Tone Burst Masseter Vestibular Evoked Myogenic Potentials: Normative Values and Test-Retest Reliability

Masseter and cervical vestibular evoked myogenic potentials in individuals with auditory neuropathy

OBJECTIVE

This study aimed to explore the functional integrity of vestibulo-masseteric and sacculo-collic reflex pathways in individuals with Auditory Neuropathy (AN). The study also aimed at finding the correlation between mVEMP and cVEMP response parameters for AN and healthy individuals.

DESIGN

Standard group comparison research design.

STUDY SAMPLE

Individuals with AN (n = 20); age-gender matched healthy individuals (n = 20) were recruited. Each participant underwent routine audiological evaluation; mVEMP and cVEMP testing. mVEMP and cVEMP were recorded using 500 Hz tone burst stimulus for all the participants.

RESULTS

Most of the AN individuals had no mVEMP (ipsilateral & contralateral - 60%; bilateral - 50%) and cVEMP (60%) responses. There was no significant association (p > 0.05) between the duration of AN with mVEMP and cVEMP findings. However, a significant correlation (p < 0.05) was found for EMG rectified amplitude of mVEMP and cVEMP in AN.

CONCLUSION

The results of this study suggested an impaired function of the vestibulomassteric and sacculocollic reflex pathways in individuals with AN. Vestibular evaluation should be included as a part of the regular test battery for individuals with AN.

Decoding Age-Linked Masseter Vestibular Evoked Myogenic Potential Changes in Healthy, Aging Individuals

PURPOSE

The primary objective of this study was to assess how age influences masseter vestibular evoked myogenic potential (mVEMP) parameters by utilizing 500-Hz tone burst stimuli delivered through air conduction.

METHOD

The study involved 110 participants ranging from 15 to 60 years of age, grouped into five categories, all of whom had no previous issues related to their vestibular system. The participants were exposed to 500-Hz tone burst stimuli at 125 dB SPL through ER-3A inserts. These stimuli were presented to one ear at a time, with alternating polarity. A Tukey's honestly significant difference test was conducted to compare rectified and unrectified amplitude, along with latencies (P11 and N21) and the asymmetric ratio across all age groups. Additionally, a multivariate analysis of variance was performed to assess the impact of sex on the study variables.

RESULTS

All 110 participants (220 ears) in the study provided mVEMP responses, encompassing 100% of the subjects. The results revealed a significant reduction in both amplitude and latency extension for the P11 and N21 peaks. Interestingly, P11 latency was also prolonged in the youngest participants (Group 1), suggesting ongoing maturation of the system even beyond the age of 16 years. Moreover, a significant sex difference was observed in the P11 latencies. However, there were no substantial sex differences (p > .05) in N1 peak latency, peak-to-peak amplitude, rectified amplitude, and asymmetric ratio.

CONCLUSIONS

Changes in structure occur due to degeneration, and the quantity of vestibular sensory hair cells gradually diminishes with age. The rate of decline is faster in semicircular canals compared to end organs, as observed by Merchant et al. (2000). Following a linear degeneration starting at the age of 40 years, a continuous reduction in sensory cells and primary neurons takes place until approximately 40% of vestibular sensory cells are lost by the age of 75 years and insufficient maturation can lead to prolonged peaks and reduced amplitudes compared with those that are considered normal. Therefore, it is crucial to consider the age of the participants when making diagnoses and incorporate relevant correction factors based on age-related reference data.

Evaluation of Masseteric Vestibular Evoked Myogenic Potentials in Patients With Migraine

PURPOSE

Masseter vestibular evoked myogenic potentials (mVEMP) involve the connection between the vestibular complex and trigeminal nerve nuclei. Given the theory that migraine is caused by increased activation of the trigeminal nerve, it is believed that mVEMP responses may have influenced in migraine patients.

METHOD

The study included 20 individuals with migraine and 20 healthy controls. Latency, amplitude, and interaural amplitude asymmetry ratio of mVEMP responses recorded in migraine patients were compared with control group.

RESULTS

Considering the mVEMP normalization study conducted by Başöz et al. (2021) in a similar age group and in the same clinic, latency prolongation and amplitude decrease were observed in subjects with migraines. Migraine is considered a central pathology, as shown in the cervical and ocular VEMP (cVEMP/oVEMP) literature. No difference was observed in the interaural amplitude asymmetry ratio, which is important in peripheral pathologies. Additionally, when the number of pathological ears was examined in order to understand the total exposure, it was observed that the number of pathological ears was significantly higher in the migraine group.

CONCLUSION

In future studies, using mVEMP together with cVEMP and oVEMP tests, which allow evaluation of otolith organs and vestibular nuclei, will be valuable in determining the lesion location.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25607901.

Measurement of Ocular Vestibular Evoked Myogenic Potentials: Nasion Reference Montage as an Alternative to the Clinical Standard Montage

OBJECTIVE

To compare two novel electrode montages for ocular, vestibular evoked myogenic potential using single-nasion reference electrodes with the clinical standard montage.

STUDY DESIGN

Randomized crossover experiment.

SETTING

Tertiary referral center.

PARTICIPANTS

Sixty healthy participants.

INTERVENTION

Normal hearing and vestibular function were confirmed with an extensive test-battery. All ocular, vestibular evoked myogenic potential settings were measured with air-conducted tone bursts at 100-dB normal hearing level and a frequency of 500 Hz. Three electrode montages were measured in randomized order: the clinical standard montage ("S"), the nasion reference montage ("N"), and the nasion reference montage with a more lateral active electrode ("L"). Upgaze was standardized to 35 degrees.

MAIN OUTCOME MEASURES

Detection rate, latency of N1 and P1, peak-to-peak amplitude of N1 and P1, signal-to-noise ratio (SNR), asymmetry ratio (AR), concordance of expert assessment, and reliability.

RESULTS

All electrode montages showed detection rates greater than 90%. Latencies for "L" were shorter than for "S" and "N." Amplitudes and SNR for "S" and "N" were higher than for "L," whereas the values for "S" and "N" did not differ significantly. For AR, no significant differences between the montages were assessed. Concordance of experts ranged from 78% for "L" and 89.8% for "N." All montages provided excellent day-to-day reliability (intraclass correlation coefficient ≥0.9) for amplitudes and SNR.

CONCLUSIONS

Montage N could be a useful alternative to the clinical standard montage: although results are roughly equivalent, montage N requires one less electrode to do so.

Masseter Vestibular evoked myogenic potentials: A new tool to assess the vestibulomasseteric reflex pathway

Purpose

This review article provides the readers with an in-depth insight in understanding and interpreting various research literatures on the masseter vestibular evoked myogenic potentials (mVEMP). The article also reviews the contemporary researches involving the clinical applications of the mVEMP.

Conclusions

Masseter VEMP is an evolving yet clinically promising neuro-otology test tool that has recently gained more research interest and is considered an additional tool to diagnose various vestibular disorders. Masseter VEMP assesses the functional integrity of the acoustic-masseteric and vestibulo-masseteric reflex pathways. The mVEMP could be used as a complementary test to evaluate the same peripheral generator as the cervical VEMP but a different central pathway i.e., vestibulo-trigeminal pathway. Various research studies that have experimented on parameters such as the effect of different electrode montages (zygomatic vs mandibular configurations), stimulation rates, filter settings and stimuli used to evoke mVEMP have been discussed in this article that could assist in the optimization of a comprehensive clinical protocol. The latency and the amplitude of mVEMP waveforms serve as significant parameters in differentiating normals from those of the clinical populations. Along with the cVEMPs and oVEMPs, mVEMP might help diagnose brainstem lesions in REM Sleep behaviour disorders, Multiple Sclerosis and Parkinson's disease. However, further studies are required to probe in this area of research.

The Auricular Injection Technique: A New Treatment for Lying Ear

SUMMARY

Lying-ear deformity refers to an auricle that bends backward excessively, is excessively folded against the head, and has a very prominent antihelix. It usually requires experienced surgeons to perform surgical treatment and a prolonged postoperative recovery process. This article proposes a simple and effective hyaluronic acid injection technique that significantly improves the shape of the outer ear and enhances perceived facial aesthetics. Twenty patients underwent treatment with multiple injections. Measure-related parameters were used to evaluate the postoperative effect, and the results were graded using a visual analog scale. Interrater reliability among graders was evaluated using intraclass correlation coefficients. After treatment, no serious complications, such as infection or embolism, occurred. Six months after the procedure, the average auriculocephalic angle increased from 25.11 ± 9.46 to 32.72 ± 8.29 degrees, the average conchoscaphal angle increased from 87.69 ± 9.06 to 95.94 ± 7.11 degrees, and patients' average visual analog scale score increased from 4.40 ± 1.14 to 8.57 ± 0.68. Interrater reliability was fair to good for visual analog scale before injection and 6 months after injection (intraclass correlation coefficients, 0.49 and 0.45, respectively; both P < 0.001). The patients were satisfied with the injection process and results. This injection protocol improved the shape of the outer ear, resulting in excellent postoperative outcomes.

Multifrequency Analysis of Masseter Vestibular Evoked Myogenic Potentials in Young Adults

PURPOSE

The purpose of this study was to explore the dynamics of multifrequency tone bursts on the masseter vestibular evoked myogenic potential (mVEMP) parameters. Furthermore, it sought to determine the optimal frequency tuning of mVEMP responses.

METHOD

Twenty young adults with normal hearing sensitivity participated in the study. Bilateral tone burst evoked mVEMPs were obtained using the zygomatic montage at 250-, 500-, 750-, 1000-, 1500-, and 2000-Hz stimulation frequencies. Self-monitoring biofeedback was given during the procedure to confirm the tension of the masseter muscle between 49.9 and 150.6 rms. Furthermore, the electromyography (EMG) scaling was done to avoid any muscle-related irregularities.

RESULTS

Tone burst evoked mVEMPs were found to be 100% present at the stimulation frequencies of 250, 500, 750, and 1000 Hz. There were no ear and gender effects seen for any of the frequencies. Significant shortening of the P1 and N1 latencies with increasing stimulation frequencies was observed. The peak-to-peak amplitude was the highest at 500 Hz and lowest at 2000 Hz tone bursts under both EMG scaled and unscaled conditions.

CONCLUSION

The present revealed higher response rates and larger amplitudes study of mVEMP at lower frequencies, and, therefore, the frequency tuning was seen for the stimulation frequency at 500 Hz.

Characteristics of ipsilateral, contralateral and bilateral masseter vestibular-evoked myogenic potential in healthy adults

OBJECTIVE

This study aimed to characterise the ipsilateral, contralateral and bilateral masseter vestibular-evoked myogenic potential using clicks and 500 Hz tone burst stimuli in healthy adults.

METHOD

Masseter vestibular-evoked myogenic potential was recorded from 20 healthy participants aged 19-28 years (11 males and 9 females). Masseter vestibular-evoked myogenic potential was recorded using 500 Hz tone burst and click stimuli in ipsilateral, contralateral and bilateral modes.

RESULTS

A statistically significant difference was observed between ipsilateral and contralateral stimulation for p11 latency, n21 latency and p11-n21 amplitude for both click and 500 Hz tone burst stimuli. The amplitude of the p11-n21 complex was higher for ipsilateral, contralateral and bilateral stimulations for 500 Hz tone burst than for click stimulus.

CONCLUSION

This study showed a significant difference for p11-n21 amplitude between click and 500 Hz tone burst evoked masseter vestibular-evoked myogenic potential. In addition, bilateral stimulation elicited a larger response than ipsilateral and contralateral stimulation.

Comparison of Chirp Versus Tone Burst- and Click-Evoked Masseteric Vestibular Evoked Myogenic Potentials in Normal-Hearing Adults

PURPOSE

This study aimed at comparing narrowband Claus Elberling level-specific chirp (NB CE-Chirp)-, click-, and tone burst-evoked masseteric vestibular evoked myogenic potentials (mVEMPs).

METHOD

Within-group study design and purposive sampling were performed. A total of 25 normal-hearing individuals participated in the study. The zygomatic electrode montage was used to elicit ipsilateral mVEMP responses using a 500-Hz NB CE-Chirp, a click of 100-μs duration, and a 500-Hz tone burst stimulus. Each of the responses was analyzed based on the absolute peak latency of P11 and N21, the electromyography-scaled peak-to-peak amplitude of the P11-N21 complex, and the interaural asymmetry ratio.

RESULTS

A total of 50 ears were tested and had 100% mVEMP responses. The latencies of click-evoked and 500-Hz NB CE-Chirp-evoked mVEMPs were significantly shorter than those of 500-Hz tone burst-evoked mVEMPs (p < .05) for both ears. It revealed a significantly superior P11-N21 amplitude of the 500-Hz NB CE-Chirp and tone burst than clicks for both ears. Intraclass correlation coefficient revealed moderate to excellent test-retest reliability for mVEMP parameters across three different stimulations.

CONCLUSION

The present study supports 500 Hz NB CE-Chirps as effective and reliable stimuli as tone bursts in eliciting mVEMP responses.

[Method of registration of vestibular myogenic evoked potentials in the diagnosis of diseases of the inner ear]

The literature review is devoted to the practical application of the method of recording vestibular evoked myogenic potentials (VEMPs) in the diagnosis of the inner ear diseases: superior semicircular canal dehiscence syndrome, Meniere's disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis. Registration of VMEP is an electrophysiological research method that allows to assess objectively the functional state of the otolith receptors (sacculus and utriculus) and their pathways, which expands the diagnostic capabilities in diagnosis of the inner ear diseases.

Effect of Electrode Montage on 500-Hz Tone Burst Evoked Masseter Vestibular Evoked Myogenic Potential

PURPOSE

Masseter vestibular evoked myogenic potentials (VEMPs) are short-latency myogenic responses obtained in response to electric or acoustic stimulation. It is a relatively newer test that helps assess the vestibulo-trigeminal pathway, thereby gaining more interest in brainstem pathologies like Parkinsonism, multiple sclerosis, and idiopathic random eye movement disorders. The purpose of the study was to compare the effect of zygomatic versus mandibular reference montage on the latency and amplitude of masseter VEMP (mVEMP) using a 500-Hz tone burst stimulus.

METHOD

Twenty healthy participants in the age range of 18-29 years, with no complaints of vestibular signs and symptoms, were recruited for the study. VEMP was recorded for all the participants using 500-Hz tone burst stimuli in zygomatic electrode montage and mandibular electrode montage. mVEMP was recorded in both ipsilateral and contralateral modes.

RESULTS

The Wilcoxon signed-ranks test revealed no significant difference between the zygomatic and mandibular montage for both the latency and amplitude parameters (p > .05).

CONCLUSIONS

This study revealed no significant difference in p11 and n21 latencies as well as p11-n21 rectified amplitude between zygomatic and mandibular montage using a 500-Hz tone burst stimulus in young adults. Hence, utilizing a 500-Hz tone burst, mVEMP can be recorded in zygomatic and mandibular electrode montage.

[Myotonia-rectified bone-conducted vibration vestibular evoked myogenic potential in normal adults]

Objective:To study the characteristics of bone-conducted vibration vestibular evoked myogenic potential（BCV-VEMP） in normal adult with and without myotonia rectification, and to provide accurate reference for clinical vestibular function evaluation. Methods:Thirty normal adults（60 ears） aged 20-32 years old were selected to receive BCV-VEMP in a sitting position. BCV-VEMP were induced by B-81 bone-conducted vibrator at 129.5 FL, the P1 latency, N1 latency, P1-N1interval, amplitude, and amplitude asymmetry ratios were recorded in two test conditions. Results:Clear and repeatable waveforms of BCV-cVEMP and BCV-oVEMP were obtained in all normal adults. The P1 and N1 latencies of BCV-cVEMP were（16.00±2.02） ms and（25.04±2.57） ms, respectively, P1-N1 interval was（9.04±1.78） ms. The N1 and P1 latencies of BCV-oVEMP were（10.39±0.81） ms and（15.85±1.00） ms, respectively, iand interval was（5.46±0.86） ms. The amplitudes of BCV-cVEMP and BCV-oVEMP in two test conditions were statistically significant（P<0.05）. The amplitude asymmetry ratios of BCV-cVEMP and BCV-oVEMP after rectification were （17.03±9.14）% and （20.43±11.65）%, respectively. Conclusion:BCV-VEMP is a feasible and reliable tool for vestibular function assessment. The establishment of a normal values such as amplitude and amplitude asymmetry ratio after rectification can provide a more reliable and accurate reference.