to measure neurophysiological alterations of the brainstem that potentially correlate with the severity of atonia loss, and determining whether a prodromal neurodegenerative disorder underlines this condition when it occurs as an isolated condition (iRBD). METHODS Subjects with iRBD and matched healthy controls were recruited. The study included the recording of one-night polysomnography, vestibular-evoked myogenic potentials (VEMPs), and a [123I]-FP-CIT dopamine transporter (DAT) scan. The quantification of REM sleep without atonia (RSWA) was made according to two previously published manual methods and one automated method. RESULTS The rate of alteration of VEMPs and VEMP score were significantly higher in iRBD patients than controls. Moreover, VEMP score was negatively correlated with the automated REM atonia index; a marginal statistical significance was also reached for the positive correlation with the visual tonic electromyographic parameter, while the other correlations, including that with DAT-scan score were not statistically significant. CONCLUSIONS Brainstem neurophysiology in iRBD can be assessed by VEMPs and their alterations may possibly indicate an early expression of the neurodegenerative process underlying this disorder at the brainstem level, which awaits future longitudinal confirmation. The correlation between RSWA and VEMP alteration might also represent a prodromal aspect anticipating the possible evolution from iRBD to neurodegeneration, whereas DAT-scan abnormalities might represent a later step in this evolution.
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Affiliation(s)
- Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Michela Figorilli
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Alessandra Serra
- Nuclear Medicine Unit, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ilaria Laccu
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Patrizia Congiu
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ludovica Tamburrino
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Gianluigi Loi
- Nuclear Medicine Unit, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Livia Fantini
- EEG and Sleep Unit, Neurology Department, CHU Clermont Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
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Lim KH, Jeong YJ, Han MS, Rah YC, Cha J, Choi J. Comparisons among vestibular examinations and symptoms of vertigo in sudden sensorineural hearing loss patients. Am J Otolaryngol 2020; 41:102503. [PMID: 32402694 DOI: 10.1016/j.amjoto.2020.102503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Vertigo in sudden sensorineural hearing loss (SSNHL) is hypothesized as an extension of the disease caused by the anatomical proximity of the cochlea and vestibule. The present study aimed to demonstrate the association of vestibular function test (VFT) results with SSNHL disease severity and prognosis. MATERIALS AND METHODS This study assessed clinical records of 263 SSNHL patients admitted to our hospital, between January 2010 and October 2017. Steroid treatment comprised high-dose intravenous dexamethasone (16 mg/d) or oral methylprednisolone (64 mg/d) for 4 days and tapered oral methylprednisolone for 8 days after discharge. Caloric tests were performed in all patients, and cervical vestibular-evoked myogenic potential (c-VEMP) and ocular VEMP (o-VEMP) tests were performed in 209 and 144 patients, respectively. RESULTS Ninety six patients had vertigo, and caloric abnormalities were observed in 119 patients. Initial PTA in patients with vertigo were worse than in those without vertigo (63.0 dB vs 72.7 dB, P = .002). Initial PTA in patients with abnormal o-VEMP was worse than in those with normal o-VEMP (61.4 dB vs 73.0 dB, P = .004). PTA improvement after steroid treatment in patients with vertigo was lower than in those without vertigo (25.0 dB vs 20.9 dB, P = .028). PTA improvement after treatment in patients with abnormal caloric results was lower than in those with normal caloric results (26.0 dB vs 18.4 dB, P = .013). CONCLUSION The functions of vestibular organs, particularly the utricle and lateral semicircular canal, are associated with disease severity and hearing outcome in SSNHL patients.
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24
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Kim JS. When the Room Is Spinning: Experience of Vestibular Neuritis by a Neurotologist. Front Neurol 2020; 11:157. [PMID: 32194499 PMCID: PMC7062794 DOI: 10.3389/fneur.2020.00157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/19/2020] [Indexed: 01/22/2023] Open
Abstract
Vestibular neuritis (VN) is the most common cause of acute prolonged spontaneous vertigo, and is characterized by acute unilateral vestibular hypofunction, probably due to inflammation of the vestibular nerve. VN is diagnosed at the bedside when there is spontaneous horizontal-torsional nystagmus beating away from the side of the lesion, abnormal head impulse tests for the semicircular canals involved on the lesion side, and when other neurological symptoms and signs are absent. Here, as a neuro-otologist, I describe my experience during an attack of VN and discuss how it may help physicians to better understand why and what a patient feels during attacks of vertigo.
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Affiliation(s)
- Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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25
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Jafari Z, Kolb BE, Mohajerani MH. Auditory Dysfunction in Parkinson's Disease. Mov Disord 2020; 35:537-550. [PMID: 32052894 DOI: 10.1002/mds.28000] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
PD is a progressive and complex neurological disorder with heterogeneous symptomatology. PD is characterized by classical motor features of parkinsonism and nonmotor symptoms and involves extensive regions of the nervous system, various neurotransmitters, and protein aggregates. Extensive evidence supports auditory dysfunction as an additional nonmotor feature of PD. Studies indicate a broad range of auditory impairments in PD, from the peripheral hearing system to the auditory brainstem and cortical areas. For instance, research demonstrates a higher occurrence of hearing loss in early-onset PD and evidence of abnormal auditory evoked potentials, event-related potentials, and habituation to novel stimuli. Electrophysiological data, such as auditory P3a, also is suggested as a sensitive measure of illness duration and severity. Improvement in auditory responses following dopaminergic therapies also indicates the presence of similar neurotransmitters (i.e., glutamate and dopamine) in the auditory system and basal ganglia. Nonetheless, hearing impairments in PD have received little attention in clinical practice so far. This review summarizes evidence of peripheral and central auditory impairments in PD and provides conclusions and directions for future empirical and clinical research. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Zahra Jafari
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada.,Department of Basic Sciences in Rehabilitation, School of Rehabilitation Sciences, Iran University of Medical Science (IUMS), Tehran, Iran
| | - Bryan E Kolb
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Majid H Mohajerani
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
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26
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Wang Y, Gu ST, Bao XL, Guo JL. Clinical value of vestibular-evoked myogenic potential tests in patients with sudden sensorineural hearing loss. BMC Neurol 2019; 19:337. [PMID: 31864340 PMCID: PMC6925420 DOI: 10.1186/s12883-019-1576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to investigate the clinical value of two kinds of vestibular-evoked myogenic potentials in patients with sudden sensorineural hearing loss (SSNHL). METHODS A total of 82 patients were divided into two groups: vertigo group and non-vertigo group. All patients underwent examinations for pure tone hearing thresholds, middle ear analysis, the videonystagmography, caloric tests, and vestibular-evoked myogenic potentials elicited from the sternocleidomastoid and extraocular muscle. In addition, 30 healthy subjects were selected as the control group. RESULTS For the 30 healthy subjects, the average latency of p13 and n23 of the cervical vestibular evoked myogenic potentials (cVEMPs) were 13.13 ± 2.89 ms and 23.51 ± 3.25 ms, respectively, and the bilateral amplitude asymmetry rate ranged within 0.05-0.31. The average latency of n10 of the ocular vestibular evoked myogenic potentials (oVEMPs) was 10.13 ± 0.48 ms. The average amplitude of the n10-p15-wave was 5.58 ± 0.65 μV. Among the 35 vertigo patients with SSNHL, 27 patients had normal cVEMP and oVEMP examination results, five patients had abnormal oVEMP examination results, and five patients had abnormal cVEMP examination results. The latency and amplifier of oVEMPs and cVEMPs were within the normal range in 47 SSNHL patients without vertigo. The chi-square value was 5.647, the P-value was equal to 0.017, and the difference was statistically significant at a confidence interval of 95%. CONCLUSIONS OVEMPs and cVEMPs can be used evaluate the vestibular nerve function of SSNHL patients with vertigo.
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Affiliation(s)
- Yuan Wang
- Department of Otolaryngology-Head & Neck Surgery, Tianjin TEDA Hospital, Tianjin, China
| | - Shun-Tong Gu
- Department of General Surgery, Tianjin Fifth Central Hospital, Tianjin, China
| | - Xiao-Lin Bao
- Department of Otolaryngology-Head & Neck Surgery, Tianjin TEDA Hospital, Tianjin, China
| | - Jia-Liang Guo
- Department of Otolaryngology-Head & Neck Surgery, Tianjin TEDA Hospital, Tianjin, China
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Colebatch JG, Rosengren SM. Investigating short latency subcortical vestibular projections in humans: what have we learned? J Neurophysiol 2019; 122:2000-2015. [PMID: 31596627 DOI: 10.1152/jn.00157.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Vestibular evoked myogenic potentials (VEMPs) are now widely used for the noninvasive assessment of vestibular function and diagnosis in humans. This review focuses on the origin, properties, and mechanisms of cervical VEMPs and ocular VEMPs; how these reflexes relate to reports of vestibular projections to brain stem and cervical targets; and the physiological role of (otolithic) cervical and ocular reflexes. The evidence suggests that both VEMPs are likely to represent the effects of excitation of irregularly firing otolith afferents. While the air-conducted cervical VEMP appears to mainly arise from excitation of saccular receptors, the ocular VEMP evoked by bone-conducted stimulation, including impulsive bone-conducted stimuli, mainly arises from utricular afferents. The surface responses are generated by brief changes in motor unit firing. The effects that have been demonstrated are likely to represent otolith-dependent vestibulocollic and vestibulo-ocular reflexes, both linear and torsional. These observations add to previous reports of short latency otolith projections to the target muscles in the neck (sternocleidomastoid and splenius) and extraocular muscles (the inferior oblique). New insights have been provided by the investigation and application of these techniques.
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Affiliation(s)
- James G Colebatch
- Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Sally M Rosengren
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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28
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Strupp M, Grimberg J, Teufel J, Laurell G, Kingma H, Grill E. Worldwide survey on laboratory testing of vestibular function. Neurol Clin Pract 2019; 10:379-387. [PMID: 33299665 DOI: 10.1212/cpj.0000000000000744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/26/2019] [Indexed: 11/15/2022]
Abstract
Background The function of the peripheral vestibular system can nowadays be quantified. The video head impulse test (vHIT) and caloric irrigation are used for the semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) for the sacculus, and ocular vestibular evoked myogenic potentials (oVEMP) for the utriculus. Because there is no agreement on normal and pathologic values, we performed a worldwide survey. Methods A web-based standardized survey questionnaire was used to collect data on "reference values" and "cutoff" values. Thirty-eight centers from all continents (except Africa) replied. Results "Reference values": vHIT: mean for the vestibulo-ocular reflex gain of the left horizontal canal 0.91 (range: 0.7-1.01) and of the left horizontal canal 0.92 (0.7-1.05); side difference 0.15 (0.25-0.3). Caloric irrigation: mean peak slow phase velocity of caloric-induced nystagmus for warm (44°C) water 18.65°/s (12-30°/s); cold (30°C) water 18.21°/s (10-25°/s). cVEMP: P13-N23 amplitude mean for the lower limit 28.67 μV (16-50 μV); upper limit 200 μV (50-350 μV). "Cutoff values": vHIT: side difference 0.26 (0.1-0.4), bilateral vestibulopathy <0.61 (0.3-0.8); unilateral vestibulopathy (UVP) <0.68 (0.4-0.8). Caloric irrigation pathologic side difference mean 25.93% (17.7%-40%) or 12°/sec (5-30°/s); side difference UVP 26.73% (20%-40%) or 29.8°/s (5-100°/s). cVEMP: P13/N23 amplitude mean lower cutoff 32.5 μV (15-50 μV), mean upper cutoff 125 μV (50-200 μV), asymmetry 36.08 μV (20-50 μV). Conclusion This worldwide survey showed a large variability in terms of reference and pathologic cutoff values in the 38 centers included. Therefore, standardization of how to achieve these values and agreement on which values should be used is highly warranted to guarantee a high quality of vestibular testing and interpretation of clinical and scientific results.
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Affiliation(s)
- Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders (MS, JT), Ludwig Maximilians University, Munich, Campus Grosshadern, Germany; Institute for Medical Information Processing (JG, EG), Biometrics and Epidemiology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany; Department of Surgical Sciences (GL), Uppsala University, Sweden; and Department of Otolaryngology (HK), Maastricht University Medical Centre, The Netherlands
| | - Joy Grimberg
- Department of Neurology and German Center for Vertigo and Balance Disorders (MS, JT), Ludwig Maximilians University, Munich, Campus Grosshadern, Germany; Institute for Medical Information Processing (JG, EG), Biometrics and Epidemiology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany; Department of Surgical Sciences (GL), Uppsala University, Sweden; and Department of Otolaryngology (HK), Maastricht University Medical Centre, The Netherlands
| | - Julian Teufel
- Department of Neurology and German Center for Vertigo and Balance Disorders (MS, JT), Ludwig Maximilians University, Munich, Campus Grosshadern, Germany; Institute for Medical Information Processing (JG, EG), Biometrics and Epidemiology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany; Department of Surgical Sciences (GL), Uppsala University, Sweden; and Department of Otolaryngology (HK), Maastricht University Medical Centre, The Netherlands
| | - Göran Laurell
- Department of Neurology and German Center for Vertigo and Balance Disorders (MS, JT), Ludwig Maximilians University, Munich, Campus Grosshadern, Germany; Institute for Medical Information Processing (JG, EG), Biometrics and Epidemiology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany; Department of Surgical Sciences (GL), Uppsala University, Sweden; and Department of Otolaryngology (HK), Maastricht University Medical Centre, The Netherlands
| | - Herman Kingma
- Department of Neurology and German Center for Vertigo and Balance Disorders (MS, JT), Ludwig Maximilians University, Munich, Campus Grosshadern, Germany; Institute for Medical Information Processing (JG, EG), Biometrics and Epidemiology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany; Department of Surgical Sciences (GL), Uppsala University, Sweden; and Department of Otolaryngology (HK), Maastricht University Medical Centre, The Netherlands
| | - Eva Grill
- Department of Neurology and German Center for Vertigo and Balance Disorders (MS, JT), Ludwig Maximilians University, Munich, Campus Grosshadern, Germany; Institute for Medical Information Processing (JG, EG), Biometrics and Epidemiology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany; Department of Surgical Sciences (GL), Uppsala University, Sweden; and Department of Otolaryngology (HK), Maastricht University Medical Centre, The Netherlands
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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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30
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Bayram A. Vestibular evoked myogenic potentials in patients with diabetes mellitus. J Otol 2019; 14:89-93. [PMID: 31467505 PMCID: PMC6712348 DOI: 10.1016/j.joto.2019.05.001] [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: 02/11/2019] [Revised: 03/27/2019] [Accepted: 05/08/2019] [Indexed: 02/01/2023] Open
Abstract
Although the exact mechanism and most involved region of the vestibular system have not yet been fully clarified, vestibular dysfunction has been demonstrated in patients with diabetes mellitus (DM). Vestibular evoked myogenic potential (VEMP) is a short latency electromyographic response to sound or vibration stimuli that may reflect otolith organ or related reflex functions. Since its first description in 1992, VEMP has become a significant part of the vestibular test battery as an objective measurement tool. In diabetic patients, VEMP responses have been studied in order to determine any otolith organ or related reflex dysfunctions. Here, we review the literature with regard to VEMP findings representing any peripheral vestibular end-organ dysfunction in patients with DM. Distinctive vestibular end-organ impairments seem to be demonstrated in patients with DM either with or without DNP via objective vestibular testing tools including VEMP recordings according to relevant studies. However, further studies with larger sample sizes are required to reveal the more definitive findings of VEMP recordings regarding the vestibular pathologies in patients with DM.
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Semmanaselvan K, Vignesh SS, Muthukumar R, Jaya V. Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo. Indian J Otolaryngol Head Neck Surg 2019; 71:195-200. [PMID: 31275830 DOI: 10.1007/s12070-019-01581-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/04/2019] [Indexed: 11/28/2022] Open
Abstract
VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix-Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.
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Affiliation(s)
- K Semmanaselvan
- 1Upgraded Institute of Otorhinolaryngology, Madras Medical College, Chennai, 600003 India
| | - S S Vignesh
- 2Upgraded Institute of Otorhinolaryngology - Institute of Speech and Hearing, Madras Medical College, Chennai, 600003 India
| | - R Muthukumar
- 1Upgraded Institute of Otorhinolaryngology, Madras Medical College, Chennai, 600003 India
| | - V Jaya
- 2Upgraded Institute of Otorhinolaryngology - Institute of Speech and Hearing, Madras Medical College, Chennai, 600003 India
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Angov G, Mihaylova-Angelova E, Petrova D, Stambolieva K. Vestibular function in panic disorder patients: a vestibular-evoked myogenic potentials and video head impulse test study. Eur Arch Otorhinolaryngol 2019; 276:1607-1616. [DOI: 10.1007/s00405-019-05398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
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Balaban CD, Black RD, Silberstein SD. Vestibular Neuroscience for the Headache Specialist. Headache 2019; 59:1109-1127. [DOI: 10.1111/head.13550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Carey D. Balaban
- Department of Otolaryngology University of Pittsburgh Pittsburgh PA USA
- Department of Neurobiology University of Pittsburgh Pittsburgh PA USA
- Department of Communication Sciences and Disorders University of Pittsburgh Pittsburgh PA USA
- Department of Bioengineering University of Pittsburgh Pittsburgh PA USA
| | | | - Stephen D. Silberstein
- Jefferson Headache Center, Department of Neurology Thomas Jefferson University Philadelphia PA USA
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Abstract
The world's population is ageing due to increased hygiene and improved medical care. Dizziness and imbalance frequently affect the elderly and is most common among individuals over the age of 60. In this age group approximately 30% of the population experience these debilitating symptoms at some point. They contribute to falls and frailty, which often result in hospitalization causing tremendous cost for the health care systems, and increased mortality. To make the matters worse balance disorders are often complex. Physicians face the difficulty of diagnosing the patient with the exact disorder especially since each disorder may manifest differently in each patient. In addition, several treatment options exist, however, with a low level of evidence. This chapter summarizes the underlying degenerative processes of the peripheral as well as the central vestibular system, diagnostic tools, the most common balance disorders in the elderly, and possible treatment options of these disorders.
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Brix GS, Ovesen T, Devantier L. Vestibular evoked myogenic potential in healthy adolescents. Int J Pediatr Otorhinolaryngol 2019; 116:49-57. [PMID: 30554707 DOI: 10.1016/j.ijporl.2018.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/16/2018] [Accepted: 10/11/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Vestibular dysfunction, which may lead to delayed motor development and reduced quality of life, is an overlooked entity among children and adolescents. Vestibular evoked myogenic potential (VEMP) is a common, safe diagnostic tool in adults with vestibular disorders. No normative data exist for children and adolescents. Our objective was to collect and assess normative VEMP data for adolescents. METHODS Cervical VEMP (cVEMP) with air-conducted sound. Endpoints were peak latencies after 13 and 23 ms (P13 and N23) and amplitude. Ocular VEMP (oVEMP) with bone-conducted vibration on the mastoid. Endpoints were latencies (N10 and P15) and amplitude. A meta-analysis of existing cVEMP data in children. RESULTS cVEMP response rate (RR) was 85%, mean P13 and N23 latencies were 15.44 and 25.55 ms, respectively, and the asymmetry ratio (AR) was 14%. oVEMP RR was 100%, mean N10 and P15 were 10.61 and 16.58 ms, respectively, and the AR was 12%. In the meta-analysis, the pooled mean P13 and N23 were 12.75 and 21.8 ms, respectively. Head elevation (HE) gave shorter latencies than head rotation (HR). CONCLUSION The oVEMP data represents normal values for adolescents aged 13-16 years. Height should be considered more important than age when interpreting cVEMP in adolescents. Separate normative cVEMP data should be established for HE and HR.
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Affiliation(s)
- Gitte Stokvad Brix
- Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, 8000, Aarhus C, Denmark.
| | - Therese Ovesen
- Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, 8000, Aarhus C, Denmark; Department of Otorhinolaryngology, Region Hospital Holstebro, Lægårdvej 12, 7500, Holstebro, Denmark.
| | - Louise Devantier
- Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, 8000, Aarhus C, Denmark; Department of Otorhinolaryngology, Region Hospital Holstebro, Lægårdvej 12, 7500, Holstebro, Denmark.
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Ogawa Y, Otsuka K, Inagaki T, Nagai N, Itani S, Kondo T, Kohno M, Suzuki M. Comparison of cervical vestibular evoked potentials evoked by air-conducted sound and bone-conducted vibration in vestibular Schwannoma patients. Acta Otolaryngol 2018; 138:898-903. [PMID: 30261801 DOI: 10.1080/00016489.2018.1490815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The vestibular evoked myogenic potential (VEMP) is associated with otolithic afferents and can be used to evaluate the function of the saccule and utricle. In this study, we compared cervical VEMP evoked by stimulation with Air-conducted sound (ACS) and bone-conducted vibration (BCV) to the forehead and investigated whether BCV can be used as a substitute for ACS. METHODS Data were obtained from 33 patients with vestibular schwannoma. Vestibular examinations were performed preoperatively. VEMP was obtained upon stimulation with ACS (ACS cVEMP) and BCV to the forehead using a minishaker (BCV cVEMP). Vestibular function was also analyzed using the caloric test and ocular VEMP (oVEMP) testing. oVEMP was measured using bone-conductive vibration to the forehead. The results of BCV cVEMP, ACS cVEMP, and oVEMP were compared by the caloric test. RESULTS Rates of patients with abnormal ACS cVEMP, BCV cVEMP, oVEMP, and caloric test results were 78.8%, 75.8%, 78.8%, and 69.7%, respectively. BCV cVEMP did not correlate with ACS cVEMP, but correlated with oVEMP and caloric test results. CONCLUSION BCV cVEMP did not correlate with ACS cVEMP. Therefore, BCV cVEMP cannot be used as a substitute for ACS cVEMP.
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Affiliation(s)
- Yasuo Ogawa
- Department of Otorhinolaryngology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Koji Otsuka
- Department of Otorhinolaryngology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Taro Inagaki
- Department of Otorhinolaryngology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Noriko Nagai
- Department of Otorhinolaryngology, Kosei Chuo General Hospital, Meguro-ku, Japan
| | - Shigeto Itani
- Department of Otorhinolaryngology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Takahito Kondo
- Department of Otorhinolaryngology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | | | - Mamoru Suzuki
- Department of Otorhinolaryngology, Tokyo Medical University, Shinjuku-ku, Japan
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MacDougall HG, Holden J, Rosengren SM, Chiarovano E. μVEMP: A Portable Interface to Record Vestibular Evoked Myogenic Potentials (VEMPs) With a Smart Phone or Tablet. Front Neurol 2018; 9:543. [PMID: 30026727 PMCID: PMC6042498 DOI: 10.3389/fneur.2018.00543] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/18/2018] [Indexed: 12/28/2022] Open
Abstract
Background: Cervical VEMPs and ocular VEMPs are tests for evaluating otolith function in clinical practice. We developed a simple, portable and affordable device to record VEMP responses on patients, named μVEMP. Our aim was to validate and field test the new μVEMP device. Methods: We recorded cervical VEMPs and ocular VEMPs in response to bone conducted vibration using taps tendon hammer to the forehead (Fz) and to air conducted sounds using clicks. We simultaneously recorded VEMP responses (same subject, same electrode, same stimuli) in three healthy volunteers (2 females, age range: 29-57 years) with the μVEMP device and with a standard research grade commercial (CED) system used in clinics. We also used the μVEMP device to record VEMP responses from six patients (6 females, age mean±SD: 50.3 ± 20.8 years) with classical peripheral audio-vestibular diseases (unilateral vestibular neuritis, unilateral neurectomy, bilateral vestibular loss, unilateral superior canal dehiscence, unilateral otosclerosis). Results: The first part of this paper compared the devices using simultaneous recordings. The average of the concordance correlation coefficient was rc = 0.997 ± 0.003 showing a strong similarity between the measures. VEMP responses recorded with the μVEMP device on patients with audio-vestibular diseases were similar to those typically found in the literature. Conclusions: We developed, validated and field tested a new device to record ocular and cervical VEMPs in response to sound and vibration.This new device is portable (powered by a phone or tablet) with pocket-size dimensions (105 × 66 × 27 mm) and light weight (150 g). Although further studies and normative data are required, our μVEMP device is simpler (easier to use) and potentially more accessible than standard, commercially available equipment.
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Affiliation(s)
| | - John Holden
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Sally M Rosengren
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia
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Park JY, Choi SY, Choi JH, Choi KD. Vestibular neuritis selectively involving posterior canal and utricle. J Neurol 2018; 265:1940-1942. [PMID: 29938335 DOI: 10.1007/s00415-018-8957-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ji-Yun Park
- Department of Neurology, Ulsan University Medical School, Ulsan University Hospital, Ulsan, South Korea
| | - Seo Young Choi
- Department of Neurology, College of Medicine, School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University, 179, Gudeok-ro, Seo-gu, Pusan, 602-739, South Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, College of Medicine, School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University, 179, Gudeok-ro, Seo-gu, Pusan, 602-739, South Korea.
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Abstract
PURPOSE OF REVIEW In the last decades, researchers suggested that clinical assessment of labyrinthine function in detail became easy thanks to video head impulse tests (VHITs), vestibular evoked myogenic potential test (VEMP) and video-oculography (VOG). It has been argued that they can replace electronystagmography, the caloric and rotatory chair tests. This review addresses the latest evaluations of these tests and the opportunities they offer, but also the limitations in clinical practice. RECENT FINDINGS The VHIT and suppression head impulse test (SHIMP) are under ideal circumstances able to accurately identify deficits of the VOR in 3D. However, in a relevant part of the patient population, pupil tracking is inaccurate, video-goggles slip and VOR quantification is problematic. The dissociation between the VHIT and caloric test suggests that these tests are complementary. A new 3D-VOG technique claims to quantify eye torsion better than before, opening multiple diagnostic possibilities. VEMPs remain difficult to standardize. Variability in normal cervical vestibular-evoked myogenic potential amplitude is large. VEMPs become smaller or absent with age, raising questions of whether there is a lower normal limit at all. Recent research shows that the labyrinth is directly stimulated in the MRI offering new opportunities for diagnostics and research. SUMMARY In clinical practice, the VHIT, SHIMP, VEMP and new 3D-VOG techniques improve diagnostic power. Unfortunately, technical issues or variability prevent reliable quantitative evaluation in a part of the regular patient population. The traditional caloric and rotatory chair test can still be considered as valuable complementary tests.
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Llorens J, Callejo A, Greguske EA, Maroto AF, Cutillas B, Martins-Lopes V. Physiological assesment of vestibular function and toxicity in humans and animals. Neurotoxicology 2018; 66:204-212. [PMID: 29428870 DOI: 10.1016/j.neuro.2018.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/29/2018] [Accepted: 02/04/2018] [Indexed: 01/15/2023]
Abstract
Physiological methods that can be similarly recorded in humans and animals have a major role in sensory toxicology, as they provide a bridge between human sensory perception data and the molecular and cellular data obtained in animal studies. Vestibular toxicity research lags well behind other sensory systems in many aspects, including the availability of methods for functional assessment in animals that could be robustly translated to human significance. Here we review the methods available for the assessment of vestibular function in both humans and laboratory animals, with an emphasis on their similarity or divergence, to highlight their potential utility for the predictive assessment of vestibular toxicity.
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Affiliation(s)
- Jordi Llorens
- Department de Ciències Fisiològiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08907 Hospitalet de Llobregat, Catalonia, Spain; Institute of Neuroscience, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, 08907 Hospitalet de Llobregat, Catalonia, Spain.
| | - Angela Callejo
- Department de Ciències Fisiològiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08907 Hospitalet de Llobregat, Catalonia, Spain
| | - Erin A Greguske
- Department de Ciències Fisiològiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08907 Hospitalet de Llobregat, Catalonia, Spain; Institute of Neuroscience, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, 08907 Hospitalet de Llobregat, Catalonia, Spain
| | - Alberto F Maroto
- Department de Ciències Fisiològiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08907 Hospitalet de Llobregat, Catalonia, Spain
| | - Blanca Cutillas
- Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, 08907 Hospitalet de Llobregat, Catalonia, Spain; Department d'Infermeria Fonamental i Medicoquirúrgica, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08907 Hospitalet de Llobregat, Catalonia, Spain
| | - Vanessa Martins-Lopes
- Department de Ciències Fisiològiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08907 Hospitalet de Llobregat, Catalonia, Spain
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Yu H, Li H. Vestibular Dysfunctions in Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. Front Neurol 2018; 9:45. [PMID: 29459846 PMCID: PMC5807659 DOI: 10.3389/fneur.2018.00045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 01/18/2018] [Indexed: 12/29/2022] Open
Abstract
Background Sudden sensorineural hearing loss (SSHL) not only involves cochlear function but might also be accompanied by vestibular disturbances. The assessment of vestibular function could be of great relevance in SSHL. Objective To investigate the prevalence of vestibulocochlear lesions in SSHL and the correlation of specific vestibular organs with hearing prognosis. Data sources A complete literature search of eligible studies in the PubMed and EMBASE databases was performed. Study selection For our aim, studies that focused on vestibular examination in the case of SSHL were retrieved, including caloric tests, cervical vestibular-evoked myogenic potential (cVEMP) tests, or ocular vestibular-evoked myogenic potential (oVEMP) tests. Results Of the 18 studies included, a caloric test was performed in 16 studies, cVEMP in 13 studies, and oVEMP in 5 studies, and together the studies included a total population of 1,468 subjects. The scores on the Agency for Healthcare Research and Quality (AHRQ) questionnaire ranged from 6 to 11. These results indicated that the most commonly damaged vestibular organ in SSHL was the utricle and superior vestibular pathway (U + S) followed by the lateral semicircular canal and superior vestibular pathway (LSC + S), the saccule and inferior vestibular pathway (S + I), and the cochlea only (C only). The meta-analysis indicated that SSHL patients with vertigo have a statistically increased risk of vestibular organ lesions compared with those without vertigo, including the LSC + S subgroup (OR = 4.89, 95% CI = 1.20-19.93, I2 = 80%, p = 0.03) and the S + I subgroup (OR = 3.58, 95% CI = 1.61-7.95, I2 = 0%, p = 0.002). The pooled possibility of hearing recovery within the LSC + S lesion group was less than half that of the non-LSC + S lesion group (OR = 0.24, 95% CI = 0.11-0.52, I2 = 68%, p = 0.0003). Conclusion This study shows the relevance of vestibular damage concomitant with SSHL and that SSHL patients with vertigo are at an increased risk of vestibular organ lesions compared with patients without vertigo. LSC + S lesions thus appear to be a critical variable that influence the possibility of hearing improvement in SSHL.
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Affiliation(s)
- Huiqian Yu
- Otorhinolaryngology Department, ENT Institute, Affiliated Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Huawei Li
- Otorhinolaryngology Department, ENT Institute, Affiliated Eye and ENT Hospital of Fudan University, Shanghai, China.,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
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Abstract
The assessment and treatment of sport-related concussion (SRC) often requires a multifaceted approach. Vestibular dysfunction represents an important profile of symptoms and pathology following SRC, with high prevalence and association with prolonged recovery. Signs and symptoms of vestibular dysfunction may include dizziness, vertigo, disequilibrium, nausea, and visual impairment. Identifying the central and peripheral vestibular mechanisms responsible for pathology can aid in management of SRC. The most common vestibular disturbances after SRC include benign paroxysmal positional vertigo, vestibulo-ocular reflex impairment, visual motion sensitivity, and balance impairment. A variety of evidence-based screening and assessment tools can help to identify the various types of vestibular pathology in SRC. When vestibular dysfunction is identified, there is emerging support for applying targeted vestibular rehabilitation to manage this condition.
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Akdal G, Tanrıverdizade T, Şengün İ, Bademkıran F, Koçoğlu K, Yüceyar AN, Ekmekçi Ö, Karasoy H, Halmágyi GM. Vestibular impairment in chronic inflammatory demyelinating polyneuropathy. J Neurol 2017; 265:381-387. [PMID: 29260355 DOI: 10.1007/s00415-017-8712-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a common, treatable, autoimmune peripheral neuropathy considered to produce imbalance by weakness and proprioceptive impairment rather than vestibular impairment. We measured semicircular canal vestibular function in 21 CIDP patients (15M/6F) by the video head impulse test and postural stability with a battery comprising the modified Clinical Test of Sensory Integration and Balance, the Berg Balance Scale, the Dynamic Gait Index, the Fall Efficiency Scale, and the International Cooperative Ataxia Rating Scale. Of the 21 patients, 16 had vestibular impairment, ranging from mild-affecting just a single semicircular canal, to severe-affecting all 6 canals. Although the severity of the vestibular impairment did not correlate either with the severity of the postural imbalance or of the peripheral neuropathy, our data show that vestibular impairment is an additional challenge to balance that some CIDP patients will face.
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Affiliation(s)
- Gülden Akdal
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Tural Tanrıverdizade
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - İhsan Şengün
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Fikret Bademkıran
- Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Koray Koçoğlu
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Ayşe Nur Yüceyar
- Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Özgül Ekmekçi
- Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hatice Karasoy
- Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - G Michael Halmágyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.
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Govender S, Colebatch JG. Location and phase effects for ocular and cervical vestibular-evoked myogenic potentials evoked by bone-conducted stimuli at midline skull sites. J Neurophysiol 2017; 119:1045-1056. [PMID: 29357475 DOI: 10.1152/jn.00695.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Our object was to investigate the effect of location and phase on the properties of oVEMPs and cVEMPs evoked by two bone conducted (BC) stimuli, 500 Hz and an impulsive stimulus for midline skull sites from Nz to Iz, in normal volunteers. Compressive and rarefactive onset phases were used and the induced linear and rotational accelerations measured. We confirmed our previous finding of marked changes in the polarity of oVEMPs with location. For cVEMPs using the 500Hz stimulus there were few changes with location or phase, but the impulsive stimulus showed clear phase-related changes at several locations, with the shortest latencies occurring with compressive stimuli at AFz and Fz and the largest amplitudes at Iz. For oVEMPs, both stimuli showed clear effects of phase, with the shortest latencies with compressive stimuli at AFz and Fz and with the largest negativity at Oz or Iz. Whereas the effectiveness at Iz is consistent with a role in the linear VOR, the inversion of polarity and shorter latency around AFz and Fz is not and could not be explained by changes in acceleration of the head. The latency for BC 500Hz oVEMPs for AFz was the same as that for air-conducted (AC) stimuli. We suggest that whereas BC stimuli at most sites work through displacement of the otolith membrane, BC oVEMPs evoked at AFz and Fz may work through a direct action on utricular hair cells. Our findings have implications for clinical testing of VEMPs using midline BC stimuli. NEW & NOTEWORTHY We investigated VEMPs evoked from multiple midline skull sites. Large oVEMP responses were obtained with compressive stimuli at Iz, consistent with a role in the linear VOR, but we also showed inversion of polarity and the shortest latency for stimuli given at AFz and Fz. We propose that BC stimuli given at AFz and Fz may have a direct effect on otolith hair cells, whereas at other sites they work through displacement of the otolith membrane.
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Affiliation(s)
- Sendhil Govender
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, New South Wales , Australia
| | - James G Colebatch
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, New South Wales , Australia
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Lascano AM, Lalive PH, Hardmeier M, Fuhr P, Seeck M. Clinical evoked potentials in neurology: a review of techniques and indications. J Neurol Neurosurg Psychiatry 2017; 88:688-696. [PMID: 28235778 DOI: 10.1136/jnnp-2016-314791] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 01/11/2023]
Abstract
Evoked potentials (EPs) are a powerful and cost-effective tool for evaluating the integrity and function of the central nervous system. Although imaging techniques, such as MRI, have recently become increasingly important in the diagnosis of neurological diseases, over the past 30 years, many neurologists have continued to employ EPs in specific clinical applications. This review presents an overview of the recent evolution of 'classical' clinical applications of EPs in terms of early diagnosis and disease monitoring and is an extension of a previous review published in this journal in 2005 by Walsh and collaborators. We also provide an update on emerging EPs based on gustatory, olfactory and pain stimulation that may be used as clinically relevant markers of neurodegenerative disorders such as Parkinson's disease, Alzheimer's disease and cortical or peripheral impaired pain perception. EPs based on multichannel electroencephalography recordings, known as high-density EPs, help to better differentiate between healthy subjects and patients and, moreover, they provide valuable spatial information regarding the site of the lesion. EPs are reliable disease-progression biomarkers of several neurological diseases, such as multiple sclerosis and other demyelinating disorders. Overall, EPs are excellent neurophysiological tools that will expand standard clinical practice in modern neurology.
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Affiliation(s)
- Agustina M Lascano
- Department of Clinical Neurosciences, Division of Neurology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Patrice H Lalive
- Department of Clinical Neurosciences, Division of Neurology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Hardmeier
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Peter Fuhr
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Margitta Seeck
- Department of Clinical Neurosciences, Division of Neurology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Young AS, Carroll AS, Welgampola MS, McCluskey PJ, van Hal SJ, Thompson EO, Burn J, Fulham MJ, Halmagyi GM. Acute unilateral peripheral vestibulopathy in neurosyphilis. J Neurol Sci 2017; 378:55-58. [DOI: 10.1016/j.jns.2017.04.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/06/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
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Brown DJ, Pastras CJ, Curthoys IS. Electrophysiological Measurements of Peripheral Vestibular Function-A Review of Electrovestibulography. Front Syst Neurosci 2017; 11:34. [PMID: 28620284 PMCID: PMC5450778 DOI: 10.3389/fnsys.2017.00034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/05/2017] [Indexed: 12/19/2022] Open
Abstract
Electrocochleography (EcochG), incorporating the Cochlear Microphonic (CM), the Summating Potential (SP), and the cochlear Compound Action Potential (CAP), has been used to study cochlear function in humans and experimental animals since the 1930s, providing a simple objective tool to assess both hair cell (HC) and nerve sensitivity. The vestibular equivalent of ECochG, termed here Electrovestibulography (EVestG), incorporates responses of the vestibular HCs and nerve. Few research groups have utilized EVestG to study vestibular function. Arguably, this is because stimulating the cochlea in isolation with sound is a trivial matter, whereas stimulating the vestibular system in isolation requires significantly more technical effort. That is, the vestibular system is sensitive to both high-level sound and bone-conducted vibrations, but so is the cochlea, and gross electrical responses of the inner ear to such stimuli can be difficult to interpret. Fortunately, several simple techniques can be employed to isolate vestibular electrical responses. Here, we review the literature underpinning gross vestibular nerve and HC responses, and we discuss the nomenclature used in this field. We also discuss techniques for recording EVestG in experimental animals and humans and highlight how EVestG is furthering our understanding of the vestibular system.
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Affiliation(s)
- Daniel J Brown
- Neurotology Laboratory, Sydney Medical School, The University of SydneySydney, NSW, Australia
| | - Christopher J Pastras
- Neurotology Laboratory, Sydney Medical School, The University of SydneySydney, NSW, Australia
| | - Ian S Curthoys
- Department of Psychology, The University of SydneySydney, NSW, Australia
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Assessment of balance and vestibular functions in patients with idiopathic sudden sensorineural hearing loss. ACTA ACUST UNITED AC 2017; 37:264-270. [DOI: 10.1007/s11596-017-1726-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/27/2017] [Indexed: 10/18/2022]
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Isaac V, Olmedo D, Aboitiz F, Delano PH. Altered Cervical Vestibular-Evoked Myogenic Potential in Children with Attention Deficit and Hyperactivity Disorder. Front Neurol 2017; 8:90. [PMID: 28348547 PMCID: PMC5346589 DOI: 10.3389/fneur.2017.00090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Emerging evidence suggests that children with attention deficit and hyperactivity disorder (ADHD) present more difficulties in standing and walking balance than typically developing children. Most of previous studies have assessed these functions using postural and sensory organization tests showing differences in balance performance between control and ADHD children. However, to date, it is unknown whether these balance alterations are accompanied with vestibular dysfunction. The principal aim of this study is to evaluate vestibular otolith function in ADHD and matched control children. METHODS We assessed vestibular otolith function in children with ADHD and controls using the subjective visual vertical (SVV) bucket test and cervical vestibular-evoked myogenic potentials (cVEMPs). In addition, gait and balance were evaluated using the dynamic gait index (DGI) and computerized posturography. RESULTS Non-significant differences between groups were obtained in SVV evaluation. DGI results show lower scores for overall test performance in children with ADHD (p < 0.001), while computerized postural recordings showed significant differences for the limit of stability between groups (p = 0.02). cVEMPs in response to 500 Hz tone bursts presented at 100 dB were absent or reduced in children with ADHD, as revealed by differences in P1 and N1 peak-to-peak amplitudes between groups (p < 0.01). CONCLUSION These findings suggest that vestibular brainstem reflexes are altered in a subset of children with ADHD. We propose to include cVEMP reflexes in the clinical evaluation of ADHD patients.
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Affiliation(s)
- Valeria Isaac
- Otolaryngology Department, Clinical Hospital of the University of Chile, Santiago, Chile; Pediatric Diagnostic and Therapy Center, CERIL, Santiago, Chile
| | - Diego Olmedo
- Otolaryngology Department, Clinical Hospital of the University of Chile , Santiago , Chile
| | - Francisco Aboitiz
- Departamento de Psiquiatría and Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Paul H Delano
- Otolaryngology Department, Clinical Hospital of the University of Chile, Santiago, Chile; Physiology and Biophysics, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
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