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Reducing Sound Exposure During Ocular Vestibular Evoked Myogenic Potential Testing for Superior Semicircular Canal Dehiscence Syndrome. Otol Neurotol 2021; 42:e735-e743. [PMID: 33710145 DOI: 10.1097/mao.0000000000003084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ocular vestibular evoked myogenic potentials (oVEMP) testing in response to air-conducted sound (ACS) has excellent sensitivity and specificity for superior semicircular canal dehiscence syndrome (SCDS). However, patients with SCDS may experience vertigo with the test, and recent works recommend minimizing acoustic energy during VEMP testing. PURPOSE To develop an oVEMP protocol that reduces discomfort and increases safety without compromising reliability. METHODS Subjects: Fifteen patients diagnosed with SCDS based on clinical presentation, audiometry, standard VEMP testing, and computed tomography (CT) imaging. There were 17 SCDS-affected ears and 13 unaffected ears. In nine (53%) of the SCDS-affected ears surgical repair was indicated, and SCD was confirmed in each. oVEMPs were recorded in response to ACS using 500 Hz tone bursts or clicks. oVEMP amplitudes evoked by 100 stimuli (standard protocol) were compared with experimental protocols with only 40 or 20 stimuli. RESULTS In all three protocols, oVEMP amplitudes in SCDS-affected ears were significantly higher than in the unaffected ears (p < 0.001). 500 Hz tone bursts evoked oVEMPs with excellent (>90%) sensitivity and specificity in each of the three protocols. However, in the unaffected ears, lowering to 20 stimuli reduced the detection of oVEMP responses in some ears. Following surgical repair, oVEMPs normalized in each of the protocols. CONCLUSION In oVEMP testing using ACS for SCDS, reducing the number of trials from 100 to 40 stimuli results in a more tolerable and theoretically safer test without compromising its effectiveness for the diagnosis of SCDS. Reducing to 20 stimuli may degrade specificity with clicks.
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Scarpa A, Gioacchini FM, Cassandro E, Tulli M, Ralli M, Re M, Cassandro C. Clinical application of cVEMPs and oVEMPs in patients affected by Ménière's disease, vestibular neuritis and benign paroxysmal positional vertigo: a systematic review. ACTA ACUST UNITED AC 2020; 39:298-307. [PMID: 31708577 PMCID: PMC6843588 DOI: 10.14639/0392-100x-2104] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 02/23/2019] [Indexed: 11/23/2022]
Affiliation(s)
- A Scarpa
- Department of Medicine and Surgery, University of Salerno, Italy
| | - F M Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - E Cassandro
- Department of Medicine and Surgery, University of Salerno, Italy
| | - M Tulli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - M Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - M Re
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - C Cassandro
- Surgical Sciences Department, University of Turin, Italy
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Kavasoğlu G, Gökçay F, Yüceyar N, Çelebisoy N. Cervical vestibular-evoked myogenic potentials in patients with multiple sclerosis: sensitive in detecting brainstem involvement? Neurol Sci 2017; 39:365-371. [DOI: 10.1007/s10072-017-3215-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 12/02/2017] [Indexed: 01/05/2023]
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Amorim FEAC, Sahdo AM, Giuliano LMP, Pinheiro DS, Braga NIDO, Manzano GM. Effects of the stimulus phase on the air-conducted ocular vestibular evoked myogenic potential in healthy subjects. Clin Neurophysiol 2017; 128:262-269. [DOI: 10.1016/j.clinph.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/19/2016] [Accepted: 10/06/2016] [Indexed: 11/25/2022]
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Vestibular evoked myogenic potentials (VEMPs) for examining vestibular function and dysfunction. Clin Neurophysiol 2016; 127:2237-9. [PMID: 27072095 DOI: 10.1016/j.clinph.2016.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 11/24/2022]
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Verrecchia L, Westin M, Duan M, Brantberg K. Ocular vestibular evoked myogenic potentials to vertex low frequency vibration as a diagnostic test for superior canal dehiscence. Clin Neurophysiol 2016; 127:2134-9. [PMID: 26818880 DOI: 10.1016/j.clinph.2016.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 12/24/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore ocular vestibular evoked myogenic potentials (oVEMP) to low-frequency vertex vibration (125 Hz) as a diagnostic test for superior canal dehiscence (SCD) syndrome. METHODS The oVEMP using 125 Hz single cycle bone-conducted vertex vibration were tested in 15 patients with unilateral superior canal dehiscence (SCD) syndrome, 15 healthy controls and in 20 patients with unilateral vestibular loss due to vestibular neuritis. Amplitude, amplitude asymmetry ratio, latency and interaural latency difference were parameters of interest. RESULTS The oVEMP amplitude was significantly larger in SCD patients when affected sides (53 μVolts) were compared to non-affected (17.2 μVolts) or compared to healthy controls (13.6 μVolts). Amplitude larger than 33.8 μVolts separates effectively the SCD ears from the healthy ones with sensitivity of 87% and specificity of 93%. The other three parameters showed an overlap between affected SCD ears and non-affected as well as between SCD ears and those in the two control groups. CONCLUSIONS oVEMP amplitude distinguishes SCD ears from healthy ones using low-frequency vibration stimuli at vertex. SIGNIFICANCE Amplitude analysis of oVEMP evoked by low-frequency vertex bone vibration stimulation is an additional indicator of SCD syndrome and might serve for diagnosing SCD patients with coexistent conductive middle ear problems.
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Affiliation(s)
- Luca Verrecchia
- Deparment of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden.
| | - Magnus Westin
- Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden
| | - Maoli Duan
- Deparment of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden
| | - Krister Brantberg
- Deparment of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden
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Kastanioudakis I, Saravakos P, Leontis T, Balatsouras DG, Ziavra N. Ocular vestibular-evoked myogenic potentials using air-conducted sound: test parameters and normative data in healthy children; effect of body position on threshold. Eur Arch Otorhinolaryngol 2015; 273:2385-94. [PMID: 26499188 DOI: 10.1007/s00405-015-3800-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/15/2015] [Indexed: 11/27/2022]
Abstract
In the present prospective study, we both investigated positioning techniques for the enhancement of oVEMP procedures and the viability of oVEMP testing in a healthy children population. A total of 41 healthy children were enrolled in this study. 21 were boys and 20 were girls, with their ages ranging from 4 to 16 years. All children underwent audiometry and tympanometry prior to oVEMP test in upright and supine position. All subjects had normal hearing. The procedure was well tolerated by all children. Typical biphasic oVEMPs presented in 97.56 % in upright position and 90.25 % in the supine position. No statistically significant difference could be found concerning which position elicits the best or worst responses. However, a trend towards the supine position was noticed. It may be concluded that oVEMP test proved to be a well-tolerated examination of the vestibular system in children aged above 4 years old. Our results did not show a statistical difference on the oVEMP thresholds between the two body positions. However, further larger studies are needed to confirm these findings.
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Affiliation(s)
- Ioannis Kastanioudakis
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Panagiotis Saravakos
- Department of Otolaryngology Head and Neck Surgery, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Theodoros Leontis
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Nausica Ziavra
- Speech and Language Therapy Department, TEI of Epirus, Ioannina, Greece
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Magnano I, Pes GM, Pilurzi G, Cabboi MP, Ginatempo F, Giaconi E, Tolu E, Achene A, Salis A, Rothwell JC, Conti M, Deriu F. Exploring brainstem function in multiple sclerosis by combining brainstem reflexes, evoked potentials, clinical and MRI investigations. Clin Neurophysiol 2014; 125:2286-2296. [DOI: 10.1016/j.clinph.2014.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/24/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
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Singh NK, Kadisonga P, Ashitha P. Optimizing Stimulus Repetition Rate for Recording Ocular Vestibular Evoked Myogenic Potential Elicited by Air-Conduction Tone Bursts of 500 Hz. Audiol Res 2014; 4:88. [PMID: 26557349 PMCID: PMC4627138 DOI: 10.4081/audiores.2014.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 04/11/2014] [Accepted: 04/23/2014] [Indexed: 11/23/2022] Open
Abstract
Amidst several publications reporting the effects of stimulus-related parameters on ocular vestibular evoked myogenic potential (oVEMP), the effect of the repetition rate on oVEMP responses has largely gone unexplored. Studies have used a repetition rate of ~5.1 Hz mainly due to a presumption that oVEMP, like cervical VEMP, should produce best responses for ~5 Hz, although there is paucity of experimental evidence to support this hypothesis. 52 healthy individuals in the age range of 17-35 years underwent air-conduction oVEMP elicited by 500 Hz tone-bursts using seven different repetition rates (3.1, 5.1, 10.1, 15.1, 20.1, 25.1 and 30.1 Hz). The results revealed a tendency for prolongation of latencies and reduction in amplitude with increasing repetition rate. However, significantly longer latencies were observed only for 20.1 Hz and larger amplitudes for 3.1 and 5.1 Hz (P<0.05). There was no significant difference between the rates of 3.1 Hz and 5.1 Hz. However 3.1 Hz produced poorer signal-to-noise ratio and required considerably longer time and thereby had lesser efficiency than 5.1 Hz (P<0.05). This would also result in higher fatigue and irritation levels considering the physical act of maintaining a supero-medial gaze. Thus the use of 5.1 Hz is recommended for clinical recording of oVEMP.
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Ocular vestibular evoked myogenic potentials in response to air-conducted sound and bone-conducted vibration in vestibular schwannoma. Otol Neurotol 2014; 34:1342-8. [PMID: 23945552 DOI: 10.1097/mao.0b013e31828d6539] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To clarify the origin and pathways of ocular vestibular evoked myogenic potentials (oVEMPs) to air-conducted sound (ACS), we compared the results of oVEMPs with ACS, with oVEMPs with bone-conducted vibration (BCV), cervical VEMPs (cVEMPs) with ACS, and the caloric test in patients with unilateral vestibular schwannoma (VS). STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS Forty-five patients with untreated unilateral VS. MAIN OUTCOME MEASURE Each patient underwent vestibular tests, including oVEMPs to ACS, oVEMPs to BCV, cVEMPs to ACS, and caloric tests. The correlations among these tests were evaluated. RESULTS Of the 45 patients recruited, 28 patients (63%) showed reduced or absent oVEMPs to ACS solely on the affected side. There were no significant differences in abnormal response ratios among oVEMPs to ACS, oVEMPs to BCV, cVEMPs to ACS, or the caloric test. The results of oVEMPs to ACS had a significant correlation with those of oVEMPs to BCV and the caloric test (p < 0.05) but not with those of cVEMPs to ACS (p > 0.05). CONCLUSION These findings support the hypothesis that oVEMP in response to ACS are predominantly mediated by the superior vestibular nerve and probably reflect the function of the utricle.
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Felipe L, Kingma H. Ocular vestibular evoked myogenic potentials. Int Arch Otorhinolaryngol 2014; 18:77-9. [PMID: 25992068 PMCID: PMC4296944 DOI: 10.1055/s-0033-1352503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 03/10/2013] [Indexed: 11/03/2022] Open
Abstract
Introduction Diagnostic testing of the vestibular system is an essential component of treating patients with balance dysfunction. Until recently, testing methods primarily evaluated the integrity of the horizontal semicircular canal, which is only a portion of the vestibular system. Recent advances in technology have afforded clinicians the ability to assess otolith function through vestibular evoked myogenic potential (VEMP) testing. VEMP testing from the inferior extraocular muscles of the eye has been the subject of interest of recent research. Objective To summarize recent developments in ocular VEMP testing. Results Recent studies suggest that the ocular VEMP is produced by otolith afferents in the superior division of the vestibular nerve. The ocular VEMP is a short latency potential, composed of extraocular myogenic responses activated by sound stimulation and registered by surface electromyography via ipsilateral otolithic and contralateral extraocular muscle activation. The inferior oblique muscle is the most superficial of the six extraocular muscles responsible for eye movement. Therefore, measurement of ocular VEMPs can be performed easily by using surface electrodes on the skin below the eyes contralateral to the stimulated side. Conclusion This new variation of the VEMP procedure may supplement conventional testing in difficult to test populations. It may also be possible to use this technique to evaluate previously inaccessible information on the vestibular system.
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Affiliation(s)
- Lilian Felipe
- Department of Speech and Hearing Therapy, Veiga de Almeida University, Rio de Janeiro/RJ, Brazil
| | - Herman Kingma
- Department of Otolaryngology and Vestibulology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Limburg, The Netherlands
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Evidence for the utricular origin of the vestibular short-latency-evoked potential (VsEP) to bone-conducted vibration in guinea pig. Exp Brain Res 2013; 229:157-70. [DOI: 10.1007/s00221-013-3602-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
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Oh SY, Kim JS, Yang TH, Shin BS, Jeong SK. Cervical and ocular vestibular-evoked myogenic potentials in vestibular neuritis: comparison between air- and bone-conducted stimulation. J Neurol 2013; 260:2102-9. [PMID: 23670310 DOI: 10.1007/s00415-013-6953-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/01/2013] [Accepted: 05/03/2013] [Indexed: 12/19/2022]
Abstract
To clarify the changes of cervical (cVEMP) and ocular (oVEMP) vestibular evoked myogenic potentials induced by air-conducted sound (ACS) and bone-conducted vibration (BCV) in patients with vestibular neuritis (VN), patients with VN (n = 30) and normal controls (n = 45) underwent recording of cVEMP and oVEMP in response to ACS (1,000 Hz, 5 ms, tone bursts) and BCV (500 Hz, short tone burst). Patients with VN showed a high proportion of oVEMP abnormalities in response to both ACS (80.0 %) and BCV at the forehead (Fz, 73.3 %) or the mastoid (76.7 %). In contrast, cVEMPs were mostly normal with both ACS and BCV in the patients. The dissociations in the abnormalities of cVEMP and oVEMP induced by ACS and BCV at the mastoids and at the forehead in patients with VN suggest that oVEMP reflects functions of the superior vestibular nerve and most likely the utricular function. The results of our study suggest that oVEMP induced by either ACS or BCV appears to depend on integrity of the superior vestibular nerve, possibly due to the utricular afferents travelling in it. In contrast, cVEMP elicited by either ACS or BCV may reflect function of the saccular afferents running in the inferior vestibular nerve.
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Affiliation(s)
- Sun-Young Oh
- Department of Neurology, Chonbuk National University College of Medicine, 634-18 Gumam-dong, Deokjin-gu, Jeonju 561-712, Korea.
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Felipe L, Kingma H, Lambertucci JR, Carneiro-Proietti AB, Gonçalves DU. Testing the vestibular evoked myogenic potential (VEMP) to identify subclinical neurological alterations in different phases of human T-lymphotropic virus type 1 infection. Spine J 2013; 13:397-401. [PMID: 23267739 DOI: 10.1016/j.spinee.2012.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/06/2012] [Accepted: 11/08/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The diagnosis of human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is based on clinical signs and the confirmation of HTLV-1 infection in the central nervous system. Electrophysiological tests may facilitate an earlier diagnosis of spinal cord involvement. Vestibular evoked myogenic potential (VEMP) testing evaluates the vestibulospinal tract, which is correlated with the motor tract; the target of damage by HAM/TSP. PURPOSE This study examines the subclinical neurological alterations related to HTLV-1 infection in individuals with asymptomatic HTLV-1 infections, possible HAM/TSP, and confirmed HAM/TSP. STUDY DESIGN Vestibular evoked myogenic potential testing was performed at the beginning of the study and repeated every 6 months for 18 months. Ninety volunteers were selected for the study: 30 were HTLV-1 seronegative (the control group) and 60 were HTLV-1 seropositive (of these, 18 were asymptomatic, 25 had possible HAM/TSP, and 17 had confirmed HAM/TSP). The VEMP response was classified as normal or abnormal (latency prolongation or no response). A change in the VEMP response from normal to abnormal was the event of interest. To perform a survival analysis, the subjects with normal VEMP responses at the first assessment were selected. METHODS The results were analyzed blindly. Vestibular evoked myogenic potential was measured using short tone bursts as acoustic stimuli (1 kHz, 118 dBHL, a rise-fall of 1 millisecond, and a plateau of 2 milliseconds). The stimulation rate was 5 Hz, and the analysis time for each response was 60 milliseconds; each trial averaged 200 responses. RESULTS The mean age of the subjects in the control group was 38 ± 11 years (median 35), and 13 (43%) were men. In the study group, the mean age was 51 ± 12 years (median 53), and 12 (20%) were men. An analysis of the survival curve indicated that the median time for a change in VEMP response from normal to abnormal was 18 months, which is in agreement with the slow progression of HTLV-1-associated neurologic disease. The survival analysis showed that the change in VEMP response was significantly different between the asymptomatic and HAM/TSP groups (p=.02). CONCLUSIONS Vestibular evoked myogenic potential testing was useful for monitoring the development of HAM/TSP in HTLV-1-infected individuals.
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Affiliation(s)
- Lilian Felipe
- Tropical Medicine Post Graduate Program, Faculty of Medicine, Federal University of Minas Gerais, Av Prof Alfredo Balena, n° 190, sala 3005, Belo Horizonte, Minas Gerais CEP 30100130, Brazil.
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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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Dournes G, Barreau X, Franco-Vidal V, Darrouzet V, Dousset V. Pre- and postoperative CT appearance of superior semicircular canal dehiscence syndrome. Diagn Interv Imaging 2012; 93:612-6. [DOI: 10.1016/j.diii.2012.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Winters SM, Berg IT, Grolman W, Klis SF. Ocular Vestibular Evoked Myogenic Potentials: Frequency Tuning to Air-Conducted Acoustic Stimuli in Healthy Subjects and Ménière’s Disease. ACTA ACUST UNITED AC 2012; 17:12-9. [DOI: 10.1159/000324858] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 01/25/2011] [Indexed: 11/19/2022]
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Ocular Vestibular Evoked Myogenic Potentials in Response to Air-Conducted Sound in Ménière's Disease. Otol Neurotol 2011; 32:1273-80. [DOI: 10.1097/mao.0b013e31822e5ac9] [Citation(s) in RCA: 31] [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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Cervical and ocular vestibular-evoked myogenic potentials in acute vestibular neuritis. Clin Neurophysiol 2011; 123:369-75. [PMID: 21775203 DOI: 10.1016/j.clinph.2011.05.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 05/08/2011] [Accepted: 05/20/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To clarify the origin and afferent pathways of short-latency ocular vestibular-evoked myogenic potential (oVEMP) in response to air-conducted sound (ACS), we evaluated cervical (cVEMP) and ocular VEMPs in patients with vestibular neuritis (VN). METHODS In response to air-conducted tone burst, the oVEMP and cVEMP were measured in 60 healthy controls and in 41 patients with acute VN. The VN selectively involved the superior vestibular nerve (superior VN) in 30 patients, affected the inferior vestibular nerve only (inferior VN) in three and damaged both superior and inferior vestibular nerve branches in eight. RESULTS All 30 patients with superior VN presented normal cVEMPs, indicating preservation of the saccular receptors and their afferents in the inferior vestibular nerve. However, the oVEMP was abnormal in all patients with superior VN. By contrast, the patients with inferior VN showed normal oVEMP and abnormal cVEMP. CONCLUSION These dissociations in the abnormalities of cVEMP and oVEMP in patients with VN selectively involving the superior or inferior vestibular nerve suggest that the origin of the vestibular nerve afferents of oVEMP differ from those of cVEMP. SIGNIFICANCE The oVEMP in response to ACS may be mediated by the superior vestibular nerve, probably due to an activation of the utricular receptors.
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Jombik P, Spodniak P, Bahyl V. Direction-dependent excitatory and inhibitory ocular vestibular-evoked myogenic potentials (oVEMP) produced by oppositely directed accelerations along the midsagittal axis of the head [corrected]. Exp Brain Res 2011; 211:251-63. [PMID: 21512797 PMCID: PMC3092914 DOI: 10.1007/s00221-011-2681-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 04/04/2011] [Indexed: 12/01/2022]
Abstract
Oppositely directed displacements of the head need oppositely directed vestibulo-ocular reflexes (VOR), i.e. compensatory responses. Ocular vestibular-evoked myogenic potentials (oVEMPs) mainly reflect the synchronous extraocular muscle activity involved in the process of generating the VOR. The oVEMPs recorded beneath the eyes when looking up represent electro-myographic responses mainly of the inferior oblique muscle. We aimed: (1) to study the properties of these responses as they were produced by head acceleration impulses to the forehead and to the back of the head; (2) to investigate the relationships between these responses and the 3-D linear head accelerations that might reflect the true stimulus that acts on the vestibular hair cells. We produced backward- and forward-directed acceleration stimuli in four conditions (positive and negative head acceleration impulses to the hairline and to the inion) in 16 normal subjects. The oVEMPs produced by backward- and forward-directed accelerations of the head showed consistent differences. They were opposite in the phase. The responses produced by backward accelerations of the head began with an initial negativity, n11; conversely, those produced by accelerations directed forward showed initially a positive response, p11. There was a high inter-subject correlation of head accelerations along the head anteroposterior and transverse axes, but almost no correlation of accelerations along the vertical axis of the head. We concluded that backward-directed head accelerations produced an initial excitatory response, and forward-directed accelerations of the head were accompanied by an initial inhibitory response. These responses showed dependence on acceleration direction in the horizontal plane of the head. This could be consistent with activation of the utricle.
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Affiliation(s)
- Peter Jombik
- Department of Neurology, Laboratory of Clinical Neurophysiology, Zvolen Hospital, Zvolen, Slovak Republic.
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Xie SJ. Response to "oVEMP to air-conducted tones reflects functions of different vestibular populations from cVEMP?". Eur Arch Otorhinolaryngol 2010; 268:151-2; author reply 153. [PMID: 21125289 DOI: 10.1007/s00405-010-1444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 11/19/2010] [Indexed: 11/24/2022]
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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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Lang EE, McConn Walsh R. Vestibular function testing. Ir J Med Sci 2010; 179:173-8. [PMID: 20178005 DOI: 10.1007/s11845-010-0465-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 01/12/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Vestibular symptoms of vertigo, dizziness and dysequilibrium are common complaints which can be disabling both physically and psychologically. Routine examination of the ear nose and throat and neurological system are often normal in these patients. An accurate history and thorough clinical examination can provide a diagnosis in the majority of patients. However, in a subgroup of patients, vestibular function testing may be invaluable in arriving at a correct diagnosis and ultimately in the optimal treatment of these patients. METHOD Literature review. CONCLUSION In this review we aim to highlight the new understanding and insight into the underlying pathophysiology of vestibular disorders which in conjunction with technological advancements have led to significant improvements in the clinical and laboratory evaluation of vestibular disease. The vestibular and balance assessment modalities which are available to help optimise the management of vestibular disease are also discussed.
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Affiliation(s)
- E E Lang
- Department of Otolaryngology Head and Neck Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland,
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Cheng PW, Chen CC, Wang SJ, Young YH. Acoustic, mechanical and galvanic stimulation modes elicit ocular vestibular-evoked myogenic potentials. Clin Neurophysiol 2009; 120:1841-4. [DOI: 10.1016/j.clinph.2009.08.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 07/09/2009] [Accepted: 08/03/2009] [Indexed: 11/29/2022]
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The role of the superior vestibular nerve in generating ocular vestibular-evoked myogenic potentials to bone conducted vibration at Fz. Clin Neurophysiol 2009; 120:588-93. [PMID: 19211301 DOI: 10.1016/j.clinph.2008.12.036] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Revised: 12/14/2008] [Accepted: 12/17/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The n10 component (n10) of the ocular vestibular evoked myogenic potential (oVEMP) to brief bone conducted vibration (BCV) of the forehead at Fz is probably caused by the vibration selectively activating vestibular otolithic receptors. If the n10 is due primarily to utricular activation then diseases which affect only the superior division of the vestibular nerve (SVN) should reduce or eliminate n10. METHODS The n10 component of the oVEMP was measured in 13 patients with unilateral SVN but with inferior vestibular nerve function preserved. RESULTS We compared the n10 to BCV of these 13 SVN patients to previously published data for healthy subjects and patients after complete unilateral vestibular loss. We found that in 12 out of the 13 patients with SVN, n10 was markedly reduced or absent under the contralesional eye. CONCLUSION Since all utricular afferents course in the superior vestibular nerve and in 12/13 of these patients the n10 was reduced we conclude that the n10 component of the oVEMP to BCV is probably mediated by the superior vestibular nerve and probably due to activation of mainly utricular receptors. SIGNIFICANCE The n10 appears to be a simple new test of superior vestibular nerve and probably mainly utricular function.
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Skull tap induced vestibular evoked myogenic potentials: An ipsilateral vibration response and a bilateral head acceleration response? Clin Neurophysiol 2008; 119:2363-9. [DOI: 10.1016/j.clinph.2008.02.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 02/21/2008] [Accepted: 02/24/2008] [Indexed: 11/22/2022]
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Iwasaki S, Smulders YE, Burgess AM, McGarvie LA, Macdougall HG, Halmagyi GM, Curthoys IS. Ocular vestibular evoked myogenic potentials to bone conducted vibration of the midline forehead at Fz in healthy subjects. Clin Neurophysiol 2008; 119:2135-47. [PMID: 18639490 DOI: 10.1016/j.clinph.2008.05.028] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 05/28/2008] [Accepted: 05/31/2008] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide the empirical basis for using ocular vestibular evoked myogenic potentials (oVEMPS) in response to Fz bone conducted vibration (BCV) stimulation to indicate vestibular function in human subjects. To show the generality of the response by testing a large number of unselected healthy subjects across a wide age range and the repeatability of the response within subjects. To provide evidence that the response depends on otolithic function. METHODS The early negative component (n10) of the oVEMP to brief BCV of the forehead, in the midline at the hairline (Fz) is recorded by surface EMG electrodes just beneath the eyes. We used a Bruel and Kjaer 4810 Mini-Shaker or a light tap with a tendon hammer to provide adequate BCV stimuli to test a large number (67) of unselected healthy people to quantify the individual differences in n10 magnitude, latency and symmetry to Fz BCV. A Radioear B-71 bone oscillator at Fz is not adequate to elicit a reliable n10 response. RESULTS The n10 oVEMP response showed substantial differences in amplitude between subjects, but is repeatable within subjects. n10 is of equal magnitude in both eyes with an average asymmetry around 11%. The average n10 amplitude for Mini Tone Burst BCV is 8.47microV+/-4.02 (sd), the average latency is 10.35ms+/-0.63 (sd). The amplitude of n10 decreases and its latency increases with age. CONCLUSIONS oVEMPs are a new reliable, repeatable test to indicate vestibular and probably otolithic function. SIGNIFICANCE This study shows the optimum conditions for recording oVEMPs and provides baseline values for individual differences and asymmetry. oVEMPs can be measured in senior subjects without difficulty.
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Affiliation(s)
- S Iwasaki
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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