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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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Reddy TM, Heinze B, Biagio-de Jager L, Maes L. Chirp-Evoked VEMPs: A Test-Retest Reliability Study. Ear Hear 2024; 45:207-218. [PMID: 37580858 DOI: 10.1097/aud.0000000000001416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To determine the test-retest reliability of cervical and ocular vestibular-evoked myogenic potentials (c&oVEMP) evoked by 500 Hz narrowband (NB) CE-Chirp and broadband (BB) CE-Chirp stimuli. DESIGN Twenty healthy participants (10 female) were tested twice on the same day to determine the within-session reliability and 1 week later to determine the between-session reliability. The latency, amplitude, and asymmetry ratio of c&oVEMPs elicited by 95 dB nHL air-conducted (AC) 500 Hz NB CE-Chirp and BB CE-Chirp were recorded bilaterally. RESULTS A moderate to good between-session reliability with intraclass correlation coefficient (ICC) values ranging from 0.52 to 0.82 was observed for cVEMP latency, amplitude, and asymmetry ratio evoked by 500 Hz NB CE-Chirp, as well as for the BB CE-Chirp cVEMP amplitude (ICC of 0.70 and 0.84). In contrast, an overall poor reliability ICC values between 0.30 and 0.42 for cVEMP latency and asymmetry ratio were observed for BB CE-Chirp. For the oVEMP, overall poor between-session reliability for all response parameters evoked by the 500 Hz NB CE-Chirp and the BB CE-Chirp was observed. CONCLUSIONS The 500 Hz NB CE-Chirp was more reliable than the BB CE-Chirp in terms of cVEMP latency, amplitude, and asymmetry ratio. Further investigation using the standard electrode montage is necessary to assess the test-retest reliability of the chirp-evoked oVEMP.
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Affiliation(s)
- Tarryn Marisca Reddy
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Barbara Heinze
- Ear Science Implant Clinic, Ear Science Institute Australia, Western Australia
| | - Leigh Biagio-de Jager
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Belgium
- Department of Ear Nose Throat, Ghent University Hospital, Belgium
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Geno O, Critelli K, Arduino C, Crane BT, Anson ER. Psychometrics of inertial heading perception. J Vestib Res 2024; 34:83-92. [PMID: 38640182 DOI: 10.3233/ves-230077] [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: 04/21/2024]
Abstract
BACKGROUND Inertial self-motion perception is thought to depend primarily on otolith cues. Recent evidence demonstrated that vestibular perceptual thresholds (including inertial heading) are adaptable, suggesting novel clinical approaches for treating perceptual impairments resulting from vestibular disease. OBJECTIVE Little is known about the psychometric properties of perceptual estimates of inertial heading like test-retest reliability. Here we investigate the psychometric properties of a passive inertial heading perceptual test. METHODS Forty-seven healthy subjects participated across two visits, performing in an inertial heading discrimination task. The point of subjective equality (PSE) and thresholds for heading discrimination were identified for the same day and across day tests. Paired t-tests determined if the PSE or thresholds significantly changed and a mixed interclass correlation coefficient (ICC) model examined test-retest reliability. Minimum detectable change (MDC) was calculated for PSE and threshold for heading discrimination. RESULTS Within a testing session, the heading discrimination PSE score test-retest reliability was good (ICC = 0. 80) and did not change (t(1,36) = -1.23, p = 0.23). Heading discrimination thresholds were moderately reliable (ICC = 0.67) and also stable (t(1,36) = 0.10, p = 0.92). Across testing sessions, heading direction PSE scores were moderately correlated (ICC = 0.59) and stable (t(1,46) = -0.44, p = 0.66). Heading direction thresholds had poor reliability (ICC = 0.03) and were significantly smaller at the second visit (t(1,46) = 2.8, p = 0.008). MDC for heading direction PSE ranged from 6-9 degrees across tests. CONCLUSION The current results indicate moderate reliability for heading perception PSE and provide clinical context for interpreting change in inertial vestibular self-motion perception over time or after an intervention.
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Affiliation(s)
- Olivia Geno
- Department of Neuroscience, University of Rochester, Rochester NY, USA
| | - Kyle Critelli
- Department of Otolaryngology, University of Rochester, Rochester NY, USA
| | - Cesar Arduino
- Department of Otolaryngology, University of Rochester, Rochester NY, USA
| | - Benjamin T Crane
- Department of Neuroscience, University of Rochester, Rochester NY, USA
- Department of Otolaryngology, University of Rochester, Rochester NY, USA
| | - Eric R Anson
- Department of Neuroscience, University of Rochester, Rochester NY, USA
- Department of Otolaryngology, University of Rochester, Rochester NY, USA
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Raciti FM, Morales Y, Snapp HA, Rajguru SM. A reliable and reproducible protocol for sound-evoked vestibular myogenic potentials in rattus norvegicus. Front Integr Neurosci 2023; 17:1236642. [PMID: 37731913 PMCID: PMC10508189 DOI: 10.3389/fnint.2023.1236642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Cervical vestibular evoked myogenic potentials (cVEMPs) provide an objective measure of the integrity of the sacculo-collic pathway leading to their widespread use as a clinical tool in the diagnostic vestibular test battery. Though the application of cVEMPs in preclinical models to assess vestibular function, as performed in relevant clinical populations, remains limited. The present study aimed to establish a rodent model of cVEMP with standardized methods and protocols, examine the neural basis of the responses, and characterize and validate important features for interpretation and assessment of vestibular function. Methods We compared air-conducted sound (ACS)-evoked VEMPs from the sternocleidomastoid muscles in naïve Brown Norway rats. A custom setup facilitated repeatable and reliable measurements which were carried out at multiple intensities with ACS between 1 and 16 kHz and over 7 days. The myogenic potentials were identified by the presence of a positive (P1)-negative (N1) waveform at 3-5 ms from the stimulus onset. Threshold, amplitude, and latency were compared with intensity- and frequency-matched responses within and between animals. Results cVEMP responses were repeatedly evoked with stimulus intensities between 50-100 dB SPL with excellent test-retest reliability and across multiple measurements over 7 days for all frequencies tested. Suprathreshold, cVEMP responses at 90 dB SPL for 6-10 kHz stimuli demonstrated significantly larger amplitudes (p < 0.01) and shorter latencies (p < 0.001) compared to cVEMP responses for 1-4 kHz stimuli. Latency of cVEMP showed sex-dependent variability, but no significant differences in threshold or amplitude between males and females was observed. Discussion The results provide a replicable and reliable setup, test protocol, and comprehensive characterization of cVEMP responses in a preclinical model which can be used in future studies to elucidate pathophysiological characteristics of vestibular dysfunctions or test efficacy of therapeutics.
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Affiliation(s)
- Federica M. Raciti
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Yasniary Morales
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Hillary A. Snapp
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Suhrud M. Rajguru
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, United States
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Narayana Swamy S, Yuvaraj P, Pruthi N, Thennarasu K, Rajasekaran AK. Comprehensive Normative Data for Objective Vestibular Tests. Cureus 2023; 15:e40080. [PMID: 37292112 PMCID: PMC10246429 DOI: 10.7759/cureus.40080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Vestibular dysfunction is a debilitating disorder frequently encountered in neurological and otological settings. The vestibular system is a complex network between peripheral and central mechanisms. This innate complexity of the vestibular system necessitates objective test procedures for evidence-based diagnostic formulations and intervention. Objective tests aid in the evaluation of both peripheral and central vestibular pathologies. Establishing and availability of comprehensive normative data for these objective tests is crucial for clinicians and researchers alike. MATERIALS AND METHODS This is a prospective study involving 120 participants (both males and females) aged between 18 and 55 years. All participants were right-handed individuals and had no significant medical history. On pre-set protocols, cVEMP (cervical vestibular evoked myogenic potential), oVEMP (ocular vestibular evoked myogenic potential), vHIT (video head impulse test), and VNG (videonystagmography) were done. RESULTS While all participants (n=120) underwent cVEMP, oVEMP, vHIT, saccade, smooth pursuit, and optokinetic tests, only 109 participants consented to the caloric test. Each test's mean, standard deviation, median, quartile, and third quartiles have been recorded. A right-left comparison yielded no significant difference on cVEMP, oVEMP, caloric test, smooth pursuit, and optokinetic test. However, few vHIT and saccade parameters did reveal significant differences. DISCUSSION This study presents comprehensive normative data for cVEMP, oVEMP, vHIT, caloric test on VNG, and oculomotor tests (smooth pursuit, saccade, optokinetic) on VNG. The test results were in concordance with previously published data. The significant difference between the right and left sides in vHIT may be because of the monocular goggles used for the testing. CONCLUSION This study brings out the normative data for various vestibular tests on individuals aged between 18-55 years. This information could aid both clinicians and researchers working in the field of vestibular science.
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Affiliation(s)
- Suman Narayana Swamy
- Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, IND
| | - Pradeep Yuvaraj
- Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, IND
| | - Nupur Pruthi
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, IND
| | - Kandavel Thennarasu
- Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, IND
| | - Aravind Kumar Rajasekaran
- Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, IND
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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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Identification of Neural Mechanisms in First Single-Sweep Analysis in oVEMPs and Novel Normative Data. J Clin Med 2022; 11:jcm11237124. [PMID: 36498697 PMCID: PMC9738122 DOI: 10.3390/jcm11237124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Bone-conducted (BC) VEMPs provide important tools for measuring otolith function. However, two major drawbacks of this method are encountered in clinical practice-small n10 amplitude and averaging technique. In this study, we present the results of a new VEMP setup measuring technique combined with a novel single-sweep analysis. METHODS The study included BC oVEMP data from 92 participants for the evaluation of normative data using a novel analysis technique. For evaluating test-retest reliability, the intraclass correlation coefficient (ICC) was used. RESULTS We found significant n10 amplitude differences in single-sweep analyses after the first and second measurements. Thereby, mathematical analyses of the head movement did not show any differences in the first or second measurements. The normative n10 amplitude was 20.66 µV with an asymmetric ratio (AR) of 7%. The new value of late shift difference (LSD) was 0.01 ms. The test retest-reliability showed good to excellent ICC results in 9 out of 10 measurements. CONCLUSIONS Our results support a phenomenon in single-sweep analysis of the first stimuli independent of head movement and signal morphology. Furthermore, the values obtained with the new measurement method appear to be more sensitive and may allow an extended diagnostic range due to the new parameter LSD.
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Lodha V, Neupane AK. Multifrequency Narrowband Chirp Evoked Cervical Vestibular Myogenic Potentials: Evaluation of Responses in Normal-Hearing Young Adults. Am J Audiol 2022; 31:1191-1201. [DOI: 10.1044/2022_aja-22-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose:
The study aimed to explore the various parameters of multifrequency narrowband Claus Elberling chirp (NB CE-chirp) evoked cervical vestibular evoked myogenic potentials (cVEMPs) in normal-hearing healthy young adults. The study also attempted to define the optimal frequency tuning characteristic of NB CE-chirp evoked cVEMPs.
Method:
cVEMP was performed on 26 young healthy adults using four different NB CE-chirps centered at 500, 1000, 2000, and 4000 Hz. The neck torsion method was applied for electrode placement. To have the acute recording, visual feedback of sternocleidomastoid muscle contraction was provided, and electromyography (EMG) scaling was done.
Results:
cVEMPs were present for 100% across all frequencies except at 4000 Hz. Amplitudes between each pair of frequencies were significantly different for EMG scaled and unscaled conditions. Frequency tuning was observed at 500 Hz regardless of scaling done. Positive peak 1 of cVEMP (P1) latencies showed no differences between frequencies while both negative peak 1 of cVEMP and the complex of positive peak 1 and negative peak 1 of cVEMP (P1N1) interpeak latency values decreased with increasing frequency. Interaural amplitude asymmetry ratio showed no difference between scaled and unscaled amplitudes. Intraclass correlation revealed a range of test–retest reliability across frequencies. EMG unscaled amplitude were having relatively lower test–retest reliability consistently across frequencies
Conclusions:
Differences in amplitudes between frequencies with a maximum at 500 Hz can be attributed to the low frequency centered saccular response. No differences in P1 were observed. Yet, N1 latency and P1N1 interpeak latency difference gradually shortened with the decrement in the stimulus duration as the stimulation frequency increased. The lower reliability of EMG unscaled amplitude across frequencies supports the need to use EMG scaling to avoid confounding variables related to muscle contraction.
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Affiliation(s)
- Vidhi Lodha
- School of Audiology & Speech-Language Pathology, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Anuj Kumar Neupane
- School of Audiology & Speech-Language Pathology, Bharati Vidyapeeth (Deemed to be University), Pune, India
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Gordon KA, Baitz J, Gnanasegaram JJ, McKnight C, Corneil BD, Camp AJ, Cushing SL. Response characteristics of vestibular evoked myogenic potentials recorded over splenius capitis in young adults and adolescents. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:164-176. [DOI: 10.1016/j.otoeng.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/02/2021] [Indexed: 11/30/2022]
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Gordon KA, Baitz J, Gnanasegaram JJ, McKnight C, Corneil BD, Camp AJ, Cushing SL. Response characteristics of vestibular evoked myogenic potentials recorded over splenius capitis in young adults and adolescents. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(21)00038-8. [PMID: 34088494 DOI: 10.1016/j.otorri.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Examine vestibular evoked myogenic potential (VEMP) responses recorded from surface electrodes over Splenius Capitis (SPC) in a seated position. SPECIFIC AIMS (1) validate response characteristics of VEMP recordings from surface electrodes over Sternocleidomastoid (SCM) and over SCP and (2) assess age effects on responses in adolescents and young adults. MATERIALS AND METHODS Simultaneous surface VEMP was recorded bilaterally from electrodes placed over the dorsal neck musculature at a location known from previous work to record from SPC in 15 healthy participants during trials with head rotation toward and away from the stimulated ear. VEMP was also recorded from electrodes over SCM, ipsilateral to the stimulus ear, in the same participants in a supine, head lift/turn position. RESULTS Response amplitudes significantly increased with contraction strength and decreased with age. Participants were able to maintain sufficient contraction strength (amplitude) with head rotation to reliably measure over SPC. Normalized response amplitudes measured from electrodes over contralateral SPC were largest with head rotation contralateral to the stimulus ear. Normalized amplitudes and peak latencies were comparable to the same measures from SCM obtained in supine, head lift/turn position. CONCLUSIONS Otolith generated myogenic responses can be recorded seated from electrodes over the dorsal neck with head rotation contralateral to the stimulus ear. In this position, contralateral recordings are consistent with responses known from previous work to arise from SPC; ipsilateral recordings may include crosstalk from activated muscles nearby, including ipsilateral SCM. Overall, techniques targeting contralateral SPC during contralateral head turn may provide additional methods of recording VEMPs.
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Affiliation(s)
- Karen A Gordon
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Joshua Baitz
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
| | - Joshua J Gnanasegaram
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Carmen McKnight
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
| | - Brian D Corneil
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada; Department of Psychology, University of Western Ontario, London, ON, Canada; Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Aaron J Camp
- Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sharon L Cushing
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Shahnaz N, David EA. Normal values for cervical and ocular vestibular-evoked myogenic potentials using EMG scaling: effect of body position and electrode montage. Acta Otolaryngol 2021; 141:440-448. [PMID: 33641604 DOI: 10.1080/00016489.2021.1887517] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The clinical utility of cervical and ocular vestibular-evoked myogenic potential (cVEMP and oVEMP) is limited by variability of testing protocols and a dearth of normative data using contemporary methods for amplitude scaling. AIMS/OBJECTIVES To investigate the effect of body position and electrode montage on VEMP responses and to establish normative values. MATERIAL AND METHODS This is a repeated measures study of 44 healthy young adult subjects (22 men and 22 women). RESULTS The highest response rate (99%) for cVEMP was achieved in the supine position with the head elevated and turned. For oVEMP, the highest response rate (90%) was achieved using nasal alar electrode montage with the subject in a sitting position. Scaled peak-to-peak amplitude was higher in males than in females for both cVEMP and oVEMP. CONCLUSION Normative data for 44 young healthy adults was successfully collected for two body positions for cVEMP and two head positions and two electrode montages for oVEMP. SIGNIFICANCE Our findings describe VEMP protocols that efficiently detect VEMP responses, and we provide normative VEMP response data for young healthy subjects. We describe a potential difference in response between males and females, which may be clinically important.
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Affiliation(s)
- Navid Shahnaz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Eytan A. David
- Department of Surgery, University of British Columbia, Vancouver, Canada
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Abstract
OBJECTIVE Vestibular evoked myogenic potentials (VEMPs) are short-latency muscle potentials measured from the neck (cervical VEMP; cVEMP) or under the eyes (ocular VEMP; oVEMP), which provide information regarding function of the saccule and utricle, respectively. VEMPs are reliable when performed in adults; however, reliability of VEMPs in children is unknown. Therefore, the purpose of the study was to determine the test-retest reliability of c- and oVEMP testing in normal control children. STUDY DESIGN Prospective. SETTING Hospital. PATIENTS Ten adults, 14 adolescent children and 13 young children with normal hearing. INTERVENTIONS c- and oVEMP testing were completed across two test sessions in response to air-conduction 500 Hz tone-burst and impulse hammer stimuli. Additionally, oVEMP was completed using eyes-open and eyes-closed conditions. MAIN OUTCOME MEASURES Intraclass correlation coefficients were calculated to determine the reliability of c- and oVEMP outcomes. RESULTS When using air-conduction stimuli, c- and oVEMP amplitudes are reliable across test sessions in normal control children and adults. With impulse hammer stimuli, cVEMP amplitudes showed high reliability; however, oVEMP amplitudes showed low reliability in both eyes-open and eyes-closed conditions. Comparison between eyes-open and eyes-closed oVEMP conditions revealed shorter latencies and higher peak-to-peak amplitudes in the eyes-open condition. CONCLUSIONS In this small cohort of normal control children, cVEMPs are reliable using air-conduction and impulse hammer stimuli and oVEMPs are reliable using air-conduction stimuli in the eyes-open condition. oVEMP in eyes-closed conditions were less reliable compared with eyes-open conditions and resulted in a large number of absent responses.
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Huang S, Zhou H, Zhou E, Zhang J, Feng Y, Yu D, Shi H, Wang J, Wang H, Yin S. A New Proposal for Severity Evaluation of Menière's Disease by Using the Evidence From a Comprehensive Battery of Auditory and Vestibular Tests. Front Neurol 2020; 11:785. [PMID: 33013611 PMCID: PMC7461919 DOI: 10.3389/fneur.2020.00785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022] Open
Abstract
To date, no widely accepted criteria exist to quantify the severity of Menière's disease (MD) by using vestibular tests. This study aimed to compare association of hearing loss and vertigo severity with association of accurate assessments of vestibular function and the vertigo severity. The severity of vertigo was documented by a comprehensive medical history with number of vertigo attacks in the past 6 months and a Dizziness Handicap Inventory (DHI) questionnaire. The involvement of vestibular organs was verified by audio-vestibular tests in 80 definite MD patients. Correlations between DHI scores, number of vertigo attacks in the past 6 months, audio-vestibular function, and the number of involved vestibular end organs were evaluated. We show that there are no significant differences in either severity of vertigo or laboratory results across the degree of hearing loss. Furthermore, the number of involved vestibular end organs was significantly correlated with vestibulo-ocular reflex gain in anterior and posterior canal video head impulse test (vHIT), interaural asymmetry ratio in vestibular-evoked myogenic potentials (VEMPs), and number of vertigo attacks in the past 6 months and DHI score. The vestibulo-ocular reflex gain in the rotatory chair test (RCT) was significantly correlated with the DHI Physical scores and number of involved vestibular end organs at 0.08 Hz. These results indicate that hearing loss is a poor indicator of vertigo severity in MD whereas the number of involved vestibular end organs may serve as an objective measure for MD progress. A battery of vestibular tests targeting different sensor organs is a complementary method for evaluating inner ear deficits and may aid in "grading" the severity of MD.
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Affiliation(s)
- Shujian Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huiqun Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Enhui Zhou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, China
| | - Jiajia Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yanmei Feng
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Dongzhen Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Haibo Shi
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, NS, Canada
| | - Hui Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shankai Yin
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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The vestibulo-masseteric reflex and the acoustic-masseteric reflex: a reliability and responsiveness study in healthy subjects. Exp Brain Res 2020; 238:1769-1779. [PMID: 32280998 DOI: 10.1007/s00221-020-05804-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
The vestibulo-masseteric reflex (VMR or p11 wave), the acoustic-masseteric reflex (AMR or p1/n21 wave) and the mixed vestibulo-cochlear p11/n21 potential are responses of masseter muscles to sound that can be employed to evaluate brainstem function. This study was aimed at establishing the test-retest reliability and responsiveness of these reflex parameters according to the type of electrode configuration. Twenty-two healthy volunteers (M:F = 11:11; mean age 25.3 ± 5.2 years) participated in two testing sessions separated by one week. Zygomatic and mandibular montages were compared following unilateral and bilateral stimulations. For reliability purposes, intraclass correlation coefficient (ICC), coefficient of variation of the method error (CVME) and standard error of measurement (SEM) were calculated. The minimal detectable difference (MDD) was also determined as a measure of responsiveness. Both VMR (p11 wave) and AMR could be consistently evoked from test to retest, although the frequency rate was significantly higher (all p values ≤ 0.009) with zygomatic (VMR: 97.7-100%; AMR: 86.9-97.6%) than mandibular montage (VMR: 84.7-89.8%; AMR: 65.0-67.8%), with no significant differences between unilateral and bilateral stimulations. Good-to-excellent reliability and responsiveness (high ICC, low CVME, SEM and MDD scores) were detected for corrected amplitudes and peak latencies for all reflex responses, whereas raw amplitudes were associated to poor reliability. The reliability of the zygomatic montage proved superior to the mandibular montage for all reflex responses. Given their high test-retest consistency and capability to study different features of the reflex arch, both peak latencies and corrected amplitudes should be reported and considered in the interpretation of reflex testing results.
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16
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The Ototoxic Potential of Cobalt From Metal-on-Metal Hip Implants: Objective Auditory and Vestibular Outcome. Ear Hear 2020; 41:217-230. [DOI: 10.1097/aud.0000000000000747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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17
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E. A, Kumar K. Test-Retest Reliability of Cervical and Ocular Vestibular Evoked Myogenic Potential With Simultaneous and Sequential Recording. Am J Audiol 2019; 28:414-421. [PMID: 31461337 DOI: 10.1044/2019_aja-ind50-18-0087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose Simultaneous recording of cervical (cVEMP) and ocular (oVEMP) vestibular evoked myogenic potentials aids in reducing the testing time when compared to conventional sequential recordings. The purpose of this study was to examine the test-retest reliability of sequential and simultaneous acquisitions of cVEMP and oVEMP. Method cVEMP and oVEMP were recorded in 35 normal-hearing individuals. The cVEMP and oVEMP were obtained using sequential and simultaneous methods. The VEMP recordings were performed across 3 sessions. The 1st 2 recording sessions were consecutive with a gap of 5 min between sessions. The 3rd recording session was after a gap of 3-5 days. Results Both simultaneous and sequential recordings showed fair-to-good test-retest reliability for latencies and amplitude of cVEMP and oVEMP. Conclusion Simultaneous cVEMP and oVEMP recordings can be used to obtain fast VEMP recording with test-retest reliability comparable with that of sequential recording.
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Affiliation(s)
- Anupriya E.
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kaushlendra Kumar
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Ertl M, Boegle R. Investigating the vestibular system using modern imaging techniques-A review on the available stimulation and imaging methods. J Neurosci Methods 2019; 326:108363. [PMID: 31351972 DOI: 10.1016/j.jneumeth.2019.108363] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023]
Abstract
The vestibular organs, located in the inner ear, sense linear and rotational acceleration of the head and its position relative to the gravitational field of the earth. These signals are essential for many fundamental skills such as the coordination of eye and head movements in the three-dimensional space or the bipedal locomotion of humans. Furthermore, the vestibular signals have been shown to contribute to higher cognitive functions such as navigation. As the main aim of the vestibular system is the sensation of motion it is a challenging system to be studied in combination with modern imaging methods. Over the last years various different methods were used for stimulating the vestibular system. These methods range from artificial approaches like galvanic or caloric vestibular stimulation to passive full body accelerations using hexapod motion platforms, or rotatory chairs. In the first section of this review we provide an overview over all methods used in vestibular stimulation in combination with imaging methods (fMRI, PET, E/MEG, fNIRS). The advantages and disadvantages of every method are discussed, and we summarize typical settings and parameters used in previous studies. In the second section the role of the four imaging techniques are discussed in the context of vestibular research and their potential strengths and interactions with the presented stimulation methods are outlined.
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Affiliation(s)
- Matthias Ertl
- Department of Psychology, University of Bern, Switzerland; Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital (Inselspital) Bern, Switzerland.
| | - Rainer Boegle
- Department of Neurology, Ludwig-Maximilians-Universität München, Germany; German Center for Vertigo and Balance Disorders, IFB-LMU, Ludwig-Maximilians Universität, Munich, Germany
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Behtani L, Maheu M, Delcenserie A, Nooristani M, Champoux F. State-of-the-art assessment allows for improved vestibular evoked myogenic potential test-retest reliability. Audiol Res 2018; 8:212. [PMID: 30505423 PMCID: PMC6218692 DOI: 10.4081/audiores.2018.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/12/2018] [Indexed: 11/23/2022] Open
Abstract
The goal of the present study was to evaluate the test-retest reliability values of myogenic responses using the latest guidelines for vestibular assessment. Twenty-two otologically and neurologically normal adults were assessed twice, on two different days. The analyses were carried out using interclass correlations. The results showed that the latest recommendations for vestibular assessment lead to test-retest reliability values that are as high, or greater, than those reported in previous studies. The results suggest that state-of-the-art testing, using the latest recommendations as well as electromyography control, improves reliability values of myogenic responses, more specifically for the cervical vestibular evoked myogenic potentials. The impact of small differences in experimental procedures on the reliability values of myogenic responses is also addressed.
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Affiliation(s)
- Lydia Behtani
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal
| | - Maxime Maheu
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal.,CIUSSS Centre-Sud-de-l'île-de-Montréal/Institut Raymond-Dewar
| | - Audrey Delcenserie
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal.,Departement of Psychology, University of Montreal, Québec, Canada
| | - Mujda Nooristani
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal
| | - François Champoux
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal.,CIUSSS Centre-Sud-de-l'île-de-Montréal/Institut Raymond-Dewar
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Ren J, Ma F, Zhou Y, Xu A, Zhang J, Ma R, Xiao X. Hearing impairment in type 2 diabetics and patients with early diabetic nephropathy. J Diabetes Complications 2018; 32:575-579. [PMID: 29776866 DOI: 10.1016/j.jdiacomp.2018.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 01/20/2023]
Abstract
AIMS The study was to investigate the hearing function in subjects with non-diabetic nephropathy and diabetic nephropathy and analyze related clinical indexes of hearing impairment. METHODS We assessed the hearing function of 30 diabetics (DM group), 30 patients with early diabetic nephropathy (DN group) and 30 healthy subjects (NC group) using pure-tone audiometry, otoacoustic emissions, electronystagmography, caloric test and cervical vestibular evoked myogenic potential (VEMP). RESULTS Pure-tone audiogram demonstrated a deficit at frequencies with elevated threshold in both DM and DN group (p < 0.05). DN group showed a significant deficit with elevated threshold at 250, 8000 Hz in left ear and 8000 Hz in right ear compared to those of DM group (p < 0.05). GHbA1c, waist and ACR were correlated with elevated thresholds. The DPOAE amplitudes of DN group were obviously smaller in the left ear (4 kHz) and right ear (0.75, 2, 4 kHz) while those of DM group were significantly smaller in the right ear (0.75, 4 kHz) than controls (p < 0.05). A larger proportion of subjects with vestibular dysfunction and VEMP response absence were observed in DN group. CONCLUSIONS Type 2 DM and DN patients have shown clinical hearing impairment and vestibular dysfunction. GHbA1c, waist, ACR, BMI, TC and diabetic retinopathy may affect hearing and vestibular function.
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Affiliation(s)
- Jianmin Ren
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China; Institute of Endocrinology and Metabolism, Shandong University, Jinan, China; Key Laboratory of Endocrinology and Metabolism, Shandong Province in Medicine & Health, Jinan, China
| | - Fufu Ma
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China; Institute of Endocrinology and Metabolism, Shandong University, Jinan, China; Key Laboratory of Endocrinology and Metabolism, Shandong Province in Medicine & Health, Jinan, China
| | - Yujing Zhou
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China; Institute of Endocrinology and Metabolism, Shandong University, Jinan, China; Key Laboratory of Endocrinology and Metabolism, Shandong Province in Medicine & Health, Jinan, China
| | - Anting Xu
- Department of Otolaryngology, The Second Hospital of Shandong University, Jinan, China
| | - Jianjian Zhang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China; Institute of Endocrinology and Metabolism, Shandong University, Jinan, China; Key Laboratory of Endocrinology and Metabolism, Shandong Province in Medicine & Health, Jinan, China; Department of Internal Medicine, The Second People's Hospital of Jinan, China
| | - Rong Ma
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China; Institute of Endocrinology and Metabolism, Shandong University, Jinan, China; Key Laboratory of Endocrinology and Metabolism, Shandong Province in Medicine & Health, Jinan, China
| | - Xiaoyan Xiao
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, China.
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Abstract
OBJECTIVES This study was performed to compare three electrode configurations for the ocular vestibular evoked myogenic potentials (oVEMPs)-"standard," "sternum," and "nose"-by making use of bone-conducted stimuli (at the level of Fz with a minishaker). In the second part, we compared the test-retest reliability of the standard and nose electrode configuration on the oVEMP parameters. DESIGN This study had a prospective design. Fourteen healthy subjects participated in the first part (4 males, 10 females; average age = 23.4 (SD = 2.6) years; age range 19.9 to 28.3 years) and second part (3 males, 11 females; average age = 22.7 (SD = 2.4) years; age range 20.0 to 28.0 years) of the study. OVEMPs were recorded making use of a hand-held bone conduction vibrator (minishaker). Tone bursts of 500 Hz (rise/fall time = 2 msec; plateau time = 2 msec; repetition rate = 5.1 Hz) were applied at a constant stimulus intensity level of 140 dB FL. RESULTS PART 1: The n10-p15 amplitude obtained with the standard electrode configuration (mean = 15.8 μV; SD = 6.3 μV) was significantly smaller than the amplitude measured with the nose (Z = -3.3; p = 0.001; mean = 35.0 μV; SD = 19.1 μV) and sternum (Z = -3.3; p = 0.001; mean = 27.1 μV; SD = 12.2 μV) electrode configuration. The p15 latency obtained with the nose electrode configuration (mean = 14.2 msec; SD = 0.54 msec) was significantly shorter than the p15 latency measured with the standard (Z = -3.08; p = 0.002) (mean = 14.9 msec; SD = 0.75 msec) and sternum (Z = -2.98; p = 0.003; mean = 15.4 msec; SD = 1.07 msec) electrode configuration. There were no differences between the n10 latencies of the three electrode configurations. The 95% prediction intervals (given by the mean ± 1.96 * SD) for the different interocular ratio values were [-41.2; 41.2], [-37.2; 37.2], and [-25.9; 25.9] for standard, sternum, and nose electrode configurations, respectively. PART 2: Intraclass correlation (ICC) values calculated for the oVEMP parameters obtained with the standard electrode configuration showed fair to good reliability for the parameters n10-p15 amplitude (ICC = 0.51), n10 (ICC = 0.52), and p15 (ICC = 0.60) latencies. The ICC values obtained for the parameters acquired with the nose electrode configuration demonstrated a poor reliability for the n10 latency (ICC = 0.37), a fair to good reliability for the p15 latency (ICC = 0.47) and an excellent reliability for the n10-p15 amplitude (ICC = 0.85). CONCLUSIONS This study showed the possible benefits from alternative electrode configurations for measuring bone-conducted-evoked oVEMPs in comparison with the standard electrode configuration. The nose configuration seems promising, but further research is required to justify clinical use of this placement.
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van Wyk A, Eksteen CA, Becker PJ, Heinze BM. A Cross-sectional Survey and Cross-sectional Clinical Trial to Determine the Prevalence and Management of Eye Movement Disorders and Vestibular Dysfunction in Post-Stroke Patients in the Sub-Acute Phase: Protocol. Front Neurol 2016; 7:140. [PMID: 27703443 PMCID: PMC5028913 DOI: 10.3389/fneur.2016.00140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 08/15/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Visual impairment, specifically eye movement disorders and vestibular dysfunction may have a negative influence on the functional recovery in post-stroke patients. This type of sensory dysfunction may further be associated with poor functional outcome in patients’ post-stroke. Methods In phase 1, a cross-sectional survey (n = 100) will be conducted to determine the prevalence of eye movement disorders and vestibular dysfunction in patients who sustained a stroke. A cross-sectional clinical trial (n = 60) will be conducted during phase 2 of the study to determine the effect of the combination of vestibular rehabilitation therapy (VRT) and visual scanning exercises (VSE) (experimental group) integrated with task-specific activities compared with the effect of task-specific activities as an intervention (control group) on patients who present with eye movement impairment and central vestibular dysfunction post-stroke. An audiologist will assess (a) visual acuity (static and dynamic), (b) nystagmus, (c) saccadic eye movements, (d) smooth pursuit eye movements, (e) vestibulo-ocular reflex, and (f) saccular, utricular, and vestibular nerve function. An independent physiotherapist will assess (1) cognitive function, (2) residual oculomotor visual performance, (3) visual–perceptual system, (4) functional balance, (5) gait, (6) functional ability, (7) presence of anxiety and/or depression, and (8) level of participation in physical activity. Ethics and dissemination Ethics approval has been obtained from the Ethics Committee of the Faculty of Health Sciences at the University of Pretoria (UP) (374/2015). The study will be submitted as fulfillment for the PhD degree at UP. Dissemination will include submission to peer-reviewed professional journals and presentation at congresses. Training of rehabilitation team members on the integration of VSE and VRT into task-specific activities in rehabilitation will be done if the outcome of the experimental group’s functional performance is clinically and statistically significantly better than the control group on the Barthel Index. Trial Registration Pan African Clinical Trials Registry (PACTR201509001223262).
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Affiliation(s)
- Andoret van Wyk
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria , Pretoria , South Africa
| | - Carina A Eksteen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria , Pretoria , South Africa
| | - Piet J Becker
- Faculty Research Office, Faculty of Health Sciences, University of Pretoria , Pretoria , South Africa
| | - Barbara M Heinze
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria , Pretoria , South Africa
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Abstract
OBJECTIVES To assess the variability of normal values for cervical vestibular-evoked myogenic potentials (cVEMP) testing and to provide guidance regarding which parameters should be reported for clinical practice. STUDY DESIGN Forty-eight normal subjects with no history of hearing loss or vestibular symptoms underwent cVEMP testing. Measurement parameters were tabulated and compared to other sets of cVEMP normal values in the literature. The literature was reviewed to assess the clinical significance of abnormal cVEMP results. The distributions of threshold and symmetry ratios for normal subjects were compared to the distributions of 90 patients who underwent cVEMP testing. SETTING Tertiary academic center. RESULTS Upper limits of 42% symmetry ratio and the range of 65 to 95 dB HL for threshold were established for our center.The quartile coefficients of dispersion were much less than 1.0 for all cVEMP parameters in the literature, suggesting that the variability in normal ranges across the literature is small. The distributions for threshold and symmetry ratio were similar between normal and patient groups. There is a lack of information in the literature regarding the impairment of function resulting from various degrees of abnormality of VEMP results. CONCLUSIONS Normal values for cVEMP parameters are statistically consistent in the literature. The clinical significance of abnormal values has not been validated. For clinical purposes, cVEMP "thresholds" should be reported. Reporting of other parameters is optional.
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Indovina I, Riccelli R, Chiarella G, Petrolo C, Augimeri A, Giofrè L, Lacquaniti F, Staab JP, Passamonti L. Role of the Insula and Vestibular System in Patients with Chronic Subjective Dizziness: An fMRI Study Using Sound-Evoked Vestibular Stimulation. Front Behav Neurosci 2015; 9:334. [PMID: 26696853 PMCID: PMC4673311 DOI: 10.3389/fnbeh.2015.00334] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/19/2015] [Indexed: 11/16/2022] Open
Abstract
Chronic subjective dizziness (CSD) is a common vestibular disorder characterized by persistent non-vertiginous dizziness, unsteadiness, and heightened sensitivity to motion stimuli that may last for months to years after events that cause acute vestibular symptoms or disrupt balance. CSD is not associated with abnormalities of basic vestibular or oculomotor reflexes. Rather, it is thought to arise from persistent use of high-threat postural control strategies and greater reliance on visual cues for spatial orientation (i.e., visual dependence), long after triggering events resolve. Anxiety-related personality traits confer vulnerability to CSD. Anomalous interactions between the central vestibular system and neural structures related to anxiety may sustain it. Vestibular- and anxiety-related processes overlap in the brain, particularly in the insula and hippocampus. Alterations in activity and connectivity in these brain regions in response to vestibular stimuli may be the neural basis of CSD. We examined this hypothesis by comparing brain activity from 18 patients with CSD and 18 healthy controls measured by functional magnetic resonance imaging during loud short tone bursts, which are auditory stimuli that evoke robust vestibular responses. Relative to controls, patients with CSD showed reduced activations to sound-evoked vestibular stimulation in the parieto-insular vestibular cortex (PIVC) including the posterior insula, and in the anterior insula, inferior frontal gyrus, hippocampus, and anterior cingulate cortex. Patients with CSD also showed altered connectivity between the anterior insula and PIVC, anterior insula and middle occipital cortex, hippocampus and PIVC, and anterior cingulate cortex and PIVC. We conclude that reduced activation in PIVC, hippocampus, anterior insula, inferior frontal gyrus, and anterior cingulate cortex, as well as connectivity changes among these regions, may be linked to long-term vestibular symptoms in patients with CSD. Furthermore, altered connectivity between the anterior insula and middle occipital cortex may underlie the greater reliance on visual cues for spatial orientation in CSD patients relative to controls.
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Affiliation(s)
- Iole Indovina
- Centre of Space BioMedicine, University of Rome Tor VergataRome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia FoundationRome, Italy
- *Correspondence: Iole Indovina
| | - Roberta Riccelli
- Department of Medical and Surgical Sciences, University “Magna Graecia,”Catanzaro, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, University “Magna Graecia,”Catanzaro, Italy
| | - Claudio Petrolo
- Department of Experimental and Clinical Medicine, University “Magna Graecia,”Catanzaro, Italy
| | - Antonio Augimeri
- Department of Medical and Surgical Sciences, University “Magna Graecia,”Catanzaro, Italy
| | - Laura Giofrè
- Department of Medical and Surgical Sciences, University “Magna Graecia,”Catanzaro, Italy
| | - Francesco Lacquaniti
- Centre of Space BioMedicine, University of Rome Tor VergataRome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia FoundationRome, Italy
- Department of Systems Medicine, University of Rome Tor VergataRome, Italy
| | - Jeffrey P. Staab
- Department of Psychiatry and Psychology, Mayo ClinicRochester, MN, USA
| | - Luca Passamonti
- Institute of Bioimaging and Molecular Physiology, National Research CouncilCatanzaro, Italy
- Department of Clinical Neurosciences, University of CambridgeCambridge, UK
- Luca Passamonti
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Indovina I, Mazzarella E, Maffei V, Cesqui B, Passamonti L, Lacquaniti F. Sound-evoked vestibular stimulation affects the anticipation of gravity effects during visual self-motion. Exp Brain Res 2015; 233:2365-71. [DOI: 10.1007/s00221-015-4306-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
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Chung JH, Lee SK, Kim SH, Yeo SG, Park MS, Byun JY. Neurotological parameters and prognosis of Bell's palsy patients. Audiol Neurootol 2015; 20:117-121. [PMID: 25765097 DOI: 10.1159/000369609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To investigate the relationship with prognosis, various neurotological examinations evaluating all four nerves within the internal auditory canal were performed in patients with Bell's palsy. METHODS A total of 69 consecutive patients with Bell's palsy were included. They were treated uniformly with steroid and an antiviral agent and underwent neurotological examinations consisting of electronystagmography, pure-tone audiometry (PTA), electroneurography (ENoG), caloric test, rotatory chair test and cervical vestibular evoked myogenic potentials (cVEMP). According to the final recovery state, patients were divided into two groups: a complete recovery group and an incomplete recovery group. The incidence of abnormal findings in each test was compared between the two groups. RESULTS Fifty-six patients recovered completely and 13 patients recovered incompletely. No association was observed between the rate of ipsilesional PTA threshold and the rate of abnormal caloric test, function tests and recovery state. However, the initial state of facial palsy, ENoG and the rate of abnormal cVEMP were significantly correlated with the rate of recovery. CONCLUSION The results indicate that Bell's palsy may be more comparable to mononeuritis multiplex and that cVEMP could be a useful tool for predicting the prognosis of Bell's palsy.
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Abstract
OBJECTIVE A systematic literature review and meta-analysis was performed to determine the effect of stimulus type, SCM muscle activation method, transducer type, and method to control SCM muscle EMG level on response parameter values for 0.1-ms click-evoked and 500-Hz tone burst cVEMPs. A description of normative response values was attempted. DESIGN An electronic systematic literature review was performed to obtain normative cVEMP response data. Subsequently a meta-analysis was conducted to determine significant effects on cVEMP response parameters and to obtain norms. STUDY SAMPLE Scopus was used to identify reports containing normative data. Reports were selected based on inclusion and exclusion criteria determined beforehand. Weighted means were calculated and compared to identify significant effects and normative data. RESULTS Sixty-six reports were included in the systematic review. Stimulus type, SCM muscle activation method, transducer type, and method to control SCM muscle EMG level had significant effects on all response parameters. CONCLUSIONS Optimal stimulus and recording parameters suggested by previous research are confirmed by the current systematic review and meta-analysis and are suggested for clinical use. Response parameter values are influenced by variations in stimulus and recording parameters and normative response values are suggested as guideline for cVEMP interpretation.
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Affiliation(s)
- Nathalie Meyer
- Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria , South Africa
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Association Between Vestibular Function and Motor Performance in Hearing-impaired Children. Otol Neurotol 2014; 35:e343-7. [DOI: 10.1097/mao.0000000000000597] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Psillas G, Pavlidou A, Lefkidis N, Vital I, Markou K, Triaridis S, Tsalighopoulos M. Vestibular evoked myogenic potentials in children after cochlear implantation. Auris Nasus Larynx 2014; 41:432-5. [DOI: 10.1016/j.anl.2014.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/29/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE To investigate the repeatability of sound-evoked vestibular evoked myogenic potentials recorded from the triceps (tVEMPs) with and without visual feedback. DESIGN tVEMP responses to 95 dB nHL 500-Hz tone bursts were recorded in a longitudinal, repeated measures study where P1 and N1 latencies and amplitudes were measured on three separate occasions from the same individuals. Analysis of variance, intra-class correlations, and limits of repeatability analyses were used to assess tVEMP repeatability and effects of visual feedback. STUDY SAMPLE Fifteen participants (nine women) aged between 18 and 41 years took part. RESULTS Response rates of 63% and 68% were obtained for tVEMPs with eyes open and closed, respectively. When present, tVEMP latencies and amplitudes exhibited fair to good repeatability. Repeatability of tVEMP latencies and amplitudes measured using Bland-Altman methods was poorer with eyes closed. CONCLUSIONS Sound-evoked tVEMP response rates are too low to support their clinical utility at the moment. tVEMP response rate may be improved by refining the balance task to include a force related target. Better tVEMP repeatability with eyes open supports the hypothesis that the response is modulated by visual feedback, and is consistent with studies reporting triceps responses to galvanic stimulation.
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Normalization Reduces Intersubject Variability in Cervical Vestibular Evoked Myogenic Potentials. Otol Neurotol 2014; 35:e222-7. [DOI: 10.1097/mao.0000000000000449] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Does the human immunodeficiency virus influence the vestibulocollic reflex pathways? A comparative study. The Journal of Laryngology & Otology 2014; 128:772-9. [PMID: 25166876 DOI: 10.1017/s0022215114001996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study compared vestibulocollic reflex and vestibulo-ocular reflex functioning in subjects with and without human immunodeficiency virus. It also described test results throughout progression of the disease and compared the results of human immunodeficiency virus positive subjects who were receiving antiretroviral therapies with those not receiving this treatment. METHODS Subjects comprised 53 adults with human immunodeficiency virus (mean age 38.5 ± 4.4 years) and 38 without human immunodeficiency virus (mean age 36.9 ± 8.2 years). Clinical examinations included cervical vestibular-evoked myogenic potential and bithermal caloric testing. RESULTS Abnormal cervical vestibular-evoked myogenic potential and caloric results were significantly higher in the human immunodeficiency virus positive group (p = 0.001), with an odds ratio of 10.2. Vestibulocollic reflex and vestibulo-ocular reflex involvement increased with progression of the disease. There were more abnormal test results in subjects receiving antiretroviral therapies (66.7 per cent) than in those not receiving antiretroviral therapies (63.6 per cent), but this difference was insignificant. CONCLUSION Human immunodeficiency virus seems to influence vestibulocollic reflex pathways. Combining cervical vestibular-evoked myogenic potential and caloric testing may be useful to detect early neurological involvement in human immunodeficiency virus positive subjects.
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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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Heinze BM, Vinck BM, Hofmeyr LM, Swanepoel DW. Vestibular involvement in adults with HIV/AIDS. Auris Nasus Larynx 2014; 41:160-8. [DOI: 10.1016/j.anl.2013.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/16/2013] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
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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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Tseng CC, Wang SJ, Young YH. Comparison of head elevation versus rotation methods for eliciting cervical vestibular-evoked myogenic potentials via bone-conducted vibration. Int J Audiol 2013; 52:200-6. [DOI: 10.3109/14992027.2012.754108] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The efficiency of simultaneous binaural ocular vestibular evoked myogenic potentials: a comparative study with monaural acoustic stimulation in healthy subjects. Clin Exp Otorhinolaryngol 2012. [PMID: 23205222 PMCID: PMC3506768 DOI: 10.3342/ceo.2012.5.4.188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objectives To evaluate the test-retest reliability and convenience of simultaneous binaural acoustic-evoked ocular vestibular evoked myogenic potentials (oVEMP). Methods Thirteen healthy subjects with no history of ear diseases participated in this study. All subjects underwent oVEMP test with both separated monaural acoustic stimulation and simultaneous binaural acoustic stimulation. For evaluating test-retest reliability, three repetitive sessions were performed in each ear for calculating the intraclass correlation coefficient (ICC) for both monaural and binaural tests. We analyzed data from the biphasic n1-p1 complex, such as latency of peak, inter-peak amplitude, and asymmetric ratio of amplitude in both ears. Finally, we checked the total time required to complete each test for evaluating test convenience. Results No significant difference was observed in amplitude and asymmetric ratio in comparison between monaural and binaural oVEMP. However, latency was slightly delayed in binaural oVEMP. In test-retest reliability analysis, binaural oVEMP showed excellent ICC values ranging from 0.68 to 0.98 in latency, asymmetric ratio, and inter-peak amplitude. Additionally, the test time was shorter in binaural than monaural oVEMP. Conclusion oVEMP elicited from binaural acoustic stimulation yields similar satisfactory results as monaural stimulation. Further, excellent test-retest reliability and shorter test time were achieved in binaural than in monaural oVEMP.
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De Kegel A, Maes L, Baetens T, Dhooge I, Van Waelvelde H. The influence of a vestibular dysfunction on the motor development of hearing-impaired children. Laryngoscope 2012; 122:2837-43. [DOI: 10.1002/lary.23529] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/02/2012] [Accepted: 05/29/2012] [Indexed: 11/09/2022]
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Menant JC, St George RJ, Fitzpatrick RC, Lord SR. Perception of the postural vertical and falls in older people. Gerontology 2012; 58:497-503. [PMID: 22759640 DOI: 10.1159/000339295] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 05/07/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research on the relationship between vestibular function and falls in older people is sparse. The perception of the postural vertical (PPV) provides an indicator measure of vestibular (otolith) function in the absence of visual input and diminished somatosensory feedback. OBJECTIVE This study examined whether impaired PPV is associated with falls in this group. METHODS One hundred and ninety-five people aged 70 plus years stood blindfolded on a motorised platform that could be tilted in the roll plane and attempted to adjust it so that their bodies were aligned to the vertical. Somatosensory feedback was minimised as the base and vertical support surfaces on the tilting platform were covered in thick soft foam rubber. PPV error from true vertical and PPV variability (°) were calculated. Participants also underwent an assessment of distal tactile sensitivity and the physiological profile assessment (PPA); fallers were defined as those who had one or more falls during a prospective 12-month follow-up period. RESULTS Eighty-eight participants (45%) reported falling in the follow-up year. Increased PPV error and variability were correlated with increased lateral sway in a condition of absent visual input and reduced foot somatosensory feedback (eyes closed/foam; r range = 0.16-0.20, p < 0.05) and with composite PPA fall risk scores (r range = 0.22-0.26, p < 0.05). PPV variability was a significant and independent predictor of falls after adjusting for the composite PPA scores, age and gender [adjusted RR = 1.42 (1.01-1.98)]. CONCLUSIONS Older people with increased PPV variability are at increased risk of falls. These findings indicate that assessment of PPV may augment fall risk assessments in older people.
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Affiliation(s)
- Jasmine C Menant
- Neuroscience Research Australia, University of New South Wales, Sydney, N.S.W., Australia
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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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Maes L, Vinck BM, Wuyts F, D'haenens W, Bockstael A, Keppler H, Philips B, Swinnen F, Dhooge I. Clinical usefulness of the rotatory, caloric, and vestibular evoked myogenic potential test in unilateral peripheral vestibular pathologies. Int J Audiol 2011; 50:566-76. [PMID: 21751944 DOI: 10.3109/14992027.2011.576706] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the diagnostic capacity of three different rotatory tests, and to investigate the clinical effectiveness of the caloric, rotatory, and vestibular evoked myogenic potential (VEMP) test. DESIGN AND STUDY SAMPLE Several rotatory tests--sinusoidal harmonic acceleration test (SHAT), pseudorandom rotation test (PRRT), velocity step test (VST)--and a caloric and a VEMP test, were given to 77 patients (mean age 52 years) with a unilateral peripheral vestibular pathology, and 80 control subjects (mean age 48 years). RESULTS For the rotatory test, the highest diagnostic capacity was obtained with the 0.01 Hz SHAT frequency, followed by 0.1 and 0.05 Hz. A higher diagnostic accuracy was reached for the caloric and VEMP test. The caloric test demonstrated high sensitivity and specificity values, but the 0.01 Hz SHAT rotation appeared more sensitive, and the VEMP more specific, than the caloric test. CONCLUSION A selection of the 0.01, 0.05, and 0.1 Hz SHAT rotations is suggested as the most ideal rotatory test protocol, and a combination of rotatory, caloric, and VEMP testing will result in a more complete examination of our vestibular system.
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Affiliation(s)
- Leen Maes
- ENT (Ear Nose Throat) Department, Faculty of Medicine, Ghent University, De Pintelaan 185, Ghent, Belgium.
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Tourtillott BM, Ferraro JA, Bani-Ahmed A, Almquist E, Deshpande N. Age-related changes in vestibular evoked myogenic potentials using a modified blood pressure manometer feedback method. Am J Audiol 2010; 19:100-8. [PMID: 20966352 DOI: 10.1044/1059-0889(2010/10-0021)] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To collect age-specific vestibular evoked myogenic potential (VEMP) data and to characterize age-related differences in VEMP parameters using a modified blood pressure manometer (BPM) method of sternocleidomastoid (SCM) muscle monitoring. METHODS VEMPs were recorded on healthy adults ranging in age from 23 to 84 years with no history of dizziness, neuromuscular pathologies, or cervical complaints. Participants were assigned to 3 groups using a nonprobability static group assignment based on their age. VEMP P1 and N1 latency, threshold, peak-to-peak amplitude, and interamplitude difference (IAD) ratios were obtained at 130 dB SPL. RESULTS Statistical differences were detected in peak-to-peak mean amplitude and threshold measures among groups. Post hoc analysis revealed that differences shown were between the young group and both older groups. No significant differences were noted in P1 and N1 latencies or IAD ratios. CONCLUSIONS This study confirmed a significant decline in VEMP amplitude and increase in VEMP thresholds in healthy older persons. Normative age-related data may be necessary to properly interpret VEMP recordings in a clinical setting when evaluating aging populations. The BPM method utilized for controlling SCM muscle may be a valuable alternative to control SCM muscle contraction when electromyography equipment is not available.
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Eleftheriadou A, Koudounarakis E. Vestibular-evoked myogenic potentials eliciting: an overview. Eur Arch Otorhinolaryngol 2010; 268:331-9. [PMID: 20963599 DOI: 10.1007/s00405-010-1408-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 10/08/2010] [Indexed: 02/07/2023]
Abstract
Recently, the favoured approach for unilateral testing of saccular function is the recently developed method of vestibular-evoked myogenic potentials (VEMPs). VEMP testing is a reliable technique, since it selectively stimulates and investigates each lateral canal in isolation from the other, providing information for the assessment of otolith function and inferior vestibular nerve integrity. The aim of this study was to provide a current review of the different methods used to record VEMPs. We noticed discrepancies in relation to the ways used to record the VEMPs in relation to the following factors: types of stimuli used (clicks or tone bursts) and body muscles tested, patient position at the time of recording, response, type of phone used and way of stimulus presentation (mono or binaural, ipsi or contralateral) and others. As a conclusion, despite the numerous studies in the field, there is no consensus in the literature as to the best recording method for VEMPs. However, the new ocular VEMPs in response to bone conducted vibration seem to be of clinical importance for the evaluation of utricular function. Further research is needed to support its clinical usefulness.
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Affiliation(s)
- Anna Eleftheriadou
- Department of Otolaryngology, General Hospital of Rethymnon, PO Box 269, Rethymnon, 74100 Crete, Greece.
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Test-retest reliability and age-related characteristics of the ocular and cervical vestibular evoked myogenic potential tests. Otol Neurotol 2010; 31:793-802. [PMID: 20517167 DOI: 10.1097/mao.0b013e3181e3d60e] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the test-retest reliability and age-related trends of the cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP, respectively) responses to air-conducted sound and bone-conducted vibration stimulation. STUDY DESIGN Prospective study. SETTING Tertiary referral center. PATIENTS Fifty-three healthy adults with no hearing or vestibular deficits. INTERVENTION(S) All subjects underwent cVEMP and oVEMP testing in response to sounds (0.1-ms clicks and 500-Hz tone bursts) and vibration (midline forehead taps at the hairline, Fz, with a reflex hammer and a Brüel & Kjaer Mini-Shaker Type 4810). Twelve subjects underwent an additional testing session that was conducted at a mean of 10 weeks after the first one. MAIN OUTCOME MEASURE(S) Test-retest reliability for VEMP response parameters (latency, peak-to-peak amplitude, and asymmetry ratio) were assessed using the intraclass correlation coefficient (ICC). RESULTS : oVEMP amplitudes had excellent test-retest reliability (ICC > 0.75) for all 4 stimuli; cVEMP amplitudes had excellent reliability for hammer taps and fair-to-good reliability for other stimuli. oVEMP asymmetry ratios had excellent reliability for clicks and fair-to-good reliability (ICC = 0.4-0.75) for other stimuli; cVEMP asymmetry ratios had fair-to-good reliability for clicks and hammer taps. Older subjects (>50 years old) were found to have significantly decreased cVEMP amplitudes in response to clicks, tones, and taps with a Mini-Shaker and significantly decreased oVEMP amplitudes in response to clicks, tones, and taps with a reflex hammer. No age-related changes were found for latencies or asymmetry ratios. CONCLUSION Overall, oVEMP response parameters demonstrated better test-retest reliability than cVEMP response parameters, but oVEMPs and cVEMPs had similar age-related changes.
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Brainstem representation of vestibular evoked myogenic potentials. Clin Neurophysiol 2010; 121:1102-8. [DOI: 10.1016/j.clinph.2010.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 01/25/2010] [Accepted: 02/07/2010] [Indexed: 11/19/2022]
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The effect of age on the sinusoidal harmonic acceleration test, pseudorandom rotation test, velocity step test, caloric test, and vestibular-evoked myogenic potential test. Ear Hear 2010; 31:84-94. [PMID: 19779351 DOI: 10.1097/aud.0b013e3181b9640e] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Age-related anatomical and morphologic vestibular deterioration has already been elaborated. Demonstrating a corresponding degradation in physiologic function, however, entails a much higher challenge. The objective of this study was to investigate age-related changes using rotational tests, caloric tests, and the vestibular-evoked myogenic potentials (VEMP) test. DESIGN Eighty healthy human subjects (38 men and 42 women) ranging in age from 18 to 80 yrs participated in this study and were subjected to an extensive vestibular test battery. Function tests included sinusoidal harmonic acceleration tests, a pseudorandom rotation test, velocity step tests, a caloric test, and a VEMP test. RESULTS No significant age trends were noted for the sinusoidal harmonic acceleration test and velocity step tests response parameters, in contrast to subtle decreasing gain values with advancing age for the pseudorandom rotation test. Increasing slow-component velocity values were measured with the caloric test, whereas the frequency parameter showed no relevant age changes. The largest age trends were detected with the VEMP, with decreasing amplitudes, increasing thresholds, and decreasing N1 latencies. All asymmetry parameters remained stable across the different age categories. CONCLUSIONS Only subtle age changes could be demonstrated with the rotational and caloric tests, in contrast to more pronounced age trends with the VEMP.
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