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Raveendran RK, Singh NK. Effect of Electrode Montage on Frequency Tuning Properties of Air-Conducted Ocular Vestibular-Evoked Myogenic Potential. Ear Hear 2024:00003446-990000000-00330. [PMID: 39292858 DOI: 10.1097/aud.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
OBJECTIVES The use of a 500 Hz tone burst over other frequencies was adopted for the clinical recording of ocular vestibular-evoked myogenic potential (oVEMP) on the basis that this stimulus frequency produces larger response amplitudes (frequency tuning) than the other frequencies. However, the possibility of reflex contamination due to a spatially displaced reference electrode from the muscle of the response origin raises questions about using an infraorbital (IO) montage. Nonetheless, the belly-tendon (BT) montage, which places both the recording electrodes over the inferior oblique muscle, increases the chances of obtaining a response with greater contribution from the inferior oblique muscle. However, whether this response continues to show the frequency tuning to 500 Hz is not known. Therefore, the present study aimed to examine the frequency tuning of oVEMP using various electrode montages. DESIGN Thirty-eight young adults underwent simultaneous oVEMP recording from IO, BT, chin-referenced, and sternum-referenced electrode montages in response to 250, 500, 750, 1000, 1500, 2000, 3000, and 4000 Hz tone bursts. RESULTS The frequency tuning most often coincided with a 750-Hz tone burst irrespective of the montage, with the BT montage exhibiting significantly higher response rates and larger peak to peak amplitudes than other montages (p < 0.008). Further, there was a "substantial" agreement on frequency tuning between BT and IO montages. CONCLUSIONS With better response rates and response amplitudes yet similar frequency tuning to the IO montage, the BT montage can be a better option for the clinical recording of oVEMP across frequencies.
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Affiliation(s)
- Rajesh Kumar Raveendran
- Department of Audiology, All India Institute of Speech and Hearing, Manasagangothri, Mysuru 570006, India
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Hançer Arslan G, Arslan M, Aran OT, Özberk EH, Baydan Aran M. Effectiveness of the sternocleidomastoid muscle contraction asymmetry and filter: cervical vestibular evoked myogenic potential. J Laryngol Otol 2024; 138:410-415. [PMID: 37581001 DOI: 10.1017/s0022215123001366] [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: 08/16/2023]
Abstract
OBJECTIVE This study aimed to determine the precautions that can be taken to increase the reliability of the vestibular evoked myogenic potentials test without being affected by the asymmetry of the sternocleidomastoid muscle and the issues that should be considered in the interpretation of vestibular evoked myogenic potential results if these precautions are not taken. METHOD Individuals with sternocleidomastoid muscle activity of less than 30 μV in cervical vestibular evoked myogenic potential testing and an asymmetry ratio of more than 0.35 were excluded. In our study, individuals were divided into different groups according to sternocleidomastoid muscle asymetry. RESULTS A total of 53 individuals were included in the study. Intergroup comparisons were made to determine the effect of electromyogram scaling and filter use on amplitude asymmetry ratio according to sternocleidomastoid muscle asymmetry. CONCLUSION Keeping the sternocleidomastoid muscle asymmetry not exceeding 10 μV maximises the reliability of cervical vestibular evoked myogenic potentials. As a result of our study, it can be concluded that in clinical applications the asymmetry should not exceed 20 μV.
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Affiliation(s)
- G Hançer Arslan
- Department of Audiometry, Vocational School of Health Services, Trakya University, Edirne, Turkey
| | - M Arslan
- Department of Audiology, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - O T Aran
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - E H Özberk
- National Foundation for Educational Research, London, UK
| | - M Baydan Aran
- Department of Audiology, Faculty of Health Sciences, Ankara University, Ankara, Turkey
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Obeidat FS, Alghwiri AA, Bell SL. Vestibular evoked myogenic potential (VEMP) test-retest reliability in adults. J Vestib Res 2024; 34:39-48. [PMID: 38108368 DOI: 10.3233/ves-230029] [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: 12/19/2023]
Abstract
BACKGROUND The technique of measuring ocular vestibular evoked myogenic potentials (oVEMP) in response to Mini-shaker vibration is relatively new, there is a limited normative data to define the presence or absence of a response in the literature. OBJECTIVE To determine the test-retest reliability of cervical and ocular VEMPs (cVEMP and oVEMP, respectively) to air-conducted sound (ACS) and bone-conducted vibration (BCV) stimulation and to determine normative ranges for the responses. METHODS Twenty normal-hearing individuals (40 ears) and 20 hearing impaired volunteers with normal balance function (40 ears) were examined in this study. ACS cVEMP and BCV oVEMP (using a Mini-shaker) were recorded from both groups to assess the test-retest reliability and to collect normative VEMP data for P1/N1 latencies and amplitudes from 20 normal hearing individuals. To test reliability, VEMP recordings were repeated within the same session. RESULTS The test-retest reliability for all the cVEMP parameters showed excellent reliability whereas oVEMP parameters showed between fair and excellent reliability depending on the parameter tested. Normative data for VEMP P1/N1 latencies and amplitudes were established. CONCLUSIONS Normative data and test-retest reliability for BCV oVEMP using the Mini-shaker at 100 Hz were established in our study for the first time in the literature. Responses appear reliable.
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Affiliation(s)
- Faten S Obeidat
- Department of Hearing and Speech Sciences, School of Rehabilitation Sciences, University of Jordan, Amman, Jordan
| | - Alia A Alghwiri
- Department of Physiotherapy, School of Rehabilitation Sciences, University of Jordan, Amman, Jordan
| | - Steven L Bell
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
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Kumar L, Kairo A, Thakar A. Normative and Pathological Ranges of Cervical Vestibular Evoked Myogenic Potentials in Normal Subjects and Patients with Complete Compensated Unilateral Vestibular Loss: A Cross Sectional Study. Indian J Otolaryngol Head Neck Surg 2022; 74:4020-4027. [PMID: 36742940 PMCID: PMC9895149 DOI: 10.1007/s12070-021-02723-5] [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: 05/22/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
To know the normative ranges of VEMP response metrics in healthy young adults. To know the pathological cutoff of VEMP metrics in unilateral vestibular loss patients. To compare our VEMP metrics with the normative values of other studies from the western world. Prospective cross-sectional study. Tertiary care audiovestibular laboratory. 30 healthy subjects and 15 cases with a unilateral complete compensated loss. Various VEMP parameters-p1 latency, n1 latency, p1-n1 amplitude and Interaural asymmetry ratio (IAR) were entered into databases and analyzed. We compared our parameters with the most cited scientific data on VEMP available in the PubMed database, and we analyzed the results. 90% of controls and 80% of cases got VEMP responses at 95 dB HL threshold, 500 Hz with subject/patient placed in sitting upright with head turned to opposite side position. The normative data of VEMP response metrics in young adults for p1, n1 latencies, p1-n1 amplitude, and IAR are 13 ± 2 ms, 21 ± 2 ms, 91 ± 33 uV, and 9.25 ± 7.3, respectively. As the VEMP test has 100% sensitivity and 100% (95% CI 87-100%) negative predictive value in detecting the saccular dysfunction, we recommend the VEMP test as a mandatory tool in the vestibular test battery. There is no statistically significant difference in various VEMP parameters between the control and normal sides of the case group.
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Affiliation(s)
- Lokesh Kumar
- Departments of Otolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605010 India
| | - Arvind Kairo
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Alok Thakar
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, 110029 India
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McNerney KM, Kaliyappan K, Wack DS, Muthaiah VPK. The Influence of Motoric Maneuvers on Cervical Vestibular Evoked Myogenic Potentials (cVEMPs). J Am Acad Audiol 2022; 33:134-141. [PMID: 36216040 DOI: 10.1055/s-0041-1739535] [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: 06/16/2023]
Abstract
BACKGROUND The cervical vestibular evoked myogenic potential (cVEMP) is a vestibular response that is produced by the saccule in response to intense, often low-frequency, short-duration auditory stimuli, and is typically recorded from a contracted sternocleidomastoid (SCM) muscle. Previous research has shown that the amplitude of the cVEMP is related to the amount of SCM electromyographic (EMG) activity. PURPOSE The aim of this study was to determine the influence of various remote motoric maneuvers on the amplitude of the cVEMP, as well as whether they influence the level of SCM EMG activity. RESEARCH DESIGN The cVEMP was recorded from the left SCM muscle to left ear stimulation, in response to the SCM condition, as well as three different motoric maneuvers (jaw clench, eye closure, and the Jendrassik maneuver). EMG activity was also varied between 50, 75, and 100% of maximal EMG activity. STUDY SAMPLE Data from 14 healthy subjects, with a mean age of 25.57 years (standard deviation = 5.93 years), was included in the present study. DATA COLLECTION AND ANALYSIS Mean latency and amplitude of the cVEMP were compared across the four conditions and varying magnitudes of EMG contraction. SPSS 26 was used to statistically analyze the results. RESULTS cVEMP latency did not vary across condition. cVEMP amplitude decreased with decreasing EMG magnitude. SCM contraction with jaw clench produced the largest increase in cVEMP amplitude; however, this condition was not significantly different from the SCM condition alone. SCM contraction with the Jendrassik maneuver produced a cVEMP amplitude that was similar and not statistically different from SCM contraction alone, and the addition of the eye closure maneuver to SCM contraction resulted in the lowest cVEMP amplitude, which was found to be statistically different from the standard SCM condition at 100 and 75% EMG activity. The amplitude relationship across the conditions was not found to vary with changes in EMG activity; however, a significant increase in EMG amplitude was found during the 50% muscle contraction condition when subjects performed the Jendrassik maneuver in addition to the standard SCM contraction. CONCLUSIONS The addition of the eye closure maneuver to SCM contraction resulted in a significant decrease in cVEMP amplitude, while the addition of the Jendrassik maneuver resulted in a significant increase in EMG activity at the lowest level of SCM activation (i.e., 50%). Additional research is necessary to determine how motoric maneuvers influence the cVEMP amplitude, and whether the results are also dependent on how SCM contraction is being produced (e.g., while supine vs. sitting).
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Affiliation(s)
| | - Kathiravan Kaliyappan
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - David S Wack
- Department of Speech-Language Pathology, SUNY Buffalo State, Buffalo, NY
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY
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Clinard CG, Lawlor KJ, Piker EG. Effects of Stimulus Polarity on Amplitude-Modulated Cervical Vestibular-Evoked Myogenic Potentials. J Am Acad Audiol 2022; 32:588-595. [PMID: 35176802 DOI: 10.1055/s-0041-1733968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Traditional approaches to cervical vestibular-evoked myogenic potentials use a transient stimulus to elicit an onset response. However, alternate approaches with long duration stimuli may allow the development of new methodologies to better understand basic function of the vestibular system, as well as potentially developing new clinical applications. PURPOSE The objective of this study was to examine the effects of stimulus polarity on response properties of amplitude-modulated cervical vestibular-evoked myogenic potentials (AMcVEMPs). RESEARCH DESIGN Prospective, repeated-measures, within-subjects design. STUDY SAMPLE Participants were 16 young, healthy adults (ages 21-38 years). DATA COLLECTION AND ANALYSIS Amplitude-modulated tones, with carrier frequency of 500 Hz and modulation frequency of 37 Hz, were used to elicit AMcVEMPs. Responses were analyzed in three different stimulus polarity conditions: condensation, rarefaction, and alternating. The resulting data were analyzed for differences across polarity conditions. RESULTS AMcVEMP amplitudes, both raw and corrected for tonic muscle activation, were equivalent across the different stimulus phase conditions. In addition, response signal-to-noise ratio and phase coherence were equivalent across the different phases of the stimulus. CONCLUSION Analyses of AMcVEMPs are stable when the carrier frequency starting phase is altered and the phase of the temporal envelope is constant.
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Affiliation(s)
- Christopher G Clinard
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, Virginia
| | - Kerri J Lawlor
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, Virginia
| | - Erin G Piker
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, Virginia
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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: 6] [Impact Index Per Article: 2.0] [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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Clinard CG, Thorne AP, Piker EG. Effects of Tonic Muscle Activation on Amplitude-Modulated Cervical Vestibular Evoked Myogenic Potentials (AMcVEMPs) in Young Females: Preliminary Findings. J Assoc Res Otolaryngol 2020; 21:445-461. [PMID: 32761291 DOI: 10.1007/s10162-020-00766-z] [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: 12/14/2019] [Accepted: 07/24/2020] [Indexed: 12/21/2022] Open
Abstract
Cervical vestibular evoked myogenic potentials (cVEMPs) are usually elicited by transient tonebursts, but when elicited by amplitude-modulated (AM) tones, they can provide new information about cVEMPs. Previous reports of cVEMPs elicited by AM tones, or AMcVEMPs, have not systematically examined the effects of tonic EMG activation on their response properties. Fourteen young, healthy female adults (ages 20-24) with clinically normal audiograms participated in this study. AMcVEMPs were elicited with bone-conducted 500 Hz tones amplitude modulated at a rate of 37 Hz and recorded for five different EMG targets ranging from 0 to 90 μV. Amplitude increased linearly as tonic EMG activation increased. Signal-to-noise ratio (SNR) was minimal at 0 μV, but robust and with equivalent values from 30 to 90 μV; phase coherence and EMG-corrected amplitude had findings similar to SNR across EMG target levels. Interaural asymmetry ratios for SNR and phase coherence were substantially lower than those for raw or corrected amplitude. AMcVEMP amplitude scaled with tonic EMG activation similar to transient cVEMPs. Signal-to-noise ratio, phase coherence, and EMG-corrected amplitude plateaued across a range of EMG values, suggesting that these properties of the response reach their maximum values at relatively low levels of EMG activation and that higher levels of EMG activation are not necessary to record robust AMcVEMPs.
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Affiliation(s)
- Christopher G Clinard
- Department of Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, MSC 4304, Harrisonburg, VA, 22807, USA.
| | - Andrew P Thorne
- Department of Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, MSC 4304, Harrisonburg, VA, 22807, USA
| | - Erin G Piker
- Department of Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, MSC 4304, Harrisonburg, VA, 22807, USA
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Optimization of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing Using an Impulse Hammer in Adults, Adolescents, and Children. Otol Neurotol 2020; 41:817-827. [PMID: 32221109 DOI: 10.1097/mao.0000000000002632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize cervical and ocular vestibular evoked myogenic potential (c- and oVEMP) responses using an impulse hammer (IH) in adults and pediatrics at standardized force levels and evaluate: the relationship of force level on VEMP amplitude, sternocleidomastoid (SCM) contraction on cVEMP amplitude, required number of tap stimuli, and subject comfort. Using these data, optimal testing parameters were selected. STUDY DESIGN Prospective study. SETTING Tertiary referral center. PATIENTS Seventy-eight healthy adults, adolescents, and children with no hearing or vestibular deficits. INTERVENTIONS All subjects received c- and oVEMP testing using IH and 500 Hz tone burst air conduction stimuli. Adults received hard, medium, and soft force levels. Adolescents and children received medium and soft force levels. A comfort questionnaire was administered pre- and post-testing. MAIN OUTCOME MEASURES IH VEMP response parameters (response rates, latency, cVEMP pre-stimulus SCM Electromyography [EMG], and peak-to-peak amplitude) were assessed per force level. Subjective reporting for patient comfort was also assessed. RESULTS VEMP response rates ranged from 92 to 100%. Force had a linear relationship with VEMP amplitude. SCM contraction had a linear relationship with raw cVEMP amplitude; however, dissipated with amplitude normalization. Force level did not impact the number of taps needed. A minimum peak force of 15 to 20 N, accounting for SCM contraction, and using a lower EMG monitoring limit for cVEMP is recommended to elicit reliable responses. CONCLUSIONS Overall, IH VEMP is appropriate and comfortable to use in adults and pediatrics and can be useful when an air conduction stimulus is contraindicated or not preferred.
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Abstract
Vertigo and dizziness in advanced age are common complaints in daily clinical practice. The otorhinolaryngologist holds a central position in the differential diagnostic clarification. Age-related disorders (e.g. benign positional vertigo, presbyvestibulopathy, otholith functional disorders) arise due to a physiological, individually distinct and objectively detectable reduction in the sensitivity of sensory and extrasensory elements of the vestibular system. They may reach pathological significance if these dysfunctions affect the physical and emotional well-being (e.g. gait disturbances and falls with subsequent morbidity). Disorders accompanying aging (e.g. neurological, cardiovascular or psychiatric) can occur simultaneously with age-related changes in sensory function. The identification, especially with respect to the risk of falling in older people and the development of individual therapeutic strategies is an interdisciplinary task. Besides a causative therapy, strength, coordination and balance training contribute to the treatment of equilibrium disorders and falls from the perspective of evidence-based medicine.
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Is There a Safe Level for Recording Vestibular Evoked Myogenic Potential? Evidence From Cochlear and Hearing Function Tests. Ear Hear 2019; 40:493-500. [DOI: 10.1097/aud.0000000000000646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guajardo-Vergara C, Pérez-Fernandez N. Air and bone stimulation in vestibular evoked myogenic potentials in patients with unilateral Ménière’s disease and in controls. HEARING BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2019.1591009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Carlos Guajardo-Vergara
- Escuela de Fonoaudiología, Universidad Austral de Chile, Sede Puerto Montt, Chile
- Department of Otorhinolaryngology, University of Navarra, Pamplona, Spain
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Cebulla M, Walther LE. Cervical vestibular evoked myogenic potentials via air conduction delivered by either sequentially or quasi-simultaneously presented narrow-band chirp stimuli. Int J Audiol 2019; 58:174-179. [DOI: 10.1080/14992027.2018.1534280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mario Cebulla
- Comprehensive Hearing Center (CHC), Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Julius Maximilian-University Hospitals, Würzburg, Germany
| | - Leif Erik Walther
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
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Effects of High Sound Exposure During Air-Conducted Vestibular Evoked Myogenic Potential Testing in Children and Young Adults. Ear Hear 2019; 39:269-277. [PMID: 29466264 DOI: 10.1097/aud.0000000000000484] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Vestibular evoked myogenic potential (VEMP) testing is increasingly utilized in pediatric vestibular evaluations due to its diagnostic capability to identify otolith dysfunction and feasibility of testing. However, there is evidence demonstrating that the high-intensity stimulation level required to elicit a reliable VEMP response causes acoustic trauma in adults. Despite utility of VEMP testing in children, similar findings are unknown. It is hypothesized that increased sound exposure may exist in children because differences in ear-canal volume (ECV) compared with adults, and the effect of stimulus parameters (e.g., signal duration and intensity) will alter exposure levels delivered to a child's ear. The objectives of this study are to (1) measure peak to peak equivalent sound pressure levels (peSPL) in children with normal hearing (CNH) and young adults with normal hearing (ANH) using high-intensity VEMP stimuli, (2) determine the effect of ECV on peSPL and calculate a safe exposure level for VEMP, and (3) assess whether cochlear changes exist after VEMP exposure. DESIGN This was a 2-phase approach. Fifteen CNH and 12 ANH participated in phase I. Equivalent ECV was measured. In 1 ear, peSPL was recorded for 5 seconds at 105 to 125 dB SPL, in 5-dB increments for 500- and 750-Hz tone bursts. Recorded peSPL values (accounting for stimulus duration) were then used to calculate safe sound energy exposure values for VEMP testing using the 132-dB recommended energy allowance from the 2003 European Union Guidelines. Fifteen CNH and 10 ANH received cervical and ocular VEMP testing in 1 ear in phase II. Subjects completed tympanometry, pre- and postaudiometric threshold testing, distortion product otoacoustic emissions, and questionnaire addressing subjective otologic symptoms to study the effect of VEMP exposure on cochlear function. RESULTS (1) In response to high-intensity stimulation levels (e.g., 125 dB SPL), CNH had significantly higher peSPL measurements and smaller ECVs compared with ANH. (2) A significant linear relationship between equivalent ECV (as measured by diagnostic tympanometry) and peSPL exists and has an effect on total sound energy exposure level; based on data from phase I, 120 dB SPL was determined to be an acoustically safe stimulation level for testing in children. (3) Using calculated safe stimulation level for VEMP testing, there were no significant effect of VEMP exposure on cochlear function (as measured by audiometric thresholds, distortion product otoacoustic emission amplitude levels, or subjective symptoms) in CNH and ANH. CONCLUSIONS peSPL sound recordings in children's ears are significantly higher (~3 dB) than that in adults in response to high-intensity VEMP stimuli that are commonly practiced. Equivalent ECV contributes to peSPL delivered to the ear during VEMP testing and should be considered to determine safe acoustic VEMP stimulus parameters; children with smaller ECVs are at risk for unsafe sound exposure during routine VEMP testing, and stimuli should not exceed 120 dB SPL. Using 120 dB SPL stimulus level for children during VEMP testing yields no change to cochlear function and reliable VEMP responses.
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Dias JW, McClaskey CM, Harris KC. Time-Compressed Speech Identification Is Predicted by Auditory Neural Processing, Perceptuomotor Speed, and Executive Functioning in Younger and Older Listeners. J Assoc Res Otolaryngol 2019; 20:73-88. [PMID: 30456729 PMCID: PMC6364265 DOI: 10.1007/s10162-018-00703-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022] Open
Abstract
Older adults typically have difficulty identifying speech that is temporally distorted, such as reverberant, accented, time-compressed, or interrupted speech. These difficulties occur even when hearing thresholds fall within a normal range. Auditory neural processing speed, which we have previously found to predict auditory temporal processing (auditory gap detection), may interfere with the ability to recognize phonetic features as they rapidly unfold over time in spoken speech. Further, declines in perceptuomotor processing speed and executive functioning may interfere with the ability to track, access, and process information. The current investigation examined the extent to which age-related differences in time-compressed speech identification were predicted by auditory neural processing speed, perceptuomotor processing speed, and executive functioning. Groups of normal-hearing (up to 3000 Hz) younger and older adults identified 40, 50, and 60 % time-compressed sentences. Auditory neural processing speed was defined as the P1 and N1 latencies of click-induced auditory-evoked potentials. Perceptuomotor processing speed and executive functioning were measured behaviorally using the Connections Test. Compared to younger adults, older adults exhibited poorer time-compressed speech identification and slower perceptuomotor processing. Executive functioning, P1 latency, and N1 latency did not differ between age groups. Time-compressed speech identification was independently predicted by P1 latency, perceptuomotor processing speed, and executive functioning in younger and older listeners. Results of model testing suggested that declines in perceptuomotor processing speed mediated age-group differences in time-compressed speech identification. The current investigation joins a growing body of literature suggesting that the processing of temporally distorted speech is impacted by lower-level auditory neural processing and higher-level perceptuomotor and executive processes.
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Affiliation(s)
- James W Dias
- Department of Otolaryngology, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425-5500, USA.
| | - Carolyn M McClaskey
- Department of Otolaryngology, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425-5500, USA
| | - Kelly C Harris
- Department of Otolaryngology, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425-5500, USA
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Köping M, Shehata-Dieler W, Schneider D, Cebulla M, Oder D, Müntze J, Nordbeck P, Wanner C, Hagen R, Schraven SP. Characterization of vertigo and hearing loss in patients with Fabry disease. Orphanet J Rare Dis 2018; 13:137. [PMID: 30111353 PMCID: PMC6094894 DOI: 10.1186/s13023-018-0882-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/29/2018] [Indexed: 01/05/2023] Open
Abstract
Background Fabry Disease (FD) is an X-linked hereditary lysosomal storage disorder which leads to a multisystemic intralysosomal accumulation of globotriaosylceramid (Gb3). Besides prominent renal and cardiac organ involvement, patients commonly complain about vestibulocochlear symptoms like high-frequency hearing loss, tinnitus and vertigo. However, comprehensive data especially on vertigo remain scarce. The aim of this study was to examine the prevalence and characteristics of vertigo and hearing loss in patients with FD, depending on renal and cardiac parameters and get hints about the site and the pattern of the lesions. Methods Single-center study with 57 FD patients. Every patient underwent an oto-rhino-laryngological examination as well as videonystagmography and vestibular evoked myogenic potentials (VEMPs) and audiological measurements using pure tone audiometry and auditory brainstem response audiometry (ABR). Renal function was measured by eGFR, cardiac impairment was graduated by NYHA class. Results More than one out of three patients (35.1%) complained about hearing loss, 54.4% about vertigo and 28.1% about both symptom. In 74% a sensorineural hearing loss of at least 25 dB was found, ABR could exclude any retrocochlear lesion. Caloric testing showed abnormal values in 71.9%, VEMPs were pathological in 68%. A correlation between the side or the shape of hearing loss and pathological vestibular testing could not be revealed. Conclusions Hearing loss and vertigo show a high prevalence in FD. While hearing loss seems due to a cochlear lesion, peripheral vestibular as well as central nervous pathologies cause vertigo. Thus, both the site of lesion and the pathophysiological patterns seem to differ. Electronic supplementary material The online version of this article (10.1186/s13023-018-0882-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Köping
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany.
| | - Wafaa Shehata-Dieler
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany
| | - Dieter Schneider
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany
| | - Mario Cebulla
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany
| | - Daniel Oder
- Department of Internal Medicine I, Comprehensive Heart Failure Center (CHFC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, Comprehensive Heart Failure Center (CHFC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, Comprehensive Heart Failure Center (CHFC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, Comprehensive Heart Failure Center (CHFC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany
| | - Sebastian P Schraven
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", University Medical Center Rostock, Doberaner Straße 137-139, D-18057, Rostock, Germany
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Fowler CG, Sweet A, Steffel E. Effects of motion sickness severity on the vestibular-evoked myogenic potentials. J Am Acad Audiol 2018; 25:814-22. [PMID: 25405837 DOI: 10.3766/jaaa.25.9.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Motion sickness is a common debilitating condition associated with both actual and perceived motion. Despite the commonality, little is known about the underlying physiological mechanisms. One theory proposes that motion sickness arises from a mismatch between reality and past experience in vertical motions. Physiological tests of the vestibular system, however, have been inconclusive regarding the underlying pathogenesis. Cervical vestibular-evoked myogenic potentials (cVEMPs) arise from the saccule, which responds to vertical motion. If vertical motion elicits motion sickness, the cVEMP should be affected. PURPOSE The purpose of this investigation was to determine if cVEMP characteristics differ among individuals with a range of motion sickness susceptibility from negligible to severe. The hypothesis was that individuals with high susceptibility would have larger cVEMP amplitudes and shorter cVEMP latencies relative to those who are resistant to motion sickness. RESEARCH DESIGN The study had two parts. The first was quasi-experimental in which participants comprised three groups based on susceptibility to motion sickness (low, mild-moderate, high) as identified on the short version of the Motion Sickness Susceptibility Questionnaire (MSSQ-S). The second part of the study was correlational and evaluated the specific relationships between the degree of motion sickness susceptibility and characteristics of the VEMPs. STUDY SAMPLE A total of 24 healthy young adults (ages 20-24 yr) were recruited from the university and the community without regard to motion sickness severity. DATA COLLECTION AND ANALYSIS Participants took the MSSQ-S, which quantifies susceptibility to motion sickness. The participants had a range of motion sickness susceptibility with MSSQ raw scores from 0.0-36.6, which correspond to percent susceptibility from 0.0-99.3%. VEMPs were elicited by 500 Hz tone-bursts monaurally in both ears at 120 dB pSPL. MSSQ-S percent scores were used to divide the participants into low, mild-moderate, and high susceptibility groups. A fixed general linear model with repeated-measures analysis of variance tested cVEMP characteristics for the susceptibility groups (between participants) and ears (within participants). A univariate analysis of variance tested the cVEMP interaural amplitudes across groups. The second analysis was a regression of the severity of motion sickness in percent on cVEMP characteristics. Significance was defined as p < 0.05. RESULTS Participants in the high susceptibility group had significantly higher cVEMP amplitudes than those in the low susceptibility group. cVEMP amplitudes did not differ between ears, and latencies did not differ between the two groups or between ears. Regression analysis on MSSQ-S percent susceptibility by VEMP amplitudes revealed a best-fit cubic function in both ears, with r(2) values of more than 42%. The interaural asymmetry ratio was negatively associated with motion sickness susceptibility (r(2) = 0.389). CONCLUSIONS The current study is the first to report that greater susceptibility to motion sickness is associated with larger cVEMP amplitudes and lower interaural cVEMP asymmetries. Larger interaural asymmetries in cVEMPs did not promote motion sickness susceptibility. The cVEMP findings implicate the saccule and its neural pathways in the production of motion sickness and are consistent with the theory that vertical motions elicit motion sickness. Motion sickness susceptibility may contribute to the variability in normative cVEMP amplitudes.
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Affiliation(s)
- Cynthia G Fowler
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI
| | - Amanda Sweet
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI; Current affiliation: Advanced Audiology, Valencia, CA
| | - Emily Steffel
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI; Currentl affiliation: Audiology Associates, Milan, IL
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Walther LE. Current diagnostic procedures for diagnosing vertigo and dizziness. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2017; 16:Doc02. [PMID: 29279722 PMCID: PMC5738933 DOI: 10.3205/cto000141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vertigo is a multisensory syndrome that otolaryngologists are confronted with every day. With regard to the complex functions of the sense of orientation, vertigo is considered today as a disorder of the sense of direction, a disturbed spatial perception of the body. Beside the frequent classical syndromes for which vertigo is the leading symptom (e.g. positional vertigo, vestibular neuritis, Menière’s disease), vertigo may occur as main or accompanying symptom of a multitude of ENT-related diseases involving the inner ear. It also concerns for example acute and chronic viral or bacterial infections of the ear with serous or bacterial labyrinthitis, disorders due to injury (e.g. barotrauma, fracture of the oto-base, contusion of the labyrinth), chronic-inflammatory bone processes as well as inner ear affections in the perioperative course. In the last years, diagnostics of vertigo have experienced a paradigm shift due to new diagnostic possibilities. In the diagnostics of emergency cases, peripheral and central disorders of vertigo (acute vestibular syndrome) may be differentiated with simple algorithms. The introduction of modern vestibular test procedures (video head impulse test, vestibular evoked myogenic potentials) in the clinical practice led to new diagnostic options that for the first time allow a complex objective assessment of all components of the vestibular organ with relatively low effort. Combined with established methods, a frequency-specific assessment of the function of vestibular reflexes is possible. New classifications allow a clinically better differentiation of vertigo syndromes. Modern radiological procedures such as for example intratympanic gadolinium application for Menière’s disease with visualization of an endolymphatic hydrops also influence current medical standards. Recent methodical developments significantly contributed to the possibilities that nowadays vertigo can be better and more quickly clarified in particular in otolaryngology.
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Zu Eulenburg P, Ruehl RM, Runge P, Dieterich M. Ageing-related changes in the cortical processing of otolith information in humans. Eur J Neurosci 2017; 46:2817-2825. [PMID: 29057523 DOI: 10.1111/ejn.13755] [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: 01/10/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022]
Abstract
Acoustic short tone bursts (STB) trigger ocular and cervical vestibular-evoked myogenic potentials (oVEMPs/cVEMPs) by activating irregular otolith afferents. Simultaneously, STBs introduce an artificial net acceleration signal of otolith origin into the vestibular network. VEMP parameters as diagnostic otolith processing markers have been shown to decline after the age of thirty. To delineate the differential effects of healthy ageing on the cortical vestibular subnetwork processing otolith information, we measured cVEMPs and the differential effects of unilateral STB in three age groups (20-40, 40-60 and 60+; n = 42) using functional neuroimaging. STB evoked responses in the main vestibular hubs in the parieto-opercular cortex. Whereas cVEMP amplitudes declined linearly with age, analysis of the BOLD response size depicted a u-shaped curve. Vestibular perception of the otolith stimulus on the other hand remained unchanged with age. Therefore, we propose that the comparably larger BOLD responses past the age of sixty could reflect a mechanism of central sensitisation for otolith perception to counterbalance the concurrent peripheral vestibular and somatosensory function decline.
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Affiliation(s)
- Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Feodor-Lynen-Str. 19, Munich, D-81377, Germany.,Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Department of Neuroradiology, Johannes Gutenberg-University, Mainz, Germany
| | - Ria Maxine Ruehl
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Feodor-Lynen-Str. 19, Munich, D-81377, Germany.,Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Pia Runge
- Department of Neuroradiology, Johannes Gutenberg-University, Mainz, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians University, Feodor-Lynen-Str. 19, Munich, D-81377, Germany.,Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Kunel'skaya NL, Baybakova EV, Guseva AL, Chugunova MA, Manaenkova EA. [The importance of vestibular evoked myogenic potentials for the assessment of the otolith function in the patients presenting with benign paroxysmal positional vertigo]. Vestn Otorinolaringol 2017; 82:5-8. [PMID: 28980586 DOI: 10.17116/otorino20178245-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to evaluate the otolith function in the patients presenting with idiopathic benign paroxysmal positional vertigo (pBPPV) attributable to the occlusion of the posterior semicircular canal (PSCC) of the inner ear with the use of vestibular evoked myogenic potentials (VEMP). Cervical (cVEMP) and ocular VEMP (oVEMP) were measured in 34 patients with idiopathic pBPPV before and 7 days after the treatment by means of reposition maneuvers. The results of the repeated Dix-Hallpike test performed 7 days after the repositioning maneuver were negative in 27 patients and positive in 7 patients. There was no statistically significant difference in the amplitude of cervical VEMP between the healthy and affected ears either before or after the repositioning treatment. The measurement of oVEMP revealed a reduction of the response amplitude on the affected side. The average values of the plnl on the healthy side were 12.84±1.09 and those on the affected side 4.62±0.69 (p<0,05). The successful repositioning treatment resulted in a significant increase of the oVEMP amplitude on the affected side (p<0,05). In the patients presenting with the persistent symptoms of pBPPV, the repositioning maneuvers did not cause an appreciable increase in the amplitude of oVEMP on the affected side (p<0.05). The results of the present study give evidence that pBPPV of the posterior semicircular canal is associated with the impairment of the function of the receptor structures of the utriculus and the preserved function of the succulus as suggested by the reduction of the oVEMP amplitude and clinically significant asymmetry of ocular VEMP on the affected side with intact cervical VEMP on both sides. The successful treatment of pBPPV of PSCC with the use of the liberatory maneuver results in the increase of the oVEMP amplitude on the affected side increases while the response asymmetry between both sides significantly decreases which indicates the repair of the utriculus otolith function.
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Affiliation(s)
- N L Kunel'skaya
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152; N.I .Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - E V Baybakova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - A L Guseva
- N.I .Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - M A Chugunova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - E A Manaenkova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
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Macambira YKDS, Carnaúba ATL, Fernandes LCBC, Bueno NB, Menezes PDL. Aging and wave-component latency delays in oVEMP and cVEMP: a systematic review with meta-analysis. Braz J Otorhinolaryngol 2017; 83:475-487. [PMID: 28237301 PMCID: PMC9442875 DOI: 10.1016/j.bjorl.2016.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/30/2016] [Accepted: 12/07/2016] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION The natural aging process may result in morphological changes in the vestibular system and in the afferent neural pathway, including loss of hair cells, decreased numbers of vestibular nerve cells, and loss of neurons in the vestibular nucleus. Thus, with advancing age, there should be a decrease in amplitudes and an increase in latencies of the vestibular evoked myogenic potentials, especially the prolongation of p13 latency. Moreover, many investigations have found no significant differences in latencies with advancing age. OBJECTIVE To determine if there are significant differences in the latencies of cervical and ocular evoked myogenic potentials between elderly and adult patients. METHODS This is a systematic review with meta-analysis of observational studies, comparing the differences of these parameters between elderly and young adults, without language or date restrictions, in the following databases: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature databases: OpenGrey.eu and DissOnline, as well as Research Gate. RESULTS The n1 oVEMP latencies had a mean delay in the elderly of 2.32ms with 95% CI of 0.55-4.10ms. The overall effect test showed p=0.01, disclosing that such difference was significant. The heterogeneity found was I2=96% (p<0.001). Evaluation of p1 latency was not possible due to the low number of articles selected for this condition. cVEMP analysis was performed in 13 articles. For the p13 component, the mean latency delay in the elderly was 1.34ms with 95% CI of 0.56-2.11ms. The overall effect test showed a p<0.001, with heterogeneity value I2=92% (p<0.001). For the n23 component, the mean latency delay for the elderly was 2.82ms with 95% CI of 0.33-5.30ms. The overall effect test showed p=0.03. The heterogeneity found was I2=99% (p<0.001). CONCLUSION The latency of oVEMP n1 wave component and latencies of cVEMP p13 and n23 wave components are longer in the elderly aged >60 years than in young adults.
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Affiliation(s)
| | - Aline Tenório Lins Carnaúba
- Universidade Federal de Alagoas (UFAL), Rede Nordeste de Biotecnologia (RENORBIO), Biotecnologia em Saúde, Maceió, AL, Brazil
| | - Luciana Castelo Branco Camurça Fernandes
- Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brazil; Universidade Federal de São Paulo (UNIFESP), Distúrbio da Comunicação, São Paulo, SP, Brazil
| | - Nassib Bezerra Bueno
- Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil; Universidade Federal de São Paulo (UNIFESP), Ciências, São Paulo, SP, Brazil
| | - Pedro de Lemos Menezes
- Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brazil; Universidade de São Paulo (USP), Física aplicada à Medicina, São Paulo, SP, Brazil.
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22
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Vestibular, Visual Acuity, and Balance Outcomes in Children With Cochlear Implants: A Preliminary Report. Ear Hear 2016; 36:e364-72. [PMID: 26182202 DOI: 10.1097/aud.0000000000000194] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is a high incidence of vestibular loss in children with cochlear implants (CCI). However, the relationship between vestibular loss and various outcomes is unknown in children. The objectives of this study are to (1) determine whether age-related changes in peripheral vestibular tests occur; (2) quantify peripheral vestibular function in children with normal hearing and CCI; and (3) determine whether amount of vestibular loss predicts visual acuity and balance performance. DESIGN Eleven CCI and 12 children with normal hearing completed the following tests of vestibular function: ocular and cervical vestibular-evoked myogenic potential to assess utricle and saccule function and the video head impulse test to assess semicircular canal function. The relationship between amount of vestibular loss and the following balance and visual acuity outcomes was assessed: dynamic gait index, single-leg stance, the sensory organization test, and tests of visual acuity, including dynamic visual acuity and the gaze stabilization test. RESULTS (1) There were no significant age-related changes in peripheral vestibular testing with the exception of the n23 cervical vestibular-evoked myogenic potential latency, which was moderately correlated with age. (2) CCI had significantly higher rates of vestibular loss for each test of canal and otolith function. (3) Amount of vestibular loss predicted performance on single-leg stance, the dynamic gait index, some conditions of the sensory organization test, and the dynamic visual acuity test. Age was also a contributing factor for predicting the performance of almost all outcomes. CONCLUSIONS Preliminarily, children with vestibular loss do not recover naturally to levels of their healthy peers, particularly with activities that utilize vestibular input; they have poorer visual acuity and balance function.
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Walther LE, Cebulla M. Band limited chirp stimulation in vestibular evoked myogenic potentials. Eur Arch Otorhinolaryngol 2016; 273:2983-91. [DOI: 10.1007/s00405-015-3888-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/29/2015] [Indexed: 01/21/2023]
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Rosengren SM. Effects of muscle contraction on cervical vestibular evoked myogenic potentials in normal subjects. Clin Neurophysiol 2015; 126:2198-206. [DOI: 10.1016/j.clinph.2014.12.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/05/2014] [Accepted: 12/29/2014] [Indexed: 11/15/2022]
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Association between saccular function and gait speed: data from the Baltimore Longitudinal Study of Aging. Otol Neurotol 2015; 36:260-6. [PMID: 25569369 DOI: 10.1097/mao.0000000000000544] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether otolith function (saccular and utricular) is associated with walking performance. STUDY DESIGN Cross-sectional analysis of observational data collected in the Baltimore Longitudinal Study of Aging. SETTING National Institute on Aging Intramural Research Program Clinical Research Unit at Harbor Hospital, Baltimore, Maryland. PATIENTS Community-dwelling participants. INTERVENTION(S) Cervical and ocular vestibular evoked myogenic potentials (VEMPs) were used to assess saccular and utricular function, respectively. MAIN OUTCOME MEASURE(S) Cervical and ocular VEMP latency and amplitude responses and usual, rapid, and narrow (20 cm) gait speed assessed over a 6-m course. RESULTS In 314 participants (mean age, 73.1 yr; range, 26-96 yr), cervical VEMP amplitude mediated the association between age and gait speed-particularly narrow walk speed-in both men and women. Cervical VEMP latency had an independent association with gait speed in age-, height-, and weight-adjusted analyses, although the direction of the association differed by sex. Greater cervical VEMP latency was associated with slower usual, rapid, and narrow gait speed in women but faster rapid gait speed in men. Neither the amplitude nor latency of ocular VEMP was associated with gait speed in men or women. CONCLUSION These findings suggest that age-related slowing of gait speed is in part mediated by the decreased magnitude of saccular response associated with age. The sex-related differential association between saccular response latency and gait speed requires further study.
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Sreenivasan A, Sivaraman G, Parida PK, Alexander A, Saxena SK, Suria G. The Clinical Utility of Vestibular Evoked Myogenic Potentials in Patients of Benign Paroxysmal Positional Vertigo. J Clin Diagn Res 2015; 9:MC01-3. [PMID: 26266140 DOI: 10.7860/jcdr/2015/9953.6058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 04/22/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT Vestibular Evoked Myogenic Potentials (VEMP) is an emerging tool to diagnose Benign Paroxysmal Positional Vertigo (BPPV). The clinical utility of VEMP has been reported only in small accord in Indian literature. AIM To study the latency and amplitude of VEMP in patients with BPPV and compare it with that of normal subjects. SETTINGS AND DESIGN The study included two groups. Group one (control group) were 18 normal subjects. Group two (test group) were 15 subjects with unilateral BPPV. MATERIALS AND METHODS Those subjects who fulfilled the selection criteria based on case history and audiological assessment were taken for the VEMP recording. The VEMP response consist of positive and negative successive waves (pI-nI), with latency values in adults about 13 and 23 milliseconds respectively. STATISTICAL ANALYSIS Data was analysed using Statistical Package for Social Sciences (SPSS) version 12 (Chicago, IL, USA). Unpaired t-test was employed to measure the statistical difference between control group and test group. RESULTS The difference in n23 and the peak to peak amplitude between the ipsilateral and contralateral ears of the test group were statistically significant, whereas such a difference in the p13 latency turned out to be statistically insignificant. It should be noted that, out of 15 patients in the test group, five patients showed only artifact tracer recordings in both the ears which is considered as no response. The heterogeneity of the results extended from absence of VEMP to prolongation of both p13, n23; prolongation of p13 alone; and even side to side variations. CONCLUSION Absent response from the ipsilateral ear, prolonged latency of n23 and decreased peak to peak amplitude (p13, n23), indicates the disease pathology. However, large sample size is required to draw further conclusions and to consolidate the usage of VEMP in the diagnosis of BPPV.
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Affiliation(s)
- Anuprasad Sreenivasan
- Tutor, Department of Otolaryngology and Head and Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
| | - Ganesan Sivaraman
- Assistant Professor, Department of Otolaryngology and Head and Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
| | - Pradiptata Kumar Parida
- Associate Professor, Department of Otolaryngology and Head and Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
| | - Arun Alexander
- Associate Professor, Department of Otolaryngology and Head and Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
| | - Sunil Kumar Saxena
- Professor and Head, Department of Otolaryngology and Head and Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
| | - Gopalakrishnan Suria
- Professor, Department of Otolaryngology and Head and Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
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Abstract
Aging affects every sensory system in the body, including the vestibular system. Although its impact is often difficult to quantify, the deleterious impact of aging on the vestibular system is serious both medically and economically. The deterioration of the vestibular sensory end organs has been known since the 1970s; however, the measurable impact from these anatomical changes remains elusive. Tests of vestibular function either fall short in their ability to quantify such anatomical deterioration, or they are insensitive to the associated physiologic decline and/or central compensatory mechanisms that accompany the vestibular aging process. When compared with healthy younger individuals, a paucity of subtle differences in test results has been reported in the healthy older population, and those differences are often observed only in response to nontraditional and/or more robust stimuli. In addition, the reported differences are often clinically insignificant insomuch that the recorded physiologic responses from the elderly often fall within the wide normative response ranges identified for normal healthy adults. The damaging economic impact of such vestibular sensory decline manifests itself in an exponential increase in geriatric dizziness and a subsequent higher prevalence of injurious falls. An estimated $10 to $20 billion dollar annual cost has been reported to be associated with falls-related injuries and is the sixth leading cause of death in the elderly population, with a 20% mortality rate. With an estimated 115% increase in the geriatric population over 65 years of age by the year 2050, the number of balanced-disordered patients with a declining vestibular system is certain to reach near epidemic proportions. An understanding of the effects of age on the vestibular system is imperative if clinicians are to better manage elderly patients with balance disorders, dizziness, and vestibular disease.
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Affiliation(s)
- Christopher K. Zalewski
- Otolaryngology Branch, Audiology Unit, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, Maryland
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Pereira AB, Silva GSDM, Assunção ARM, Atherino CCT, Volpe FM, Felipe L. Cervical vestibular evoked myogenic potentials in children. Braz J Otorhinolaryngol 2015; 81:358-62. [PMID: 26163229 PMCID: PMC9442738 DOI: 10.1016/j.bjorl.2014.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 08/12/2014] [Indexed: 12/01/2022] Open
Abstract
Introduction Cervical vestibular evoked myogenic potential is a test used in neurotological examination. It verifies the integrity of vestibular function through a muscular response evoked by an acoustic stimulation which activates the saccular macula. Normal standards in adults have been established, however, there are few published data on the normal responses in children. Objective To establish normal standards for vestibular myogenic responses in children without neurotological complaints. Methods This study's design is a cohort with cross-sectional analysis. The sample consisted of 30 subjects, 15 females (50%) and 15 males (50%). Results The age of the subjects ranged between 8 and 13 years, with a mean of 10.2 (± 1.7). P1 peak showed an average latency of 17.26 (± 1.78) ms and a mean amplitude of 49.34 (± 23.07) μV, and the N2 peak showed an average latency of 24.78 (± 2.18) ms and mean amplitude of 66.23 (± 36.18) μV. P1–N2 mean amplitude was 115.6 (± 55.7) μV. There were no statistically significant differences when comparing by gender or by laterality. Conclusion We established normal values of cervical myogenic vestibular responses in children between 8 and 13 years without neurotological complaints.
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Affiliation(s)
| | | | | | | | - Fernando Madalena Volpe
- Teaching and Research Management, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lilian Felipe
- Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
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de Oliveira AC, Menezes PDL, Pereira LD. Reproducibility (test–retest) of vestibular evoked myogenic potential. Braz J Otorhinolaryngol 2015; 81:264-9. [PMID: 25382429 PMCID: PMC9452242 DOI: 10.1016/j.bjorl.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/06/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction There is still no consensus in the literature as to the best acoustic stimulus for capturing vestibular evoked myogenic potential (VEMP). Low-frequency tone bursts are generally more effective than high-frequency, but recent studies still use clicks. Reproducibility is an important analytical parameter to observe the reliability of responses. Objective To determine the reproducibility of p13 and n23 latency and amplitude of the VEMP for stimuli with different tone-burst frequencies, and to define the best test frequency. Methods Cross-sectional cohort study. VEMP was captured in 156 ears, on the sternocleidomastoid muscle, using 100 tone-burst stimuli at frequencies of 250, 500, 1000, and 2000 Hz, and sound intensity of 95 dB nHL. Responses were replicated, that is, recorded three times on each side. Results No significant difference was observed for p13 and n23 latencies of the VEMP, captured at three moments with tone-burst stimuli at 250, 500, and 1000 Hz. Only the frequency of 2000 Hz showed a difference between captures of this potential (p < 0.001). p13 and n23 amplitude analysis was also similar in the test–retest for all frequencies analyzed. Conclusion p13 and n23 latencies and amplitudes of VEMP for tone-burst stimuli at frequencies of 250, 500, and 1000 Hz are reproducible.
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Louza J, Mertes L, Braun T, Gürkov R, Krause E. Influence of insertion depth in cochlear implantation on vertigo symptoms and vestibular function. Am J Otolaryngol 2015; 36:254-8. [PMID: 25516142 DOI: 10.1016/j.amjoto.2014.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/17/2014] [Accepted: 11/22/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the present study was to investigate the effect of the electrode insertion depth in vestibular function after cochlear implantation. MATERIAL AND METHODS In a retrospective observational study design, 41 adult patients who had undergone cochlear implantation between 2006 and 2012 at a tertiary referral university hospital were included. The postoperative performed radiograph images of the petrous bone were acquired according to the Stenvers method. These were analyzed to determine electrode insertion depth. Pre- and postoperative subjective vertigo symptoms were assessed by a questionnaire. The function of the horizontal semi-circular canal was evaluated by caloric irrigation and the function of the sacculus was tested by using cervical vestibular evoked myogenic potentials pre- and postoperatively. RESULTS The average electrode insertion depth was 464°. A certain variability of insertion depth existed among the different electrodes according to their designs. No statistical difference of the insertion depth was found between patients with or without vertigo. There was also no correlation between electrode insertion depth and alterations of the measurable vestibular function. CONCLUSION In our study the variability of insertion depth didn't have a significant influence on subjective vertigo, horizontal semi-circular canal function or saccular function. Plain radiography is a rapid, simple and cost-effective method to determine electrode insertion depth after implantation. However the scalar position of the electrode cannot be analyzed in plain radiography, so that an interscalar dislocation as a possible influence in vestibular function remains undetected.
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Affiliation(s)
- Julia Louza
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich.
| | - Lynn Mertes
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich
| | - Thomas Braun
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich
| | - Robert Gürkov
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich
| | - Eike Krause
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich
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Epidemiology of vestibular evoked myogenic potentials: Data from the Baltimore Longitudinal Study of Aging. Clin Neurophysiol 2015; 126:2207-15. [PMID: 25703943 DOI: 10.1016/j.clinph.2015.01.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/17/2014] [Accepted: 01/04/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate whether age-related changes in vestibular evoked myogenic potentials (VEMPs) differ by demographic and cardiovascular risk groups. METHODS Participants in the Baltimore Longitudinal Study of Aging underwent cervical and ocular VEMP testing. VEMP latency, amplitude, asymmetry ratios, and prevalence of absent responses were compared across demographic and cardiovascular risk groups. RESULTS In 257 participants (mean age 72.9, 57% female), ocular VEMP (oVEMP) n10 latency increased by 0.12ms/decade while amplitude decreased by 2.9μV/decade. Black participants had better oVEMP function (shorter latency, increased amplitude, and decreased odds of absent responses) relative to white participants. In 250 participants (mean age 72.6, 54% female), EMG-corrected cervical VEMP (cVEMP) amplitude decreased by 0.14μV/decade and p13 latency was 0.38ms longer in males. The odds of absent responses were significantly higher in individuals age ⩾80 for oVEMPs, and age ⩾70 for cVEMPs. Cardiovascular risk factors had no association with VEMP parameters. CONCLUSIONS We confirmed age-related declines in otolith function, and observed a protective effect of black race on oVEMP latency and amplitude. SIGNIFICANCE These results illustrate how measures of otolith function change with age in community-dwelling adults. Further investigations are needed to ascertain whether better otolith function in blacks might contribute to a lower risk of mobility disability and falls.
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Yetiser S, Gok MH, Kutukcu Y, Ince D. Vestibular Evoked Myogenic Potentials in a Female Population with Migraine. Indian J Otolaryngol Head Neck Surg 2014; 68:207-10. [PMID: 27340638 DOI: 10.1007/s12070-014-0812-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/28/2014] [Indexed: 11/24/2022] Open
Abstract
The objective is to analyze the vestibular system by vestibular evoked myogenic potential (VEMP) in 30 female patients with migraine and balance problem in a controlled study. Thirty female patients with migraine and vestibular problems were enrolled in the study (2009-2012). Fifteen age-matched healthy subjects were selected as the controls. Air conduction cervical VEMP was used. Tone-burst sound stimuli of 95 dB nHL with rarefaction polarity, 5 Hz stimulus repetition rate, 1 ms rise/fall time and 2 ms plateau time were delivered at 500 Hz. 200 sweeps were averaged. Myogenic responses were amplified and band-pass filtered (800-10 Hz). The latency and the amplitude of p1 and n1 waves and interpeak amplitude and latency differences were measured. Results were given as mean and SDs. Interaural p1 and n1 amplitude greater than 30 % asymmetry was accepted as abnormal. VEMP results were compared with controls. The One-way ANOVA test was used. Statistical significance was set at P < 0.05. VEMP responses were elicited in all controls and the patients. Comparative analysis of p1 amplitude between the patients and the controls was statistically significant (P = 0.010). P1n1 interaural amplitude difference was greater than 30 % in 4 patients (13.4 %). No statistically significant difference was found when comparing latency of all wave forms between the patients and healthy controls (P > 0.05). VEMP is an useful tool to test the vestibular system in patients with migraine and balance problem at the very early period. Clinicians should always consider migraine in patients with vertigo.
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Affiliation(s)
- Sertac Yetiser
- Department of ORL and HNS, Anadolu Medical Center, Cumhuriyet mah, 2255 sok, No:3, Gebze, 41400 Kocaeli Turkey
| | - Meltem Hale Gok
- Department of Neurology, Anadolu Medical Center, Kocaeli, Turkey
| | - Yasar Kutukcu
- Department of Neurology, Anadolu Medical Center, Kocaeli, Turkey
| | - Dilay Ince
- Department of ORL and HNS, Anadolu Medical Center, Cumhuriyet mah, 2255 sok, No:3, Gebze, 41400 Kocaeli Turkey
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Rahne T, Weiser C, Plontke S. Neurofeedback-Controlled Comparison of the Head Elevation versus Head Rotation and Head-Hand Methods in Eliciting Cervical Vestibular Evoked Myogenic Potentials. Audiol Neurootol 2014; 19:327-35. [DOI: 10.1159/000362661] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 04/04/2014] [Indexed: 11/19/2022] Open
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de Oliveira AC, Pereira LD, Colafêmina JF, de Lemos Menezes P. Amplitude modulated vestibular evoked myogenic responses: a study of carrier and modulating frequencies. Acta Otolaryngol 2014; 134:796-801. [PMID: 24909625 DOI: 10.3109/00016489.2014.909605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Responses with greater amplitude were recorded when carrier frequencies were modulated at 37, 40, and 43 Hz. These responses can be recorded even in patients with significant sensorineural hearing loss, from the sternocleidomastoid (SCM) muscle for a 500 Hz tone, 100% modulated at 40 Hz. OBJECTIVE To determine the best carrier and modulating frequencies to evoke steady-state myogenic responses. METHODS The present study investigated 156 ears of 78 normal-hearing young adults, with carrier frequencies of 250, 500, and 1000 Hz, modulated at 20, 37, 40, 43, 70, 77, and 80 Hz, with an intensity of 95 dBA. Furthermore, we observed responses evoked by stimulus carrier frequency of 500 Hz, modulated at 40 Hz, with an intensity of 95 dBA in a group of five subjects with severe sensorineural loss. RESULTS Responses were found for all stimuli studied (p < 0.01). Modulated stimuli at frequencies of 37, 40, and 43 Hz evoked better steady-state vestibular evoked myogenic potential (S-VEMP) (p < 0.05). No statistically significant differences were found between the group of normal hearers and the group of subjects with hearing loss (p = 0.431), for the stimulus used.
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Yetiser S, Ince D, Gul M. An Analysis of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo. Ann Otol Rhinol Laryngol 2014; 123:686-95. [DOI: 10.1177/0003489414532778] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Vestibular evoked myogenic potentials (VEMPs) selectively test the vestibular end-organ. The aim of this study was to analyze how the site of the diseased canal, type of particulate deposition, duration of symptoms, severity of nystagmus, recurrence, and age affect the VEMP in patients with benign paroxysmal positional vertigo (BPPV). Methods: One hundred two patients were enrolled in the study between 2009 and 2012. There were 36 men and 66 women with ages ranging from 16 to 71 years (mean age, 42.28 ± 11.29 years). Patients with BPPV were tested with roll-on and head-hanging maneuvers under video-electronystagmography monitoring and with air conduction cervical VEMP testing. Patients were grouped for duration, severity, recurrence, age, site of canal involvement, and so on, and the results were compared in each subgroup. Kruskal–Wallis and Mann–Whitney U tests were used for the comparative analysis. Results: Twenty-four patients (23.5%) had a gross VEMP abnormality (absence of VEMP in 6 and greater than 25% depression of the amplitude in 18). Abnormality of VEMPs was not correlated with factors including age, severity of nystagmus, number of maneuvers applied, and the site of canal involvement ( P < .05). However, persistence or recurrence of symptoms has an effect on VEMP results ( P = .016). Conclusion: Vestibular evoked myogenic potential is a useful tool to study the otolithic function in patients with BPPV and should be included in the test battery.
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Affiliation(s)
- Sertac Yetiser
- Department of Otorhinolaryngology–Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | - Dilay Ince
- Department of Otorhinolaryngology–Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | - Murat Gul
- Department of Statistics, University of Giresun, Giresun, Turkey
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Abstract
Nowadays, specific and reproducible side-separated neurotologic testing of all vestibular receptors is possible. Assessment of saccular function by measuring cervical vestibular-evoked myogenic potentials (cVEMP) is well established. Reliable screening tests exist for the isolated assessment of utricular function. These tests can be performed even in less well-equipped surroundings to generate information regarding a possible partial dysfunction of the otolith organs. Apart from assessing the functionality of the semicircular canals by caloric irrigation and the head impulse test, screening for otolith disorders should be part of a comprehensive modern vestibular examination. Neurofeedbacktraining is an effective therapy in the treatment of otholith disorders.
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Affiliation(s)
- J H Wagner
- HNO- Klinik am Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland.
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Miller DM, Klein CS, Suresh NL, Rymer WZ. Asymmetries in vestibular evoked myogenic potentials in chronic stroke survivors with spastic hypertonia: evidence for a vestibulospinal role. Clin Neurophysiol 2014; 125:2070-8. [PMID: 24680197 DOI: 10.1016/j.clinph.2014.01.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/15/2014] [Accepted: 01/29/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Indirect evidence suggests that lateralized changes in motoneuron behavior post-stroke are potentially due to a depolarizing supraspinal drive to the motoneuron pool, but the pathways responsible are unknown. In this study, we assessed vestibular evoked myogenic potentials (VEMPs) in the neck muscles of hemispheric stroke survivors with contralesional spasticity to quantify the relative levels of vestibular drive to the spastic-paretic and contralateral motoneuron pools. METHODS VEMPs were recorded from each sternocleidomastoid muscle in chronic stroke survivors. Side-to-side differences in cVEMP amplitude were calculated and expressed as an asymmetry ratio, a proxy for the relative amount of vestibular drive to each side. RESULTS Spastic-paretic VEMPs were larger than contralateral VEMPs in 13/16 subjects. There was a strong positive relationship between the degree of asymmetry and the severity of spasticity in this subset of subjects. Remaining subjects had larger contralateral responses. CONCLUSION Vestibular drive to cervical motoneurons is asymmetric in spastic stroke survivors, supporting our hypothesis that there is an imbalance in descending vestibular drive to motoneuron pools post-stroke. We speculate this imbalance is a consequence of the unilateral disruption of inhibitory corticobulbar projections to the vestibular nuclei. SIGNIFICANCE This study sheds new light on the underlying mechanisms of post-stroke spasticity.
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Affiliation(s)
- Derek M Miller
- Northwestern University Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL 60611, USA; Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA.
| | - Cliff S Klein
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
| | - Nina L Suresh
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
| | - William Z Rymer
- Northwestern University Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL 60611, USA; Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
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Khan FK, Balraj A, Lepcha A. Normative data for vestibular evoked myogenic potential in different age groups among a heterogeneous Indian population. Indian J Otolaryngol Head Neck Surg 2013; 66:149-54. [PMID: 24822153 DOI: 10.1007/s12070-013-0685-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022] Open
Abstract
To establish normative data of vestibular evoked myogenic potential in different age groups among a heterogeneous Indian population. Prospective study design using a sample of convenience. Eighty five normal controls ranging between the ages 7 and 71 years were asked to provide a written signed consent for the study. Demographic characteristics of the patients were summarized using descriptive statistical methods using SPSS-17 analysing software. The outcome variable (VEMP recording) was expressed in percentiles as function of age. In all patients the stimulus which gave the best response was 95 dB (97.7 %) and 100 dB (95 %). The mean of wave latencies (p1 & n1) for 95-VEMP were, 11.2 ± 3.2 and 17.3 ± 4.7 ms on the right and 11.0 ± 2.8 and 17.0 ± 4.2 ms on the left respectively. The amplitude was 45.1 ± 54 mV on right and 46.9 ± 61.6 mV on the left. The mean of latency difference was 0.87 ms. The VEMP is a relatively simple test. The VEMP response rate was maximum in the younger age group; the optimum intensity was 95 dB. The asymmetry ratio interpretation should be done according to the age specific values.
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Affiliation(s)
- Feroze K Khan
- Department of ENT, Dr SMCSI Medical College, Karakkonam, Trivandrum, 695504 Kerala India
| | - Achamma Balraj
- Audiovestibular Unit, Christian Medical College, Vellore, India
| | - Anjali Lepcha
- Audiovestibular Unit, Christian Medical College, Vellore, India
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Carnaúba ATL, Lins OG, Soares IDA, de Andrade KCL, de Lemos Menezes P. The impact of stimulation rates in vestibular evoked myogenic potential testing. Braz J Otorhinolaryngol 2013; 79:594-8. [PMID: 24141674 PMCID: PMC9442447 DOI: 10.5935/1808-8694.20130106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 05/29/2013] [Indexed: 12/01/2022] Open
Abstract
Vestibular evoked myogenic potentials (VEMP) have been used in complementary otoneurological assessment, but the use of VEMP in clinical settings is limited. VEMPs can be used to assess vestibular function, particularly of the saccule, the inferior vestibular nerve, and/or the vestibular nucleus. Objective To verify the highest possible - and reliable - stimulation rate to obtain VEMPs. Method The VEMPs of 18 subjects were acquired using stimulation rates ranging between 5.1 and 40.8 stimuli per second. Study design: cross-sectional contemporary cohort study. Results Latencies were kept unaltered and amplitudes were progressively reduced as stimulation rates were increased. However, ANOVA and the Kruskal-Wallis test failed to find statistically significant differences between the tested parameters. The study further indicated that when stimulation rates of 5.1 and 10.2 stimuli per second were compared, no statistically significant differences were observed in latency. Conclusion The highest reliable stimulation rate observed in the group of young adults with normal hearing included in this study was 10.2 stimuli per second.
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Affiliation(s)
- Aline Tenório Lins Carnaúba
- MSc. Student, Human Communication Health, Federal University of Pernambuco (Speech and Hearing Therapist)
- Send correspondence to: Aline Tenório Lins Carnaúba. Av. Prof. Moraes Rego, nº 1235. Cidade Universitária. Recife - PE. Brazil. CEP: 50670-901.
| | - Otávio Gomes Lins
- PhD, Medicine (Neurology), UNIFESP (Adjunct Professor, Federal University of Pernambuco)
| | - Ilka do Amaral Soares
- MSc., Human Communication Disorders, UNIFESP (Assistant Professor, Alagoas State University of Health Sciences - UNCISAL)
| | | | - Pedro de Lemos Menezes
- PhD, Physics Applied to Medicine, USP (Professor, Alagoas State University of Health Sciences - UNCISAL - UNCISAL). Federal University of Pernambuco
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Effects of Acoustic Stimuli Used for Vestibular Evoked Myogenic Potential Studies on the Cochlear Function. Otol Neurotol 2013; 34:1186-92. [DOI: 10.1097/mao.0b013e31829ce7b4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Role of cervical vestibular evoked myogenic potential response in identifying vestibular dysfunction. The Journal of Laryngology & Otology 2013; 127:848-53. [DOI: 10.1017/s0022215113001655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractObjectives:To analyse cervical vestibular evoked myogenic potential response parameters in normal volunteers and vertiginous patients.Subjects and methods:A prospective study of 50 normal subjects and 50 patients with vertigo was conducted at Chiang Mai University Hospital, Thailand. Cervical vestibular evoked myogenic potential responses were measured using air-conducted, 500-Hz, tone-burst stimuli with subjects in a sitting position with their head turned toward the contralateral shoulder.Results:The mean ± standard deviation age and male:female ratio in the normal (44.0 ± 9.3 years; 12:38) and vertigo groups (44.7 ± 9.8 years; 17:33) were not significantly different. The prevalence of absent responses in the normal (14 per cent) and vertigo ears (46 per cent) differed significantly (p < 0.0001). Other cervical vestibular evoked myogenic potential parameters (i.e. response threshold, P1 and N1 latency, P1–N1 interlatency and interamplitude, inter-ear difference in P1 threshold, and asymmetry ratio) showed no inter-group differences.Conclusion:The absence of a cervical vestibular evoked myogenic potential response is useful in the identification of vestibular dysfunction. However, patients should undergo a comprehensive battery of other vestibular tests to supplement their cervical vestibular evoked myogenic potential response findings.
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In vivo visualized endolymphatic hydrops and inner ear functions in patients with electrocochleographically confirmed Ménière's disease. Otol Neurotol 2012; 33:1040-5. [PMID: 22772006 DOI: 10.1097/mao.0b013e31825d9a95] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To study the correlation between the degree of endolymphatic hydrops as detected in vivo by magnetic resonance (MR) imaging and the auditory and vestibular function in patients with definite Ménière's disease. STUDY DESIGN Prospective observational study. SETTING Tertiary referral center for balance disorders. SUBJECTS AND METHODS In this prospective study, 41 patients who fulfilled the criteria for definite unilateral Ménière's disease according to the American Association of Otolaryngology-Head and Neck Surgery and who showed a summating potential-to-action potential ratio of greater than 0.4 on electrocochleography were included. Intratympanic contrast-enhanced 3 Tesla MR imaging of the inner ear was performed using a 3D Inversion Recovery Turbo Spin Echo sequence. The degree of endolymphatic hydrops was graded on a Likert scale (0-3) in the cochlea and by vestibular endolymph space ratio in the vestibulum. The degree of hydrops was then analyzed with respect to its correlation with audiometric hearing levels, interaural amplitude ratios of vestibular evoked myogenic potentials, degree of horizontal semicircular canal paresis on caloric irrigation, and disease duration. RESULTS The degree of hearing loss and the disease duration correlated significantly with cochlear hydrops (r = 0.85; r = 0.34). Sacculus dysfunction was significantly correlated with vestibular hydrops (r = -0.47). There was no significant correlation between horizontal semicircular canal paresis and vestibular hydrops. CONCLUSION In patients with clinically and electrocochleographically confirmed definite Ménière's disease, the degree of MR morphological hydrops severity correlates significantly with impairment of hearing function and sacculus function.
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Abstract
AIM Postoperative vertigo is a well-known complication after cochlear implantation. The aim of the study was to investigate whether the electrical stimulation of the auditory structures via cochlear implant electrodes can affect the vestibular system and induce vertigo. MATERIALS AND METHODS In the first group, 114 patients were surveyed retrospectively via questionnaires to evaluate the occurrence and frequency of sound-induced vertigo after cochlear implantation. In the second group of 26 patients, the effects of electrical stimulation on the vestibular system were studied prospectively. RESULTS In the first group of patients without any preoperative sound-induced vertigo (n = 104), 20 patients (18%) reported sound-induced vertigo, which occurred after cochlear implantation. In the second group, an acoustic stimulus delivered via the speech processor of the cochlear implant elicited a vestibular evoked myogenic potential response in 4 of the 26 patients as a sign of vestibular costimulation (of the macula sacculi as part of the otolith organs). Horizontal and vertical nystagmus was triggered, whereas utricular function and postural stability remained unchanged. No correlation was found between C/M levels and the vestibular evoked myogenic potentials and nystagmus responses. CONCLUSION Sound-induced vertigo can occur in cochlear implantees. This seems to be primarily caused by electrical costimulation of the sacculus as part of the otolith organs.
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Ernst A. Perspectives in vestibular diagnostics and therapy. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc05. [PMID: 22558055 PMCID: PMC3341582 DOI: 10.3205/cto000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vestibular diagnostics and therapy ist the mirror of technological, scientific and socio-economics trends as are other fields of clinical medicine. These trends have led to a substantial diversification of the field of neurotology.The improvements in diagnostics have been characterized by the introduction of new receptor testing tools (e.g., VEMPs), progress in imaging (e.g., the endolymphatic hydrops) and in the description of central-vestibular neuroplasticity. The etiopathology of vestibular disorders has been updated by geneticists (e.g., the description of the COCH gene mutations), the detection of structural abnormalities (e.g., dehiscence syndromes) and related disorders (e.g. migraine-associated vertigo). The therapeutic options were extended by re-evaluation of techniques known a long time ago (e.g., saccus exposure), the development of new approaches (e.g., dehiscence repair) and the introduction of new drug therapy concepts (e.g., local drug delivery). Implantable, neuroprosthetic solutions have not yet reached experimental safety and validity and are still far away. However, externally worn neuroprosthetic solution were introduced in the rehab of vestibular disorders (e.g., VertiGuard system).These and related trends point into a medical future which is characterized by presbyvertigo as classical sign of the demographic changes ahead, by shortage of financial resources and a medico-legally over-regulated, even hostile environment for physicians in clinical medicine.
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Cervical vestibular-evoked myogenic potentials: norms and protocols. Int J Otolaryngol 2012; 2012:913515. [PMID: 22577386 PMCID: PMC3332197 DOI: 10.1155/2012/913515] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/23/2011] [Accepted: 12/21/2011] [Indexed: 12/19/2022] Open
Abstract
Vestibular-evoked myogenic potential (VEMP) testing is a vestibular function test used for evaluating saccular and inferior vestibular nerve function. Parameters of VEMP testing include VEMP threshold, latencies of p1 and n1, and p1-n1 interamplitude. Less commonly used parameters were p1-n1 interlatency, interaural difference of p1 and n1 latency, and interaural amplitude difference (IAD) ratio. This paper recommends using air-conducted 500 Hz tone burst auditory stimulation presented monoaurally via an inserted ear phone while the subject is turning his head to the contralateral side in the sitting position and recording the responses from the ipsilateral sternocleidomastoid muscle. Normative values of VEMP responses in 50 normal audiovestibular volunteers were presented. VEMP testing protocols and normative values in other literature were reviewed and compared. The study is beneficial to clinicians as a reference guide to set up VEMP testing and interpretation of the VEMP responses.
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Viciana D, Lopez-Escamez JA. Short tone bursts are better than clicks for cervical vestibular-evoked myogenic potentials in clinical practice. Eur Arch Otorhinolaryngol 2012; 269:1857-63. [PMID: 22237760 DOI: 10.1007/s00405-011-1912-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
Abstract
Our aim is to compare short tone burst (STB)--and clicks--stimuli to evoke vestibular-evoked myogenic potentials (VEMPs) in healthy controls. A cross-sectional study in which VEMPs were measured in two sets of 185 and 55 normal volunteers by an air-conducted 500 Hz STBs and clicks, respectively. The test-retest reliability between different sessions was assessed in two subsets of 35 individuals. Moreover, 53 individuals were examined with both stimuli within the same session. Intraclass correlation coefficients (ICC) were used to assess reliability for P1 and N1 latencies, corrected amplitude and asymmetry ratio (AR). The results included that STBs produced a reliable response between different sessions (N = 35; [ICC] = 0.61-0.94, all p < 0.0001). Although clicks produced a reliable response for P1 and N1 latencies and corrected amplitudes (ICC = 0.62-0.74, all p < 0.0001), the amplitude ratio showed a lower reliability [ICC = 0.32 (-0.10 to 0.59)]. The amplitude of VEMP was consistently larger with 500 Hz STBs than clicks for a given sound pressure level. Within the same session, STBs evoked a response in 52/53 subjects (98%) whereas clicks evoked VEMPs only in 44/53 individuals (83%). Conclusions revealed that a 500 Hz STBs elicited consistently larger amplitudes, better reliability across recording sessions and fewer missing responses compared with click-induced VEMPs.
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Affiliation(s)
- David Viciana
- Otology & Neurotology Group CTS495, Department of Otolaryngology, Hospital de Poniente, Ctra de Almerimar, El Ejido, 04700 Almería, Spain
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Rosengren SM, Govender S, Colebatch JG. Ocular and cervical vestibular evoked myogenic potentials produced by air- and bone-conducted stimuli: Comparative properties and effects of age. Clin Neurophysiol 2011; 122:2282-9. [DOI: 10.1016/j.clinph.2011.04.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 04/04/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
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The Effect of Age on the Vestibular Evoked Myogenic Potential and Sternocleidomastoid Muscle Tonic Electromyogram Level. Ear Hear 2011; 32:617-22. [DOI: 10.1097/aud.0b013e318213488e] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Oliveira Barreto AC, Colafêmina JF, de Lemos Menezes P. Saccular sensitivity function measured by vestibular evoked myogenic potential. Acta Otolaryngol 2011; 131:618-23. [PMID: 21319943 DOI: 10.3109/00016489.2010.545186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Vestibular myogenic potential responses were present when evoked by tone burst stimuli of 250, 500, 1000, and 2000 Hz; however, they were more effective for low-frequency stimuli. OBJECTIVES Few studies refer to specific frequency sensitivities of the saccular afferents. Accordingly, the aim of the present study was to analyze p13 and n23 latency and amplitude parameters of vestibular evoked myogenic potential (VEMP) captured with tone bursts at frequencies of 250, 500, 1000, and 2000 Hz. METHODS VEMP was captured in 156 ears (78 subjects), recorded in the sternocleidomastoid muscle, averaging 200 stimuli, stimulus rate of 5 Hz, duration 10 ms (rise, 4 ms; plateau, 2 ms; fall, 4 ms), at intensity of 95 dB nHL. The recordings were performed in 50 ms windows. RESULTS We found lower p13 latencies in women compared with men, except for the frequency of 250 Hz. We found higher mean absolute latency values for p13 and n13 and lower p13-n13 amplitude and p13-n13 inter-peak values for a frequency of 2000 Hz. Higher amplitudes were observed at frequencies of 250 and 500 Hz. When frequencies of 250, 500, 1000, and 2000 Hz were compared using ANOVA, we found statistically significant differences for all the VEMP parameters (p ≤ 0.005).
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Walther LE, Hörmann K, Pfaar O. [Recording cervical and ocular vestibular evoked myogenic potentials. Part 2: influencing factors, evaluation of findings and clinical significance]. HNO 2011; 58:1129-42; quiz 1143. [PMID: 20963394 DOI: 10.1007/s00106-010-2184-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
VEMP measurements are subject to various influencing factors: patient age, threshold, sound intensity and frequency. Using air (AC) and bone conduction (BC) the vestibular receptors and afferents of the otolith organs can be activated to varying degrees. Recordings of cervical (cVEMP) and ocular VEMP (oVEMP) are clinically possible. AC-cVEMP are primarily an indicator of the sacculocollic reflex pathway. Together with findings on the vestibuloocular reflex (VOR) and complimentary otolith tests, VEMP enable otolith function analysis of each side separately. In addition, the distinction between combined or isolated canal and otolith dysfunction in terms of subtyping and patterns of damage in mono- and bilateral disorders, such as vestibular neuritis or bilateral vestibulopathy, is possible. Moreover, VEMP is relevant in terms of prognostic and therapeutic considerations as well as expert assessments.
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Affiliation(s)
- L E Walther
- HNO-Gemeinschaftspraxis, Main-Taunus-Zentrum, 65843, Sulzbach (Taunus), Deutschland.
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