Vestibular evoked myogenic potential according to middle ear condition in chronic otitis media with tympanic membrane perforation

The advantages of vestibular-evoked myogenic potentials induced by bone-conducted vibration in patients with otitis media

BACKGROUND

At present, there is no consensus on the optimal methods for the diagnosis of vestibular dysfunction.

OBJECTIVE

To explore the advantages of bone-conducted vibration (BCV) related vestibular-evoked myogenic potentials (VEMPs).

MATERIAL AND METHODS

Fifty patients with otitis media volunteered for VEMP examination. They were randomly selected with air-conducted sound and BCV stimulation VEMPs assessed in both ears.

RESULTS

The provocation rate of BCV-VEMPs was significantly higher than that of air-conducted sound VEMPs. Among 50 affected ears, there was no significant difference in the provocation rate of BCV-VEMPs between patients with air-bone conduction gaps lower or higher than 20 dB. There was no significant difference in the provocation rate of BCV-VEMPs between both ears in 30 patients with unilateral otitis media and the comparison of BCV-oVEMP parameters made no significant difference in amplitude, N1 latency, P1 latency, or N1-P1 duration, except for the threshold. A comparison of BCV-cVEMP parameters between affected and healthy ears revealed no significant difference between groups in terms of threshold, amplitude, N1 latency, P1 latency, or n1-p1 duration.

CONCLUSIONS AND SIGNIFICANCE

BCV-VEMPs may be stably induced in patients with conductive hearing loss.

Relative efficacy of veria and mastoidectomy techniques of cochlear implantation in preservation of sound-induced saccular responses

OBJECTIVE

Cochlear implantation (CI) is a safe technique to give hearing sensation to a person with hearing impairment. The present study aimed to compare the two surgical approaches of CI, mastoidectomy and veria, for their effects on saccular function assessed using cervical vestibular-evoked myogenic potential (cVEMP).

DESIGN

Multiple group time series design.

STUDY SAMPLE

The study included 63 children (3-8 years old) who underwent CI using veria technique (n = 20) and mastoidectomy approach (n = 43). The 500-Hz tone-burst evoked cVEMP were recorded on three occasions- a day before CI surgery, a day after the device switch-on and 4 months after the switch-on.

RESULTS

The post-implant results revealed the absence of cVEMP in nearly 40% of the participants. The amplitudes were significantly lower at the time of the switch-on and at the 4-months follow-up period (p < 0.05). Among the participants undergoing CI using mastoidectomy approach, amplitudes were significantly larger after surgery than those undergoing surgery using veria technique (p < 0.05).

CONCLUSIONS

The saccular responses are better preserved with the mastoidectomy technique than the veria technique for CI surgery.

Current evidence of peripheral vestibular symptoms secondary to otitis media

BACKGROUND

The association between otitis media and vestibular symptoms has been hypothesized in the past. Thus, in this study, we aimed to critically analyze (based in a systematic review of the literature) whether patients who have otitis media are at greater risk of developing vestibular impairment or not.

METHODS

We performed a systematic review of the literature and identified potentially relevant articles reporting vestibular symptoms and results of vestibular function tests in patients with otitis media through searches of the PubMED, Web of Science, Scopus, and Google Scholar databases. The quality of the final set of records was assessed using the "Newcaste-Ottawa Scale".

RESULTS

Of the 2334 records searched, 43 met our inclusion and exclusion criteria, and those included 2250 patients. The records comprised 20 longitudinal studies, 21 cross-sectional studies, and 2 case reports. Regarding the type of otitis media studied, 25 examined vestibular impairment in otitis media with effusion, 6 acute otitis media, and 12 chronic otitis media. Results of anamnesis, clinical exams, and several vestibular function tests are reported and critically discussed.

CONCLUSION

Most studies evaluating the association between otitis media and vestibular symptoms have potential methodological flaws. Clinical evidence suggests that patients with otitis media have increased chances for having vestibular symptoms, delayed acquisition of developmental milestones, and abnormalities in several vestibular function tests as compared with controls. Future studies with rigorous methodology aiming to assess the clinical significance (and prognostic factors) of the association between otitis media and vestibular impairment are warranted. Key message Several studies demonstrated long-term sequelae secondary to otitis media. However, the evidence supporting those assumptions are based in low-quality evidence. Thus, better structured studies are warranted to better understand the clinical relevance of such association.

Evaluation of ocular and cervical vestibular evoked myogenic potentials in a conductive hearing loss model

Objective

To investigate the effects of conductive hearing loss (CHL) on vestibular evoked myogenic potentials (VEMPs) using a simulated CHL model, and to provide the basis for future studies.

Methods

Twenty-one healthy subjects were recruited in this study. We measured ocular VEMPs (oVEMPs) and cervical VEMPs (cVEMPs) in these subjects by air-conduction sound (ACS) stimulation. CHL was simulated later by blocking the right external auditory canal with a soundproof earplug to evaluate its impacts on VEMPs. Subjects' responses before simulated CHL served as the control, and were compared to their responses following simulated CHL.

Results

oVEMPs following simulated CHL showed decreased response rate, elevated thresholds, attenuated amplitudes and prolonged N1 latencies compared with those before simulated CHL, and the differences were statistically significant. Similarly, cVEMPs following simulated CHL also showed decreased response rate, elevated thresholds and attenuated amplitudes, with prolonged P1 latencies compared with those before simulated CHL, although only differences in response rate, threshold and amplitude were significant.

Conclusions

Conductive hearing loss affects the response rate and other response parameters in oVEMPs and cVEMPs.