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Bassett AM, Suresh C. Infant Cervical Vestibular Evoked Myogenic Potentials: A Scoping Review. Ear Hear 2024:00003446-990000000-00325. [PMID: 39099011 DOI: 10.1097/aud.0000000000001548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
OBJECTIVES Children diagnosed with hearing loss typically demonstrate increased rates of vestibular loss as compared with their peers, with hearing within normal limits. Decreased vestibular function is linked with delays in gross motor development, acquisition of gross motor skills, and academic challenges. Timely development of sitting and walking gross motor skills aids in the progress of environmental exploratory activities, which have been tied to cognitive, language, and vocabulary development. Considering the time-sensitive development of gross motor skills and cognitive, language, and vocabulary development, identifying vestibular loss in infancy can support early intervention. This scoping review analyzes stimulus, recording, and participant factors relevant to assessing cervical vestibular evoked myogenic potentials (cVEMPs) in the infant population. DESIGN The scoping literature review was conducted on literature published between 2000 and 2023, focusing on articles assessing cVEMPs in infants. Two authors independently followed Preferred Reporting Items for Systematic and Meta-Analysis guidelines for title and abstract screening, full-text review, data extraction, and quality assessments. Sixteen articles meeting the inclusion criteria were included in the analysis. RESULTS The existing literature lacks consensus regarding stimulus and recording parameters for measuring infant cVEMPs. In addition, the review reveals a decrease in cVEMP response occurrence rates with the severity of hearing loss, especially in cases of severe to profound hearing loss, compared with mild to moderate sensorineural hearing loss in infants. CONCLUSIONS This scoping review demonstrates the increasing use of cVEMP as a reliable tool for objectively assessing infant vestibular function. The lack of consensus in stimulus and recording parameters emphasizes the need for systematic research to establish an evidence-based protocol for cVEMP measurements in infants. Such a protocol will ensure the reliable measurement of cVEMPs in infants and enhance the effectiveness of cVEMP as part of the infant vestibular test battery. In addition, there is a necessity for a comprehensive large-scale study to evaluate the practicality and feasibility of implementing vestibular screening protocols for infants diagnosed with sensorineural hearing loss in the United States.
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Affiliation(s)
- Alaina M Bassett
- Department of Communication Disorders, California State University, Los Angeles, Los Angeles, California, USA
- Dual first authorship request
| | - Chandan Suresh
- Department of Communication Disorders, California State University, Los Angeles, Los Angeles, California, USA
- Dual first authorship request
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Karaçaylı C, Karababa E, Satar B. Bone conducted cervical vestibular evoked myogenic potentials: comparison of tone burst stimulus vs chirp stimulus. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08886-5. [PMID: 39098957 DOI: 10.1007/s00405-024-08886-5] [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: 04/21/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Vestibular evoked myogenic potential (VEMP) is a test used to evaluate the function of otolith organs. In healthy individuals, air-conducted (AC) responses are obtained, whereas, in conductive hearing loss, the inability to transmit the signal well enough with AC stimuli has led to the need for bone-conducted (BC) stimuli. This study aimed to compare 500 Hz Chirp and Tone Burst stimuli in terms of latency and amplitude in BC cVEMP. METHODS This prospective observational case control study included 35 healthy participants (70 ears) between the age of 20-50. Participants underwent VEMP testing with BC 500 Hz Tone Burst stimulus and 500 Hz narrow band Chirp stimulus without changing the position of the bone conducted vibrator. The intensity of the stimuli was 50 dB nHL. RESULTS Response rate of 500 Hz TB Stimulus was 51.4% and 95.7% in Chirp stimulus. It was observed that significantly more responses were obtained with Chirp stimulus than TB stimulus (p < 0.001). In terms of p1 latency, n1 latency, both latencies were significantly shorter in Chirp stimulus (p < 0.001). p1n1 amplitude was found significantly larger in Chirp stimulus (p < 0.001). CONCLUSION Compared to 500 Hz TB stimulus, 500 Hz Chirp stimulus results in a higher response rate, larger p1n1 amplitude, and shorter p1 and n1 latency. A higher response rate may provide a more accurate assessment of otolith organs, reducing false negatives due to signal transmission in patients.
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Affiliation(s)
- Ceren Karaçaylı
- Department of Otorhinolaryngology, University of Health Sciences, Gülhane Traning and Research Hospital, Ankara, Turkey.
- Department of Audiology, Gulhane Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey.
| | - Ercan Karababa
- Department of Otorhinolaryngology, University of Health Sciences, Gülhane Traning and Research Hospital, Ankara, Turkey
- Department of Audiology, Gulhane Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey
| | - Bülent Satar
- Department of Otorhinolaryngology, University of Health Sciences Gulhane Faculty of Medicine, Ankara, Turkey
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Zakaria MN, Salim R, Anual MSI, Patuzzi R. The Narrowband CE-Chirp Stimulus Does Not Necessarily Produce More Robust Cervical Vestibular Evoked Myogenic Potential. Ear Hear 2024; 45:1010-1018. [PMID: 38383959 DOI: 10.1097/aud.0000000000001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Various studies have been conducted to search for the most optimal stimulus for eliciting cervical vestibular evoked myogenic potential (cVEMP). More recently, there is a growing interest to study the usefulness of chirp stimuli in cVEMP recording. Nevertheless, contradictory outcomes have been reported across the studies, and further research with larger samples would be beneficial to provide better insight into this matter. As such, the present study was carried out to compare cVEMP results between narrowband (NB) CE-Chirp (centered at 500 Hz) and 500 Hz tone burst stimuli. DESIGN In this study that employed a comparative study design, 98 normally hearing adults aged between 19 and 24 years were enrolled. All of them underwent the cVEMP testing based on the recommended test protocol. The stimuli were a 500 Hz tone burst and a NB CE-Chirp (360-720 Hz) presented through insert earphones at an intensity level of 120.5 dB peSPL. RESULTS For each stimulus, cVEMP results did not differ significantly between the ears ( p > 0.05). Relative to the 500 Hz tone burst, the NB CE-Chirp stimulus produced statistically shorter P1 and N1 latencies ( p < 0.001). On the other hand, P1-N1 amplitude was found to be comparable between the two stimuli ( p > 0.05). CONCLUSIONS The present study did not find any supporting evidence that the NB CE-Chirp stimulus (centered at 500 Hz) outperformed the conventional 500 Hz tone burst in the cVEMP testing. Both stimuli are considered equally appropriate to record cVEMP responses in clinical settings.
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Affiliation(s)
- Mohd Normani Zakaria
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Rosdan Salim
- Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Muhammad Shafiq Imran Anual
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Demant Malaysia Sdn Bhd, Plaza Mont Kiara, Mont Kiara, Kuala Lumpur, Malaysia
| | - Robert Patuzzi
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Zakaria MN, Abdallatif AMR, Wan Mohamad WN, Rashid MFN, Patuzzi R, Abdullah B, Salim R, Omar M. A meta-analysis comparing the performance of narrowband CE-Chirp and 500 Hz tone burst stimuli in recording cervical vestibular evoked myogenic potential (cVEMP). Sci Rep 2024; 14:14707. [PMID: 38926500 PMCID: PMC11208609 DOI: 10.1038/s41598-024-64402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Due to contradictory outcomes in the literature, the aim of this meta-analysis is to verify whether the narrowband (NB) CE-Chirp stimulus (centred at 500 Hz) would produce more robust cervical vestibular evoked myogenic potential (cVEMP) responses relative to the conventional 500 Hz tone burst. The literature search was conducted using PubMed, Scopus, and Web of Science databases and the terms used were "vestibular evoked myogenic potential" and "chirp". The cVEMP parameters to be analysed were P1 latency, N1 latency, and P1-N1 amplitude. A total of 59 potential articles were obtained from the database search. Eventually, five articles were found to be eligible for the meta-analysis (with n = 222). As found, P1 and N1 latencies of cVEMP were significantly shorter for the chirp stimulus (p < 0.001), with substantially large effect sizes. On the other hand, P1-N1 amplitude values were found to be not statistically different between the two stimuli (p = 0.189), with a small effect size. It appears that there is no indication to support the superiority of the NB CE-Chirp stimulus (centred at 500 Hz) in the cVEMP testing (relative to the conventional 500 Hz tone burst). In particular, both stimuli produce comparable P1-N1 amplitude values. Even though P1 and N1 latencies are statistically shorter for the chirp stimulus, this may not reflect that it should be the preferred stimulus for recording cVEMP responses (and the reasons for this are discussed accordingly).
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Affiliation(s)
- Mohd Normani Zakaria
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - Wan Najibah Wan Mohamad
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Fadzil Nor Rashid
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Robert Patuzzi
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Rosdan Salim
- Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Marniza Omar
- Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Scherer F, Beule AG, Lütkenhöner B, Heitkötter F, Rudack C. Measurement of Ocular Vestibular Evoked Myogenic Potentials: Nasion Reference Montage as an Alternative to the Clinical Standard Montage. Otol Neurotol 2024; 45:e57-e65. [PMID: 38085768 DOI: 10.1097/mao.0000000000004046] [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: 12/18/2023]
Abstract
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.
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Affiliation(s)
- Florian Scherer
- Department of Otorhinolaryngology, University Hospital Münster, Münster
| | | | - Bernd Lütkenhöner
- Department of Otorhinolaryngology, University Hospital Münster, Münster
| | - Felix Heitkötter
- Department of Otorhinolaryngology, University Hospital Münster, Münster
| | - Claudia Rudack
- Department of Otorhinolaryngology, University Hospital Münster, Münster
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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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Zakaria MN, Salim R, Abdul Wahat NH, Md Daud MK, Wan Mohamad WN. Cervical vestibular evoked myogenic potential (cVEMP) findings in adults with sensorineural hearing loss (SNHL): comparisons between 500 Hz tone burst and narrowband CE-Chirp stimuli. Sci Rep 2023; 13:22842. [PMID: 38129442 PMCID: PMC10739870 DOI: 10.1038/s41598-023-48810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
There has been a growing interest in studying the usefulness of chirp stimuli in recording cervical vestibular evoked myogenic potential (cVEMP) waveforms. Nevertheless, the study outcomes are debatable and require verification. In view of this, the aim of the present study was to compare cVEMP results when elicited by 500 Hz tone burst and narrowband (NB) CE-Chirp stimuli in adults with sensorineural hearing loss (SNHL). Fifty adults with bilateral SNHL (aged 20-65 years) underwent the cVEMP testing based on the established protocol. The 500 Hz tone burst and NB CE-Chirp (centred at 500 Hz) stimuli were presented to each ear at an intensity level of 120.5 dB peSPL. P1 latency, N1 latency, and P1-N1 amplitude values were analysed accordingly. The NB CE-Chirp stimulus produced significantly shorter P1 and N1 latencies (p < 0.001) with large effect sizes (d > 0.80). In contrast, both stimuli elicited cVEMP responses with P1-N1 amplitude values that were not statistically different from one another (p = 0.157, d = 0.15). Additionally, age and hearing level were found to be significantly correlated (r = 0.56, p < 0.001), as were age and cVEMP amplitude for each stimulus (p < 0.001). To conclude, since both stimuli were presented at an equivalent intensity level (in dB peSPL), the shorter P1 and N1 latencies of cVEMP produced by the NB CE-Chirp stimulus (centred at 500 Hz) were unlikely due to enhanced saccular stimulation. Another more sensible reason is the temporal adjustment of the chirp stimulus.
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Affiliation(s)
- Mohd Normani Zakaria
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Rosdan Salim
- Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Nor Haniza Abdul Wahat
- Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Mohd Khairi Md Daud
- Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Wan Najibah Wan Mohamad
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
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Pastras CJ, Curthoys IS. Vestibular Testing-New Physiological Results for the Optimization of Clinical VEMP Stimuli. Audiol Res 2023; 13:910-928. [PMID: 37987337 PMCID: PMC10660708 DOI: 10.3390/audiolres13060079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
Both auditory and vestibular primary afferent neurons can be activated by sound and vibration. This review relates the differences between them to the different receptor/synaptic mechanisms of the two systems, as shown by indicators of peripheral function-cochlear and vestibular compound action potentials (cCAPs and vCAPs)-to click stimulation as recorded in animal studies. Sound- and vibration-sensitive type 1 receptors at the striola of the utricular macula are enveloped by the unique calyx afferent ending, which has three modes of synaptic transmission. Glutamate is the transmitter for both cochlear and vestibular primary afferents; however, blocking glutamate transmission has very little effect on vCAPs but greatly reduces cCAPs. We suggest that the ultrafast non-quantal synaptic mechanism called resistive coupling is the cause of the short latency vestibular afferent responses and related results-failure of transmitter blockade, masking, and temporal precision. This "ultrafast" non-quantal transmission is effectively electrical coupling that is dependent on the membrane potentials of the calyx and the type 1 receptor. The major clinical implication is that decreasing stimulus rise time increases vCAP response, corresponding to the increased VEMP response in human subjects. Short rise times are optimal in human clinical VEMP testing, whereas long rise times are mandatory for audiometric threshold testing.
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Affiliation(s)
- Christopher J. Pastras
- Faculty of Science and Engineering, School of Engineering, Macquarie University, Sydney, NSW 2109, Australia;
| | - Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
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