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Dumas G, Curthoys I, Castellucci A, Dumas L, Peultier-Celli L, Armato E, Malara P, Perrin P, Schmerber S. Skull Vibration-Induced Nystagmus in Superior Semicircular Canal Dehiscence: A New Insight into Vestibular Exploration-A Review. Audiol Res 2024; 14:96-115. [PMID: 38391766 PMCID: PMC10886119 DOI: 10.3390/audiolres14010009] [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: 11/15/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024] Open
Abstract
The third window syndrome, often associated with the Tullio phenomenon, is currently most often observed in patients with a superior semicircular-canal dehiscence (SCD) but is not specific to this pathology. Clinical and vestibular tests suggestive of this pathology are not always concomitantly observed and have been recently complemented by the skull-vibration-induced nystagmus test, which constitutes a bone-conducted Tullio phenomenon (BCTP). The aim of this work was to collect from the literature the insights given by this bedside test performed with bone-conducted stimulations in SCD. The PRISMA guidelines were used, and 10 publications were included and analyzed. Skull vibration-induced nystagmus (SVIN), as observed in 55 to 100% of SCD patients, usually signals SCD with greater sensitivity than the air-conducted Tullio phenomenon (ACTP) or the Hennebert sign. The SVIN direction when the test is performed on the vertex location at 100 Hz is most often ipsilaterally beating in 82% of cases for the horizontal and torsional components and down-beating for the vertical component. Vertex stimulations are more efficient than mastoid stimulations at 100 Hz but are equivalent at higher frequencies. SVIN efficiency may depend on stimulus location, order, and duration. In SCD, SVIN frequency sensitivity is extended toward high frequencies, with around 400 Hz being optimal. SVIN direction may depend in 25% on stimulus frequency and in 50% on stimulus location. Mastoid stimulations show frequently diverging results following the side of stimulation. An after-nystagmus observed in 25% of cases can be interpreted in light of recent physiological data showing two modes of activation: (1) cycle-by-cycle phase-locked activation of action potentials in SCC afferents with irregular resting discharge; (2) cupula deflection by fluid streaming caused by the travelling waves of fluid displacement initiated by sound or vibration at the point of the dehiscence. The SVIN direction and intensity may result from these two mechanisms' competition. This instability explains the SVIN variability following stimulus location and frequency observed in some patients but also discrepancies between investigators. SVIN is a recent useful insight among other bedside examination tests for the diagnosis of SCD in clinical practice.
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Affiliation(s)
- Georges Dumas
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, University Hospital, 38043 Grenoble, France
- Research Unit 3450 DevAH-Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Ian Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Laurent Dumas
- INSERM UMR 1039 Bioclinic Radiopharmaceutics Laboratory, University Grenoble Alpes, 38700 La Tronche, France
| | - Laetitia Peultier-Celli
- Research Unit 3450 DevAH-Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Enrico Armato
- Research Unit 3450 DevAH-Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
- Department of Neurosciences, University of Padova, 35100 Padova, Italy
| | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, 6500 Bellinzona, Switzerland
| | - Philippe Perrin
- Research Unit 3450 DevAH-Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
- Department of Paediatric Oto-Rhino-Laryngology, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, University Hospital, 38043 Grenoble, France
- INSERM UMR 2015, Brain Tech Laboratory, 38700 La Tronche, France
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Damien M, Wiener-Vacher SR, Reynard P, Thai-Van H. Bone Conduction Cervical Vestibular Evoked Myogenic Potentials as an Alternative in Children with Middle Ear Effusion. J Clin Med 2023; 12:6348. [PMID: 37834992 PMCID: PMC10573357 DOI: 10.3390/jcm12196348] [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: 08/22/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE To compare the amplitude ratio and P-wave latency of cervical vestibular evoked myogenic potentials (c-VEMPs) for bone conduction (BC) and air conduction (AC) stimulation in children with otitis media with effusion (OME). MATERIAL AND METHODS This is an observational study of a cohort of 27 children and 46 ears with OME. The c-VEMP amplitude ratio and P-wave latency were compared between BC and AC in children with OME and healthy age-matched children. RESULTS The c-VEMP response rate in children with OME was 100% when using BC stimulation and 11% when using AC stimulation. The amplitude ratio for BC was significantly higher in the OME group than the age-matched healthy control group (p = 0.004). When focusing on ears with an AC c-VEMP response (n = 5), there was a significant difference in the amplitude ratio between the AC and BC stimulation modes, but there was no significant difference in the AC results between the OME group and the age-matched control group. CONCLUSIONS BC stimulation allows for reliable vestibular otolith testing in children with middle ear effusion. Given the high prevalence of OME in children, clinicians should be aware that recording c-VEMPs with AC stimulation may lead to misinterpretation of otolith dysfunction in pediatric settings.
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Affiliation(s)
- Maxime Damien
- Service d’Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 69003 Lyon, France; (M.D.)
- Centre de Recherche et d’Innovation en Audiologie Humaine, Institut Pasteur, Institut de l’Audition, rue du Docteur Roux, 75015 Paris, France
- Faculté de Médecine, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | - Sylvette R. Wiener-Vacher
- Centre de Recherche et d’Innovation en Audiologie Humaine, Institut Pasteur, Institut de l’Audition, rue du Docteur Roux, 75015 Paris, France
- Service ORL, Centre d’Exploration Fonctionnelle de l’Équilibre chez l’Enfant (EFEE), Hôpital Robert-Debré AP-HP, 75019 Paris, France
| | - Pierre Reynard
- Service d’Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 69003 Lyon, France; (M.D.)
- Centre de Recherche et d’Innovation en Audiologie Humaine, Institut Pasteur, Institut de l’Audition, rue du Docteur Roux, 75015 Paris, France
- Faculté de Médecine, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | - Hung Thai-Van
- Service d’Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 69003 Lyon, France; (M.D.)
- Centre de Recherche et d’Innovation en Audiologie Humaine, Institut Pasteur, Institut de l’Audition, rue du Docteur Roux, 75015 Paris, France
- Faculté de Médecine, Université Claude Bernard Lyon 1, 69003 Lyon, France
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Dumas G, Curthoys IS, Castellucci A, Dumas L, Perrin P, Schmerber S. A bone-conducted Tullio phenomenon-A bridge to understand skull vibration induced nystagmus in superior canal dehiscence. Front Neurol 2023; 14:1183040. [PMID: 37360355 PMCID: PMC10288865 DOI: 10.3389/fneur.2023.1183040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Nystagmus produced in response to air-conducted sound (ACS) stimulation-the Tullio phenomenon-is well known in patients with a semicircular canal (SCC) dehiscence (SCD). Here we consider the evidence that bone-conducted vibration (BCV) is also an effective stimulus for generating the Tullio phenomenon. We relate the clinical evidence based on clinical data extracted from literature to the recent evidence about the physical mechanism by which BCV may cause this nystagmus and the neural evidence confirming the likely mechanism. The hypothetical physical mechanism by which BCV activates SCC afferent neurons in SCD patients is that traveling waves are generated in the endolymph, initiated at the site of the dehiscence. We contend that the nystagmus and symptoms observed after cranial BCV in SCD patients is a variant of Skull Vibration Induced Nystagmus (SVIN) used to identify unilateral vestibular loss (uVL) with the major difference being that in uVL the nystagmus beats away from the affected ear whereas in Tullio to BCV the nystagmus beats usually toward the affected ear with the SCD. We suggest that the cause of this difference is a cycle-by-cycle activation of SCC afferents from the remaining ear, which are not canceled centrally by simultaneous afferent input from the opposite ear, because of its reduced or absent function in uVL. In the Tullio phenomenon, this cycle-by-cycle neural activation is complemented by fluid streaming and thus cupula deflection caused by the repeated compression of each cycle of the stimuli. In this way, the Tullio phenomenon to BCV is a version of skull vibration-induced nystagmus.
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Affiliation(s)
- Georges Dumas
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France
- EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, AUSL–IRCCS di reggio Emilia, Reggio Emilia, Italy
| | - Laurent Dumas
- Laboratoire Radiopharmaceutiques Biocliniques (LRB), INSERM U1039, Faculté de Médecine La Tronche, Université Grenoble Alpes, Grenoble, France
| | - Philippe Perrin
- EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Nancy, France
- Department of Paediatric Oto-Rhino-Laryngology, University Hospital of Nancy, Vandovuvre-lés-Nancy, France
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France
- Brain Tech Laboratory, INSERM UMR 2015, Grenoble, France
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Emami SF. Central Representation of Cervical Vestibular Evoked Myogenic Potentials. Indian J Otolaryngol Head Neck Surg 2023; 75:1-7. [PMID: 37362135 PMCID: PMC10163579 DOI: 10.1007/s12070-023-03829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/28/2023] Open
Abstract
Sensitivity of vestibular system to sounds (SVSS) can be measureable by cervical vestibular evoked myogenic potentials (cVEMPs). The aim of this study is to investigate central representation of vestibular system sensitivity to sound. The research was conducted in 2022-2023 by searching English language databases. The criterion for selecting documents was their overlap with the aim of this work. The animals studies were not included. The saccule is stimulated by sounds, that are transmitted through air and bone conduction. Utricle and semicircular canals are activated only by the vibrations. The afferent nerve fibers of the vestibular system project to the temporal, frontal, parietal, primary visual cortex, insula and the cingulate cortex. There is a relationship between normal results of the cVEMPs and these parameters. Improved phonemes recognition scores and word recognition scores in white noise, the efficiency of auditory training, incraed amplitude of the auditory brainstem responses to 500 HZ tone burst. Learning the first words is not only based on the hearing and other senses participate. The auditory object is a three-dimensional imaging in people's minds, when they hear a word. The words expressed by a speaker create different auditory objects in people's minds. Each of these auditory objects has its own color, shape, aroma and characteristics. For the formation of the auditory objects, all senses and whole areas of the brain contribute. Like other senses, central representation of vestibular system sensitivity to sound are also involved in the formation of auditory objects.
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Affiliation(s)
- Seyede Faranak Emami
- Department of Audiology, School of Rehabilitation Sciences, Hearing Disorder Research Center, Hamadan University of Medical Sciences, Hamedan, Iran
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Wiener-Vacher SR, Campi M, Boizeau P, Thai-Van H. Cervical vestibular evoked myogenic potentials in healthy children: Normative values for bone and air conduction. Front Neurol 2023; 14:1157975. [PMID: 37143993 PMCID: PMC10152971 DOI: 10.3389/fneur.2023.1157975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 05/06/2023] Open
Abstract
Objectives To characterize cervical vestibular evoked myogenic potentials (c-VEMPs) in bone conduction (BC) and air conduction (AC) in healthy children, to compare the responses to adults and to provide normative values according to age and sex. Design Observational study in a large cohort of healthy children (n = 118) and adults (n = 41). The c-VEMPs were normalized with the individual EMG traces, the amplitude ratios were modeled with the Royston-Wright method. Results In children, the amplitude ratios of AC and BC c-VEMP were correlated (r = 0.6, p < 0.001) and their medians were not significantly different (p = 0.05). The amplitude ratio was higher in men than in women for AC (p = 0.04) and BC (p = 0.03). Children had significantly higher amplitude ratios than adults for AC (p = 0.01) and BC (p < 0.001). Normative values for children are shown. Amplitude ratio is age-dependent for AC more than for BC. Confidence limits of interaural amplitude ratio asymmetries were less than 32%. Thresholds were not different between AC and BC (88 ± 5 and 86 ± 6 dB nHL, p = 0.99). Mean latencies for AC and BC were for P-wave 13.0 and 13.2 msec and for N-wave 19.3 and 19.4 msec. Conclusion The present study provides age- and sex-specific normative data for c-VEMP for children (6 months to 15 years of age) for AC and BC stimulation. Up to the age of 15 years, c-VEMP responses can be obtained equally well with both stimulation modes. Thus, BC represents a valid alternative for vestibular otolith testing, especially in case of air conduction disorders.
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Affiliation(s)
- Sylvette R. Wiener-Vacher
- Institut de l’Audition, Institut Pasteur, CERIAH, Paris, France
- Service ORL, Centre d’Exploration Fonctionnelle de l’Equilibre chez l’Enfant (EFEE), Hôpital Universitaire Robert-Debré AP-HP, Paris, France
- *Correspondence: Sylvette R. Wiener-Vacher,
| | - Marta Campi
- Institut de l’Audition, Institut Pasteur, CERIAH, Paris, France
| | - Priscilla Boizeau
- Unité d’Epidémiologie Clinique, INSERM CIC1426, Hôpital Universitaire Robert-Debré AP-HP, Paris, France
| | - Hung Thai-Van
- Institut de l’Audition, Institut Pasteur, CERIAH, Paris, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot & Hôpital Femme Mère Enfant, Service d’Audiologie & Explorations Oto-Neurologiques, University of Lyon, Lyon, France
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Fröhlich L, Wilke M, Plontke SK, Rahne T. Response to: Commentary to "Bone conducted vibration is an effective stimulus for otolith testing in cochlear implant patients". J Vestib Res 2023; 33:433-434. [PMID: 36617766 DOI: 10.3233/ves-220203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Zhang Y, Chen Z, Zhao H, Shen J, Zhong B, Wu Q, Yang J, Jin Y, Zhang Q, Ren P. B81 Bone Vibrator-Induced Vestibular-Evoked Myogenic Potentials: Normal Values and the Effect of Age. Front Neurol 2022; 13:881682. [PMID: 35645948 PMCID: PMC9131004 DOI: 10.3389/fneur.2022.881682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo define the normal values and examine the influence of aging on B81 bone vibrator-induced cervical vestibular-evoked myogenic potentials (B81-cVEMPs) and ocular vestibular-evoked myogenic potentials (B81-oVEMPs).MethodsSeventy healthy subjects, divided into seven groups according to their ages, were enrolled in this study. The 4–9-, 10–19-, 20–29-, 30–39-, 40–49-, 50–59-, and 60–70-year-old participants were divided into groups I–VII, respectively. B81-cVEMP and B81-oVEMP were recorded in each group.ResultsThe B81-cVEMP response rates for groups I–VII were 100, 100, 100, 100, 95, 95, and 75%, respectively, with significant differences only between groups I–VI and group VII (p = 0.047, p < 0.05). The B81-oVEMP response rates for groups I–VII were 100, 100, 100, 100, 70, 65, and 40%, respectively, with significant differences only between groups I–IV and groups V–VII (p = 0.020, p = 0.008, p = 0.000; p < 0.05). The threshold, P13, and N23 latencies of B81-cVEMP positively correlated with age (r = 0.756, p = 0.000; r = 0.357, p = 0.003; r = 0.316, p = 0.009; p < 0.05). The raw amplitudes and corrected amplitudes negatively correlated with age (r = −0.641, p = 0.000; r = −0.609, p = 0.000, p < 0.05). For B81-oVEMP, the corrected amplitudes negatively correlated with age (r = −0.638, p = 0.000, p<0.05), but the threshold and N10 latency positively correlated with age (r = 0.768, p = 0.000; r = 0.334, p = 0.009, p < 0.05). Moreover, the interaural asymmetry ratio did not significantly correlate with age for B81-cVEMP and B81-oVEMP.ConclusionAs age increased, the B81-cVEMP response rate decreased, the thresholds increased, P13 and N23 latencies were prolonged, and the raw amplitude and corrected amplitude decreased. The B81-oVEMP response rate and corrected amplitude decreased, the thresholds increased, and N10 latency was prolonged with age. These changes are probably due to the occurrence of morphological and functional changes in the vestibular system with aging. Therefore, we suggest establishing different reference values according to different age groups when evaluating the VEMP results in patients with vestibular diseases.
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Affiliation(s)
- Yuzhong Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zichen Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huandi Zhao
- Department of Otorhinolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiali Shen
- Department of Otorhinolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Ear Science, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Otolaryngology and Translational Medicine, Shanghai, China
| | - Bo Zhong
- Division of Mechanics and Acoustics, National Institute of Metrology, Beijing, China
| | - Qiong Wu
- Department of Otorhinolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Ear Science, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Otolaryngology and Translational Medicine, Shanghai, China
| | - Jun Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Ear Science, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Otolaryngology and Translational Medicine, Shanghai, China
| | - Yulian Jin
- Department of Otorhinolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Ear Science, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Otolaryngology and Translational Medicine, Shanghai, China
- Yulian Jin
| | - Qing Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Otorhinolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Ear Science, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Otolaryngology and Translational Medicine, Shanghai, China
- Qing Zhang
| | - Pengyu Ren
- Department of Otorhinolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Pengyu Ren
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Temporal Modulation Transfer Functions of Amplitude-Modulated Cervical Vestibular-Evoked Myogenic Potentials in Young Adults. Ear Hear 2022; 43:1456-1465. [PMID: 35319517 DOI: 10.1097/aud.0000000000001221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cervical vestibular-evoked myogenic potentials (cVEMPs) are widely used to evaluate saccular function in clinical and research applications. Typically, transient tonebursts are used to elicit cVEMPs. In this study, we used bone-conducted amplitude-modulated (AM) tones to elicit AMcVEMPs. This new approach allows the examination of phase-locked vestibular responses across a range of modulation frequencies. Currently, cVEMP temporal modulation transfer functions (TMTFs) are not well defined. The purposes of the present study were (1) to characterize the AMcVEMP TMTF in young, healthy individuals, (2) to compare AMcVEMP TMTFs across different analysis approaches, and (3) to determine the upper frequency limit of the AMcVEMP TMTF. DESIGN Young adults (ages 21 to 25) with no history of vestibular lesions or middle ear pathologies participated in this study. Stimuli were amplitude-modulated tones with a carrier frequency of 500 Hz and modulation frequencies ranging from 7 to 403 Hz. Stimuli were presented at 65 dB HL via a B81 bone-oscillator. RESULTS AMcVEMP waveforms consisted of transient onset responses, steady-state responses, and transient offset responses; the behavior of these different types of responses varied with modulation frequency. Differences in the TMTF shape were noted across different measures. The amplitude TMTF had a sharp peak, while signal-to-noise ratio and phase coherence TMTFs had broader shapes with plateaus across a range of modulation frequencies. Amplitude was maximal at modulation frequencies of 29 and 37 Hz. Signal-to-noise ratio maintained its peak value at modulation frequencies between 17 Hz and 127 Hz. Phase coherence and modulation gain maintained their peak values at modulation frequencies between 17 Hz and 143 Hz. CONCLUSIONS AMcVEMPs reflect transient onset and offset responses, as well as a sustained response with the periodicity of an amplitude-modulation frequency. AMcVEMP TMTFs had variable shapes depending on the analysis being applied to the response; amplitude had a narrow shape while others were broader. Average upper frequency limits of the AMcVEMP TMTF were as high as approximately 300 Hz in young, healthy adults.
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Clinard CG, Lawlor KJ, Thorne AP, Piker EG. Nonlinearity in bone-conducted amplitude-modulated cervical vestibular evoked myogenic potentials: Harmonic distortion products. J Neurophysiol 2022; 127:791-800. [PMID: 35171737 DOI: 10.1152/jn.00347.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Otolith organs of the balance system, the saccule and utricle, encode linear acceleration. Integrity of the saccule is commonly assessed using cervical vestibular evoked myogenic potentials (cVEMPs) arising from an inhibitory reflex along the vestibulospinal pathway. Conventional approaches to eliciting these responses use brief, transient sounds to elicit onset responses. Here we used long-duration amplitude-modulated (AM) tones to elicit cVEMPs (AMcVEMPs) and analyzed their spectral content for evidence of nonlinear processing consistent with known characteristics of vestibular hair cells. Twelve young adults (ages 21-25) with no hearing or vestibular pathologies participated in this study. AMcVEMPs were elicited by bone-conducted AM tones with a 500 Hz carrier frequency. Eighteen modulation frequencies were used between 7 and 403 Hz. All participants had robust distortion products at harmonics of the modulation frequency. Total harmonic distortion ranged from approximately 10 to 80%. AMcVEMPs contain harmonic distortion products consistent with vestibular hair cell nonlinearities, and this new approach to studying the otolith organs may provide a non-invasive, in vivo method to study nonlinearity of vestibular hair cells in humans.
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Affiliation(s)
- Christopher G Clinard
- Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, United States
| | - Kerri J Lawlor
- Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, United States
| | - Andrew P Thorne
- Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, United States
| | - Erin G Piker
- Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, United States
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Gattie M, Lieven EVM, Kluk K. Weak Vestibular Response in Persistent Developmental Stuttering. Front Integr Neurosci 2021; 15:662127. [PMID: 34594189 PMCID: PMC8477904 DOI: 10.3389/fnint.2021.662127] [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: 01/31/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Vibrational energy created at the larynx during speech will deflect vestibular mechanoreceptors in humans (Todd et al., 2008; Curthoys, 2017; Curthoys et al., 2019). Vestibular-evoked myogenic potential (VEMP), an indirect measure of vestibular function, was assessed in 15 participants who stutter, with a non-stutter control group of 15 participants paired on age and sex. VEMP amplitude was 8.5 dB smaller in the stutter group than the non-stutter group (p = 0.035, 95% CI [−0.9, −16.1], t = −2.1, d = −0.8, conditional R2 = 0.88). The finding is subclinical as regards gravitoinertial function, and is interpreted with regard to speech-motor function in stuttering. There is overlap between brain areas receiving vestibular innervation, and brain areas identified as important in studies of persistent developmental stuttering. These include the auditory brainstem, cerebellar vermis, and the temporo-parietal junction. The finding supports the disruptive rhythm hypothesis (Howell et al., 1983; Howell, 2004) in which sensory inputs additional to own speech audition are fluency-enhancing when they coordinate with ongoing speech.
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Affiliation(s)
- Max Gattie
- Manchester Centre for Audiology and Deafness (ManCAD), The University of Manchester, Manchester, United Kingdom
| | - Elena V M Lieven
- Child Study Centre, The University of Manchester, Manchester, United Kingdom.,The ESRC International Centre for Language and Communicative Development (LuCiD), The University of Manchester, Manchester, United Kingdom
| | - Karolina Kluk
- Manchester Centre for Audiology and Deafness (ManCAD), The University of Manchester, Manchester, United Kingdom
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Nakul E, Bartolomei F, Lopez C. Vestibular-Evoked Cerebral Potentials. Front Neurol 2021; 12:674100. [PMID: 34621231 PMCID: PMC8490637 DOI: 10.3389/fneur.2021.674100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
The human vestibular cortex has mostly been approached using functional magnetic resonance imaging and positron emission tomography combined with artificial stimulation of the vestibular receptors or nerve. Few studies have used electroencephalography and benefited from its high temporal resolution to describe the spatiotemporal dynamics of vestibular information processing from the first milliseconds following vestibular stimulation. Evoked potentials (EPs) are largely used to describe neural processing of other sensory signals, but they remain poorly developed and standardized in vestibular neuroscience and neuro-otology. Yet, vestibular EPs of brainstem, cerebellar, and cortical origin have been reported as early as the 1960s. This review article summarizes and compares results from studies that have used a large range of vestibular stimulation, including natural vestibular stimulation on rotating chairs and motion platforms, as well as artificial vestibular stimulation (e.g., sounds, impulsive acceleration stimulation, galvanic stimulation). These studies identified vestibular EPs with short latency (<20 ms), middle latency (from 20 to 50 ms), and late latency (>50 ms). Analysis of the generators (source analysis) of these responses offers new insights into the neuroimaging of the vestibular system. Generators were consistently found in the parieto-insular and temporo-parietal junction-the core of the vestibular cortex-as well as in the prefrontal and frontal areas, superior parietal, and temporal areas. We discuss the relevance of vestibular EPs for basic research and clinical neuroscience and highlight their limitations.
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Affiliation(s)
- Estelle Nakul
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Neurosciences Cognitives (LNC), FR3C, Aix Marseille Univ, Marseille, France
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, Inserm, Aix Marseille Univ, Marseille, France
- Service de Neurophysiologie Clinique, Hôpital Timone, Aix Marseille Univ, Marseille, France
| | - Christophe Lopez
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Neurosciences Cognitives (LNC), FR3C, Aix Marseille Univ, Marseille, France
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Fredén Jansson KJ, Håkansson B, Reinfeldt S, Persson AC, Eeg-Olofsson M. Bone Conduction Stimulated VEMP Using the B250 Transducer. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:225-237. [PMID: 34267559 PMCID: PMC8275207 DOI: 10.2147/mder.s317072] [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: 04/24/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Bone conduction (BC) stimulation is rarely used for clinical testing of vestibular evoked myogenic potentials (VEMPs) due to the limitations of conventional stimulation alternatives. The aim of this study is to compare VEMP using the new B250 transducer with the Minishaker and air conduction (AC) stimulation. Methods Thirty normal subjects between 20 and 37 years old and equal gender distribution were recruited, 15 for ocular VEMP and 15 for cervical VEMP. Four stimulation conditions were compared: B250 on the mastoid (FM); Minishaker and B250 on the forehead (FZ); and AC stimulation using an insert earphone. Results It was found that B250 at FM required a statistically significant lower hearing level than with AC stimulation, in average 41 dB and 35 dB lower for ocular VEMP and cervical VEMP, respectively, but gave longer n10 (1.1 ms) and n23 (1.6 ms). No statistical difference was found between B250 at FM and Minishaker at FZ. Conclusion VEMP stimulated with B250 at FM gave similar response as the Minishaker at FZ and for a much lower hearing level than AC stimulation using insert earphones.
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Affiliation(s)
| | - Bo Håkansson
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Sabine Reinfeldt
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Ann-Charlotte Persson
- Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Måns Eeg-Olofsson
- Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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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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14
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Age Effects of Bone Conduction Vibration Vestibular-evoked Myogenic Potentials (VEMPs) Using B81 and Impulse Hammer Stimuli. Ear Hear 2021; 42:1328-1337. [PMID: 33735908 DOI: 10.1097/aud.0000000000001024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recently developed, the Radioear B81 bone oscillator allows for higher bone conduction vibration output; however, normative data are lacking regarding its use in vestibular-evoked myogenic potential (VEMP) testing. The purpose of this study was to examine the effect of age on cervical and ocular VEMP (c- and oVEMP) responses using the B81 and to compare with air conduction stimuli (ACS) and impulse hammer (IH) VEMP response characteristics. DESIGN c- and oVEMP were completed with ACS, B81, and IH stimuli in healthy participants (age range = 10 to 87 years, n = 85). RESULTS Regardless of stimulus type, c- and oVEMP amplitudes and response rates decreased with age. For cVEMP response rates, ACS performed better or equal to B81, which was superior to the IH. For cVEMP corrected amplitude, ACS had significantly higher amplitudes compared with B81 and IH. There was no difference in cVEMP corrected amplitude between B81 and IH. For oVEMP, response rates were comparable between stimuli with the largest disparity in response rates occurring in the oldest groups where IH outperformed both ACS and B81. For oVEMP amplitude, IH had significantly higher amplitudes compared with B81 and ACS. There was no difference in oVEMP amplitude between B81 and ACS. CONCLUSIONS Age significantly affected c- and oVEMP amplitudes regardless of stimulus type (ACS, B81, IH). All stimuli are appropriate for eliciting c- and oVEMP in the young individuals. While ACS resulted in higher cVEMP corrected amplitudes, either ACS or B81 are appropriate for older individuals. However, for oVEMPs, higher response rates and larger amplitudes were noted for IH followed by B81 and ACS. Overall, the B81 performed well across the lifespan for c- and oVEMPs and may be a reasonable bone conduction vibration option for patients with absent ACS VEMPs, but at this time is not recommended as a replacement to ACS.
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Comparison of Bone-Conducted Cervical VEMPs Elicited by B71 and B81 Bone Vibrators. Ear Hear 2021; 42:596-605. [PMID: 33577217 DOI: 10.1097/aud.0000000000000978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A variety of stimulus delivery methods can elicit vestibular evoked myogenic potentials (VEMPs). The current study compared bone conduction (BC) cervical VEMPs (cVEMPs) across two different clinical bone vibrators. It was hypothesized that the B81 transducer would be more effective for producing larger BC-cVEMP peak to peak amplitudes due to its low-frequency advantages in pure-tone audiometry applications. DESIGN Twenty young adults under the age of 40 years with no reported history of hearing or balance disorders participated in the study. BC cVEMPs were elicited using two clinical bone transducers: the Radioear B71 bone vibrator and the Radioear B81 bone vibrator. Both transducers were calibrated using the acoustic method of calibration before data collection, and the linear dynamic range of the transducers was determined. Participants were asked to sit and match a fixed electromyography (EMG) target level of 100 µV, while BC cVEMPs were recorded using stimulus frequencies of 250, 500, and 750 Hz. RESULTS Statistically significant differences in raw amplitude at 250 and 750 Hz between the B71 and B81 were observed; the B71 produced larger peak to peak amplitudes over the B81. At 500 Hz, larger amplitudes were observed with the B71, but results were not statistically significant. The B71 produced significantly lower cVEMP thresholds at all three frequencies. Across both transducers, 500 Hz produced the largest peak to peak amplitude compared with 250 and 750 Hz. Peak to peak amplitude did not increase above 55 dB nHL for 250 and 500 Hz, but amplitude continued to increase at 750 Hz. DISCUSSION The present study found statistically significant differences in BC-cVEMP amplitude and threshold between the B71 and B81, but results were not what we hypothesized. In general, the B71 elicited larger BC-cVEMP amplitudes and lower thresholds compared with the B81. Additionally, 500 Hz was found to be the best frequency for both BC transducers, contrasting previous studies suggesting lower frequencies yield larger BC-cVEMP amplitudes. It is possible that these average differences could also be clinically significant when looking at individual amplitude differences. Larger peak to peak amplitudes at 500 Hz may be partially due to the underlying physical levels used in the current study, as well as the output spectra of the transducers, and may explain the larger response amplitudes observed at 500 Hz compared with 250 Hz.
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Clinard CG, Thorne AP, Piker EG. Effects of Tonic Muscle Activation on Amplitude-Modulated Cervical Vestibular Evoked Myogenic Potentials (AMcVEMPs) in Young Females: Preliminary Findings. J Assoc Res Otolaryngol 2020; 21:445-461. [PMID: 32761291 DOI: 10.1007/s10162-020-00766-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/24/2020] [Indexed: 12/21/2022] Open
Abstract
Cervical vestibular evoked myogenic potentials (cVEMPs) are usually elicited by transient tonebursts, but when elicited by amplitude-modulated (AM) tones, they can provide new information about cVEMPs. Previous reports of cVEMPs elicited by AM tones, or AMcVEMPs, have not systematically examined the effects of tonic EMG activation on their response properties. Fourteen young, healthy female adults (ages 20-24) with clinically normal audiograms participated in this study. AMcVEMPs were elicited with bone-conducted 500 Hz tones amplitude modulated at a rate of 37 Hz and recorded for five different EMG targets ranging from 0 to 90 μV. Amplitude increased linearly as tonic EMG activation increased. Signal-to-noise ratio (SNR) was minimal at 0 μV, but robust and with equivalent values from 30 to 90 μV; phase coherence and EMG-corrected amplitude had findings similar to SNR across EMG target levels. Interaural asymmetry ratios for SNR and phase coherence were substantially lower than those for raw or corrected amplitude. AMcVEMP amplitude scaled with tonic EMG activation similar to transient cVEMPs. Signal-to-noise ratio, phase coherence, and EMG-corrected amplitude plateaued across a range of EMG values, suggesting that these properties of the response reach their maximum values at relatively low levels of EMG activation and that higher levels of EMG activation are not necessary to record robust AMcVEMPs.
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Affiliation(s)
- Christopher G Clinard
- Department of Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, MSC 4304, Harrisonburg, VA, 22807, USA.
| | - Andrew P Thorne
- Department of Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, MSC 4304, Harrisonburg, VA, 22807, USA
| | - Erin G Piker
- Department of Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, MSC 4304, Harrisonburg, VA, 22807, USA
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Rotem Betito H, Himmelfarb M, Handzel O. Effects of Occlusion and Conductive Hearing Loss on Bone-Conducted cVEMP. Otolaryngol Head Neck Surg 2020; 164:407-413. [PMID: 32746733 DOI: 10.1177/0194599820944903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the effects of conductive hearing loss and occlusion on bone-conducted cervical vestibular evoked myogenic potentials (cVEMPs). STUDY DESIGN Prospective cohort study conducted in the year 2018. The right ear of each volunteer was evaluated under 3 conditions by using bone-conducted cVEMPs: normal (open external auditory canal), occluded (conductive hearing loss with occlusion effect), and closed (conductive hearing loss without the occlusion effect). SETTING Single academic center. SUBJECTS AND METHODS The study comprised 30 healthy volunteers aged 20 to 35 years (16 women, 14 men). All had normal hearing and no vestibular or auditory pathologies. The thresholds and amplitudes of cVEMP responses were recorded for the 3 conditions. The results of each condition for a particular participant were compared. RESULTS As compared with the open condition, the conductive condition increased thresholds by 2.8 dB (P = .01), and the occluded condition decreased thresholds by 3.8 dB (P = .008). The amplitude in the occluded condition was larger than the normal condition and the conductive condition (mean difference: 20.64 [P = .009] and 31.76 [P < .001], respectively). CONCLUSION The occlusion effect is present in cVEMP responses. The mechanism is not due to the conductive hearing loss induced. Clinical implications include potentially altering vestibular function with sealed hearing aids and in the surgically modified ears (ie, obliterated ears and open cavity mastoidectomy).
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Affiliation(s)
| | - Mordechai Himmelfarb
- Department of Communication Disorders, School of Medical Science, University of Ariel, Ariel, Israeli.,Department of Otolaryngology-Head, Neck, and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ophir Handzel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Otolaryngology-Head, Neck, and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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Greenwalt NL, Patterson JN, Rodriguez AI, Fitzpatrick D, Gordon KR, Janky KL. Bone Conduction Vibration Vestibular Evoked Myogenic Potential (VEMP) Testing: Reliability in Children, Adolescents, and Young Adults. Ear Hear 2020; 42:355-363. [PMID: 32701728 DOI: 10.1097/aud.0000000000000925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Bone conduction vibration (BCV) vestibular evoked myogenic potentials (VEMP) are clinically desirable in children for multiple reasons. However, no accepted standard exists for stimulus type and the reliability of BCV devices has not been investigated in children. The objective of the current study was to determine which BCV VEMP method (B-71, impulse hammer, or Mini-shaker) yields the highest response rates and reliability in a group of adults, adolescents, and children. It was hypothesized that the Mini-shaker would yield the highest response rates and reliability because it provides frequency specificity, higher output levels without distortion, and the most consistent force output as compared to the impulse hammer and B-71. DESIGN Participants included 10 child (ages 5 to 10), 11 adolescent (ages 11 to 18), and 11 young adult (ages 23 to 39) normal controls. Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) were measured in response to suprathreshold air-conducted, 500 Hz tone bursts and 3 types of BCV (B-71, impulse hammer, and Mini-shaker) across 2 test sessions to assess reliability. RESULTS For cVEMP, response rates were 100% for all methods in all groups with the exception of the adult group in response to the impulse hammer (95%). For oVEMP, response rates varied by group and BCV method. For cVEMP, reliability was highest in adults using the Mini-shaker, in adolescents using the impulse hammer, and in children using the B-71. For oVEMP, reliability was highest in adults using the Mini-shaker, in adolescents using the Mini-shaker or impulse hammer, and in children using the impulse hammer. Age positively correlated with air-conducted oVEMP amplitude, but not cVEMP amplitude or cVEMP corrected amplitude. Age negatively correlated with all BCV VEMP amplitudes with the exception of cVEMP corrected amplitude in response to the Mini-shaker. CONCLUSIONS All BCV methods resulted in consistent cVEMP responses (response rates 95 to 100%) with at least moderate reliability (intraclass correlation coefficient ≥ 0.5) for all groups. Similarly, all BCV methods resulted in consistent oVEMP responses (89 to 100%) with at least moderate reliability (intraclass correlation coefficient ≥ 0.5) except for the B-71 in adults.
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Affiliation(s)
- Nicole L Greenwalt
- The Ohio State University, Ohio, USA.,Boys Town National Research Hospital, Omaha, Nebraska, USA
| | | | - Amanda I Rodriguez
- Boys Town National Research Hospital, Omaha, Nebraska, USA.,University of Nebraska-Lincoln, Nebraska, USA
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Clinard CG, Piker EG, Thorne AP, Surface EN, Anderson AE, Beacham VA, Crouse MC, Whitney VH, Depaolis RA. Maximum Output and Low-Frequency Limitations of B71 and B81 Clinical Bone Vibrators: Implications for Vestibular Evoked Potentials. Ear Hear 2020; 41:847-854. [DOI: 10.1097/aud.0000000000000808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Dyball AC, Govender S, Taylor RL, Young AS, Welgampola MS, Rosengren SM. Bone-conducted vestibular and stretch reflexes in human neck muscles. Exp Brain Res 2020; 238:1237-1248. [PMID: 32279086 DOI: 10.1007/s00221-020-05798-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/24/2020] [Indexed: 12/01/2022]
Abstract
In normal humans, tapping the forehead produces a neck muscle reflex that is used clinically to test vestibular function, the cervical vestibular evoked myogenic potential (cVEMP). As stretch receptors can also be activated by skull taps, we investigated the origin of the early and late peaks of the bone-conducted cVEMP. In twelve normal participants, we differentially stimulated the vestibular and neck stretch receptors by applying vibration to the forehead (activating both vestibular and stretch receptors) and to the sternum (activating mainly stretch receptors). Patients with bilateral vestibulopathy (BVP; n = 26) and unilateral vestibular loss (uVL; n = 17) were also investigated for comparison. Comparison of peaks in normal subjects suggested that the early peaks were vestibular-dependent, while the later peaks had mixed vestibular and stretch input. The late peaks were present but small (1.1 amplitude ratio) in patients with BVP and absent VEMPs, confirming that they do not strictly depend on vestibular function, and largest in age-matched controls (1.5 amplitude ratio, p = 0.049), suggesting that there is an additional vestibular reflex at this latency (approx. 30 ms). Patients with uVL had larger late peaks on the affected than the normal side (1.4 vs 1.0 amplitude ratio, p = 0.034). The results suggest that the early responses in SCM to skull vibration in humans are vestibular-dependent, while there is a late stretch reflex bilaterally and a late vestibular reflex in the contralateral muscle.
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Affiliation(s)
- Alyssa C Dyball
- Audiology, Department of Linguistics, Macquarie University, Sydney, Australia
| | - Sendhil Govender
- Department of Neurological Sciences, Prince of Wales Hospital, Randwick, Sydney, Australia.,Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Level 8, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia
| | - Rachael L Taylor
- Department of Physiology and Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Allison S Young
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Miriam S Welgampola
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Level 8, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sally M Rosengren
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Level 8, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia. .,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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Mapping the vestibular cerebellar evoked potential (VsCEP) following air- and bone-conducted vestibular stimulation. Exp Brain Res 2020; 238:601-620. [DOI: 10.1007/s00221-020-05733-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/08/2020] [Indexed: 01/19/2023]
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22
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Kabbaligere R, Layne CS, Karmali F. Perception of threshold-level whole-body motion during mechanical mastoid vibration. J Vestib Res 2019; 28:283-294. [PMID: 30149483 DOI: 10.3233/ves-180636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vibration applied on the mastoid has been shown to be an excitatory stimulus to the vestibular receptors, but its effect on vestibular perception is unknown. OBJECTIVE Determine whether mastoid vibration affects yaw rotation perception using a self-motion perceptual direction-recognition task. METHODS We used continuous, bilateral, mechanical mastoid vibration using a stimulus with frequency content between 1 and 500 Hz. Vestibular perception of 10 healthy adults (M±S.D. = 34.3±12 years old) was tested with and without vibration. Subjects repeatedly reported the perceived direction of threshold-level yaw rotations administered at 1 Hz by a motorized platform. A cumulative Gaussian distribution function was fit to subjects' responses, which was described by two parameters: bias and threshold. Bias was defined as the mean of the Gaussian distribution, and equal to the motion perceived on average when exposed to null stimuli. Threshold was defined as the standard deviation of the distribution and corresponded to the stimulus the subject could reliably perceive. RESULTS The results show that mastoid vibration may reduce bias, although two statistical tests yield different conclusions. There was no evidence that yaw rotation thresholds were affected. CONCLUSIONS Bilateral mastoid vibration may reduce left-right asymmetry in motion perception.
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Affiliation(s)
- Rakshatha Kabbaligere
- Department of Health and Human Performance, University of Houston, Houston, TX, USA.,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - Charles S Layne
- Department of Health and Human Performance, University of Houston, Houston, TX, USA.,Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA.,Center for Neuro-Engineering and Cognitive Science, University of Houston, Houston, TX, USA
| | - Faisal Karmali
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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Abstract
BACKGROUND Vestibular evoked myogenic potentials (VEMP) are transient alteration in tonic activity of muscles elicited by auditory stimulation of the otolithic organs of the ear. VEMP can be triggered by auditory stimulation via air or bone conduction. Occlusion of the external auditory meatus has long been known to decrease thresholds for sound perception medicated by the cochlea. OBJECTIVE Proof that the occlusion effect is present for bone conducted (BC) cervical VEMPs (cVEMP). METHODS Measurement of the thresholds and raw amplitudes of BC-VEMPs in twenty healthy adults with the external auditory canal open and occluded. RESULTS Thresholds for BC-VEMPs were similar for the open vs. the occluded condition. However, amplitudes were statistically significantly higher in the occluded (average 76.34μV) vs. open group (average 69.9μV). CONCLUSIONS The occlusion effect is present in cVEMPs. This finding, described herein for the first time, has a number of clinical implications such as the surgically altered ear and the use of occluding hearing aids.
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Affiliation(s)
- Ophir Handzel
- Department of Otolaryngology/Head, Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechai Himmelfarb
- Department of Otolaryngology/Head, Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Department of Communication Disorders, Ariel University, Ariel, Israel
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Colebatch JG, Rosengren SM. Investigating short latency subcortical vestibular projections in humans: what have we learned? J Neurophysiol 2019; 122:2000-2015. [PMID: 31596627 DOI: 10.1152/jn.00157.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Vestibular evoked myogenic potentials (VEMPs) are now widely used for the noninvasive assessment of vestibular function and diagnosis in humans. This review focuses on the origin, properties, and mechanisms of cervical VEMPs and ocular VEMPs; how these reflexes relate to reports of vestibular projections to brain stem and cervical targets; and the physiological role of (otolithic) cervical and ocular reflexes. The evidence suggests that both VEMPs are likely to represent the effects of excitation of irregularly firing otolith afferents. While the air-conducted cervical VEMP appears to mainly arise from excitation of saccular receptors, the ocular VEMP evoked by bone-conducted stimulation, including impulsive bone-conducted stimuli, mainly arises from utricular afferents. The surface responses are generated by brief changes in motor unit firing. The effects that have been demonstrated are likely to represent otolith-dependent vestibulocollic and vestibulo-ocular reflexes, both linear and torsional. These observations add to previous reports of short latency otolith projections to the target muscles in the neck (sternocleidomastoid and splenius) and extraocular muscles (the inferior oblique). New insights have been provided by the investigation and application of these techniques.
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Affiliation(s)
- James G Colebatch
- Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Sally M Rosengren
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Rosengren SM, Colebatch JG, Young AS, Govender S, Welgampola MS. Vestibular evoked myogenic potentials in practice: Methods, pitfalls and clinical applications. Clin Neurophysiol Pract 2019; 4:47-68. [PMID: 30949613 PMCID: PMC6430081 DOI: 10.1016/j.cnp.2019.01.005] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 02/07/2023] Open
Abstract
Vestibular evoked myogenic potentials (VEMPs) are used to test the otolith organs in patients with vertigo and imbalance. This review discusses the optimal procedures for recording VEMPs and the pitfalls commonly encountered by clinicians. Better understanding of VEMP methodology should lead to improved quality of recordings.
Vestibular evoked myogenic potentials (VEMPs) are a useful and increasingly popular component of the neuro-otology test battery. These otolith-dependent reflexes are produced by stimulating the ears with air-conducted sound or skull vibration and recorded from surface electrodes placed over the neck (cervical VEMPs) and eye muscles (ocular VEMPs). VEMP abnormalities have been reported in various diseases of the ear and vestibular system, and VEMPs have a clear role in the diagnosis of superior semicircular canal dehiscence. However there is significant variability in the methods used to stimulate the otoliths and record the reflexes. This review discusses VEMP methodology and provides a detailed theoretical background for the techniques that are typically used. The review also outlines the common pitfalls in VEMP recording and the clinical applications of VEMPs.
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Key Words
- AC, air-conducted
- AR, asymmetry ratio
- AVS, acute vestibular syndrome
- BAER, brainstem auditory evoked potential
- BC, bone-conducted
- BPV, benign positioning vertigo
- BVP, bilateral vestibulopathy
- CANVAS, cerebellar ataxia, neuropathy and vestibular areflexia syndrome
- Deg, degrees
- ECG, electrocardiographic
- EEG, electroencephalographic
- EMG, electromyographic activity/electromyogram
- FL, force level
- HL, hearing level
- IO, inferior oblique
- MD, Meniere’s disease
- Method
- NIOSH, National Institutes of Occupational Safety and Health
- Otolith
- PCS, posterior circulation stroke
- PICA, posterior inferior cerebellar artery
- PP, peak-to-peak
- RMS, root mean square
- SCC, semicircular canal
- SCD, superior canal dehiscence
- SCM, sternocleidomastoid
- SL, sensation level
- SPL, sound pressure level, being the RMS value for a sinusoid
- SVH, subjective visual horizontal
- Sound
- UW, unilateral weakness
- VEMP
- VEMP, vestibular evoked myogenic potential
- VM, vestibular migraine
- VN, vestibular neuritis
- VS, vestibular schwannoma
- Vestibular
- Vibration
- cVEMP, cervical vestibular evoked myogenic potential
- dB, decibels, the logarithm of the relative power versus a reference
- dBA, decibels, measured using an “A” weighting
- nHL, normal hearing level
- oVEMP, ocular vestibular evoked myogenic potential
- pkFL, peak force level
- pkSPL, peak sound pressure level (3 dB higher than RMS for a sinusoid)
- vHIT, video head impulse test
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Affiliation(s)
- Sally M Rosengren
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, Australia.,Central Clinical School, University of Sydney, Sydney, Australia
| | - James G Colebatch
- Prince of Wales Hospital Clinical School and Neuroscience Research Australia, Randwick, Sydney, NSW, Australia
| | - Allison S Young
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, Australia.,Central Clinical School, University of Sydney, Sydney, Australia
| | - Sendhil Govender
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, Australia.,Prince of Wales Hospital Clinical School and Neuroscience Research Australia, Randwick, Sydney, NSW, Australia
| | - Miriam S Welgampola
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, Australia.,Central Clinical School, University of Sydney, Sydney, Australia
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Lütkenhöner B. Vestibular Evoked Myographic Correlation. J Assoc Res Otolaryngol 2018; 20:99-114. [PMID: 30421148 DOI: 10.1007/s10162-018-00698-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022] Open
Abstract
This work started from the hypothesis that the physiological processes giving rise to the vestibular evoked myogenic potential (VEMP) can be induced not only by transient sounds but also by a continuous stimulation with a stochastic signal. The hypothesis is based on the idea that the number of motor unit action potentials (MUAPs) decreases after a momentary amplitude increase of the effective stimulus, whereas a momentary amplitude decrease has the opposite effect. This concept was theoretically analyzed by assuming that the effective stimulus is closely related to the envelope of the stimulus actually presented. The analysis led to the prediction that the cross-correlation function of the effective stimulus and the measured electromyogram (EMG) has VEMP-like properties. Experiments confirmed this prediction, thus providing evidence of a novel electrophysiological response: the vestibular evoked myographic correlation (VEMCorr). The methodological approach corresponded to a conventional VEMP study, except that the stimulus (delivered with a hand-held minishaker) comprised not only a series of 500-Hz tone pulses (classical VEMP measurement, for comparison) but also sequences of narrow-band noise with a center frequency of 500 Hz (VEMCorr measurement). Each of the 12 test persons showed a clear VEMCorr. Moreover, VEMP and VEMCorr largely resembled each other, as predicted. Apparently they are two different expressions of a more general mechanism that leads to a roughly linear relationship between stimulus envelope and expectation of the EMG. Future applications of the VEMCorr could exploit that a continuous-stimulation paradigm allows for varying the center frequency of the stimulus without changing the relative bandwidth.
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Affiliation(s)
- Bernd Lütkenhöner
- ENT Clinic, Münster University Hospital, Kardinal-von-Galen-Ring 10, 48129, Münster, Germany.
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Håkansson B, Jansson KJF, Tengstrand T, Johannsen L, Eeg-Olofsson M, Rigato C, Dahlström E, Reinfeldt S. VEMP using a new low-frequency bone conduction transducer. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:301-312. [PMID: 30233258 PMCID: PMC6134943 DOI: 10.2147/mder.s171369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective A new prototype bone conduction (BC) transducer B250, with an emphasized low-frequency response, is evaluated in vestibular evoked myogenic potential (VEMP) investigations. The aim was to compare cervical (cVEMP) and ocular (oVEMP) responses using tone bursts at 250 and 500 Hz with BC stimulation using the B250 and the conventional B81 transducer and by using air conduction (AC) stimulation. Methods Three normal subjects were investigated in a pilot study. BC stimulation was applied to the mastoids in cVEMP, and both mastoid and forehead in oVEMP investigations. Results BC stimulation was found to reach VEMP thresholds at considerably lower hearing levels than in AC stimulation (30–40 dB lower oVEMP threshold at 250 Hz). Three or more cVEMP and oVEMP responses at consecutive 5 dB increasing mastoid stimulation levels were only obtained in all subjects using the B250 transducer at 250 Hz. Similar BC thresholds were obtained for both ipsilateral and contralateral mastoid stimulation. Forehead stimulation, if needed, may require a more powerful vibration output. Conclusion Viable VEMP responses can be obtained at a considerably lower hearing level with BC stimulation than by AC stimulation. The cVEMP and oVEMP responses were similar when measured on one side and with the B250 attached to both ipsilateral and contralateral mastoids.
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Affiliation(s)
- Bo Håkansson
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden,
| | | | - Tomas Tengstrand
- Department of Audiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Måns Eeg-Olofsson
- Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cristina Rigato
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden,
| | - Elisabeth Dahlström
- Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sabine Reinfeldt
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden,
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Clinical Evaluation of the Vestibular Nerve Using Vestibular Evoked Myogenic Potentials. J Clin Neurophysiol 2018; 35:39-47. [PMID: 29298211 DOI: 10.1097/wnp.0000000000000422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Vestibular evoked myogenic potentials are currently the most clinically accessible method to evaluate the otolith reflex pathways. These responses provide unique information regarding the status of the utriculo-ocular and sacculo-collic reflex pathways, information that has previously been unavailable. Vestibular evoked myogenic potentials are recorded from tonically contracted target muscles known to be innervated by these respective otolith organs. Diagnosticians can use vestibular evoked myogenic potentials to better evaluate the overall integrity of the inner ear and neural pathways; however, there are specific considerations for each otolith reflex protocol. In addition, specific patient populations may require protocol variations to better evaluate atypical function of the inner ear organs, vestibular nerve transmission, or subsequent reflex pathways. This is a review of the clinical application and interpretation of cervical and ocular vestibular evoked myogenic potentials.
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Rosengren SM, Colebatch JG. The Contributions of Vestibular Evoked Myogenic Potentials and Acoustic Vestibular Stimulation to Our Understanding of the Vestibular System. Front Neurol 2018; 9:481. [PMID: 30013504 PMCID: PMC6037197 DOI: 10.3389/fneur.2018.00481] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/04/2018] [Indexed: 12/16/2022] Open
Abstract
Vestibular-evoked myogenic potentials (VEMPs) are short-latency muscle reflexes typically recorded from the neck or eye muscles with surface electrodes. They are used clinically to assess otolith function, but are also interesting as they can provide information about the vestibular system and its activation by sound and vibration. Since the introduction of VEMPs more than 25 years ago, VEMPs have inspired animal and human research on the effects of acoustic vestibular stimulation on the vestibular organs, their projections and the postural muscles involved in vestibular reflexes. Using a combination of recording techniques, including single motor unit recordings, VEMP studies have enhanced our understanding of the excitability changes underlying the sound-evoked vestibulo-collic and vestibulo-ocular reflexes. Studies in patients with diseases of the vestibular system, such as superior canal dehiscence and Meniere's disease, have shown how acoustic vestibular stimulation is affected by physical changes in the vestibule, and how sound-evoked reflexes can detect these changes and their resolution in clinical contexts. This review outlines the advances in our understanding of the vestibular system that have occurred following the renewed interest in sound and vibration as a result of the VEMP.
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Affiliation(s)
- Sally M Rosengren
- Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - James G Colebatch
- Prince of Wales Hospital Clinical School and Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
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Maxwell AK, Banakis Hartl RM, Greene NT, Benichoux V, Mattingly JK, Cass SP, Tollin DJ. Semicircular Canal Pressure Changes During High-intensity Acoustic Stimulation. Otol Neurotol 2017; 38:1043-1051. [PMID: 28570420 PMCID: PMC6561339 DOI: 10.1097/mao.0000000000001456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Acoustic stimulation generates measurable sound pressure levels in the semicircular canals. BACKGROUND High-intensity acoustic stimuli can cause hearing loss and balance disruptions. To examine the propagation of acoustic stimuli to the vestibular end-organs, we simultaneously measured fluid pressure in the cochlea and semicircular canals during both air- and bone-conducted sound presentation. METHODS Five full-cephalic human cadaveric heads were prepared bilaterally with a mastoidectomy and extended facial recess. Vestibular pressures were measured within the superior, lateral, and posterior semicircular canals, and referenced to intracochlear pressure within the scala vestibuli with fiber-optic pressure probes. Pressures were measured concurrently with laser Doppler vibrometry measurements of stapes velocity during stimulation with both air- and bone-conduction. Stimuli were pure tones between 100 Hz and 14 kHz presented with custom closed-field loudspeakers for air-conducted sounds and via commercially available bone-anchored device for bone-conducted sounds. RESULTS Pressures recorded in the superior, lateral, and posterior semicircular canals in response to sound stimulation were equal to or greater in magnitude than those recorded in the scala vestibuli (up to 20 dB higher). The pressure magnitudes varied across canals in a frequency-dependent manner. CONCLUSION High sound pressure levels were recorded in the semicircular canals with sound stimulation, suggesting that similar acoustical energy is transmitted to the semicircular canals and the cochlea. Since these intralabyrinthine pressures exceed intracochlear pressure levels, our results suggest that the vestibular end-organs may also be at risk for injury during exposure to high-intensity acoustic stimuli known to cause trauma in the auditory system.
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Affiliation(s)
| | | | - Nathaniel T. Greene
- 2. Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, Colorado
| | - Victor Benichoux
- 2. Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Daniel J. Tollin
- 1. Department of Otolaryngology
- 2. Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, Colorado
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Govender S, Colebatch JG. Effects of midline sagittal location on bone-conducted cervical and ocular vestibular evoked myogenic potentials. J Appl Physiol (1985) 2017; 122:1470-1484. [PMID: 28336540 DOI: 10.1152/japplphysiol.01069.2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/21/2017] [Accepted: 03/20/2017] [Indexed: 11/22/2022] Open
Abstract
We have investigated the effectiveness of two bone-conducted (BC) stimuli in producing vestibular evoked myogenic potentials (VEMPs) following stimulation along midsagittal skull sites. Twenty subjects (mean age 24 yr, range: 18-34 yr; 6 men; 14 women) were studied using a smoothed impulse and a 500-Hz tone burst applied to Nz, Fpz, AFz, Fz, FCz, and Cz with both compressive and rarefactive onset phases. Cervical (cVEMPs) and ocular VEMPs (oVEMPs) were recorded as well as linear acceleration in three axes. cVEMPs evoked by 500 Hz showed no change in response polarity to either stimulus location or phase. cVEMPs evoked by the impulsive stimulus showed larger initial peak amplitudes at AFz and Fz using compressive stimuli and differences in initial peak latency between the two phases. In contrast, amplitude, latency, and response polarity for oVEMPs were markedly affected by stimulus location and phase, which were similar for both BC stimuli, with little correlation with induced acceleration of the head. Latencies were earliest at AFz and Fz where compressive onset stimuli evoked an initial negativity (average latency 8.6-11.0 ms). At other sites compressive onset stimuli usually evoked oVEMPs with an initial positivity. We conclude that both 500 Hz and impulsive stimuli are effective means of evoking cVEMPs and oVEMPs from mid sagittal skull sites. The effects depend upon both location and phase and differ for oVEMPs and cVEMPs. Initial negativities for oVEMPs following compressive stimuli were most consistently obtained using the AFz and Fz sites.NEW & NOTEWORTHY We investigated the effect of stimulus location and phase (compressive and rarefactive) in the midsagittal plane for the cVEMP and oVEMP evoked by bone-conducted (BC) 500 Hz and BC impulsive stimuli. For cVEMPs, location effects were limited but were observed for BC impulses. For oVEMPs, both stimuli affected amplitude, latency, and polarity, depending on stimulus location and phase. Compressive stimuli at Fz and AFz evoked early negative oVEMPs most reliably.
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Affiliation(s)
- Sendhil Govender
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - James G Colebatch
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, New South Wales, Australia
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Govender S, Fernando T, Dennis DL, Welgampola MS, Colebatch JG. Properties of 500Hz air- and bone-conducted vestibular evoked myogenic potentials (VEMPs) in superior canal dehiscence. Clin Neurophysiol 2016; 127:2522-31. [DOI: 10.1016/j.clinph.2016.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/28/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
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Ernst A, Todt I, Seidl RO, Eisenschenk A, Blödow A, Basta D. The application of vestibular-evoked myogenic potentials in otoneurosurgery. Otolaryngol Head Neck Surg 2016; 135:286-90. [PMID: 16890084 DOI: 10.1016/j.otohns.2006.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 03/06/2006] [Indexed: 10/24/2022]
Abstract
Objective To evaluate the applicability of vestibular-evoked myogenic potentials (VEMPs) in the diagnostics, intraoperative monitoring, and postoperative follow-up of patients in otoneurosurgery. Study Design A prospective study of patients who underwent either cochlear implantation (CI, n = 18) or were diagnosed with an acoustic neuroma (AN, n = 9) or with neuro(micro)vascular compression of the VIIIth nerve (NVC, n = 27) in the period 2002 to 2004. The follow-up was 1 year for all patients. Setting A tertiary-referral unit. Results VEMPs could be recorded in 64% of all patients before CI and in 22% after surgery. The patients with AN had normal VEMPs in 22% of all cases when first diagnosed. Normal VEMPs were found in 37% of those patients with NVC. From the 5 AN patients who had to be operated, only 1 had intact VEMPs after surgery. In contrast, after microvascular decompression all patients (4) had normal VEMPs. Conclusions VEMPs are helpful in diagnosing patients with vertigo to better identify saccular defects. They are highly sensitive in the early diagnosis of retrocochlear lesions. Significance VEMPs can help to reliably identify patients with a retrocochlerar lesion at an early stage and can be used in intraoperative, neurophysiological monitoring. EBM rating: C-4
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Affiliation(s)
- Arne Ernst
- Department of Otolaryngology at UKB, Hospital of the University of Berlin (Charité Medical School), Warener Strasse 7, D-12683 Berlin, Germany.
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Manzari L, Curthoys IS. How can air conducted sound be an otolithic stimulus and cause VEMPs? Clin Neurophysiol 2016; 127:23-25. [DOI: 10.1016/j.clinph.2015.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
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Colebatch JG, Rosengren SM, Welgampola MS. Vestibular-evoked myogenic potentials. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:133-155. [PMID: 27638068 DOI: 10.1016/b978-0-444-63437-5.00010-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The vestibular-evoked myogenic potential (VEMP) is a short-latency potential evoked through activation of vestibular receptors using sound or vibration. It is generated by modulated electromyographic signals either from the sternocleidomastoid muscle for the cervical VEMP (cVEMP) or the inferior oblique muscle for the ocular VEMP (oVEMP). These reflexes appear to originate from the otolith organs and thus complement existing methods of vestibular assessment, which are mainly based upon canal function. This review considers the basis, methodology, and current applications of the cVEMP and oVEMP in the assessment and diagnosis of vestibular disorders, both peripheral and central.
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Affiliation(s)
- J G Colebatch
- Neuroscience Research Australia and Department of Neurology, Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, Australia.
| | - S M Rosengren
- Neurology Department, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney, Australia
| | - M S Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney Australia
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Properties of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) evoked by 500 Hz and 100 Hz bone vibration at the mastoid. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.06.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Single motor unit responses underlying cervical vestibular evoked myogenic potentials produced by bone-conducted stimuli. Clin Neurophysiol 2015; 126:1234-1245. [DOI: 10.1016/j.clinph.2014.07.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/11/2014] [Accepted: 07/15/2014] [Indexed: 11/19/2022]
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Vestibular evaluation in children with otitis media with effusion. The Journal of Laryngology & Otology 2015; 129:326-36. [DOI: 10.1017/s0022215115000535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Fifty per cent of children with serous otitis media may have some balance disturbances.Objective:To evaluate vestibular function in children with otitis media with effusion.Methods:The control group comprised 25 children with bilateral normal hearing and middle-ear function. The study group consisted of 30 children with bilateral otitis media with effusion; these were divided into 2 subgroups according to air–bone gap size. Measures included the Arabic Dizziness Handicap Inventory, an imbalance evaluation sheet for children, vestibular bedside tests for children, and air- and bone-conducted vestibular-evoked myogenic potential testing.Results:Arabic Dizziness Handicap Inventory scores and some vestibular bedside test results were significantly abnormal, with normal video-nystagmography results, in children with otitis media with effusion. Air-conducted vestibular-evoked myogenic potentials were recorded in 73 per cent of children with otitis media with effusion, with significantly delayed latencies. Bone-conducted vestibular-evoked myogenic potentials were successfully detected in 100 per cent of children with otitis media with effusion with similar results to the control group.Conclusion:The Arabic Dizziness Handicap Inventory and vestibular bedside tests are valuable tools for detecting vestibular impairment in children. Bone-conducted vestibular-evoked myogenic potentials are useful for vestibular system evaluation.
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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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Electrophysiologic Diagnosis of Meniere’s Disease. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0051-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Emami SF. Hypersensitivity of vestibular system to sound and pseudoconductive hearing loss in deaf patients. ISRN OTOLARYNGOLOGY 2014; 2014:817123. [PMID: 24729901 PMCID: PMC3960553 DOI: 10.1155/2014/817123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/22/2014] [Indexed: 06/03/2023]
Abstract
The objective of this cross-sectional study is to compare bone-conducted low-frequency hearing thresholds (BClf) to cervical vestibular evoked myogenic potentials (cVEMPs) findings in prelingual adult deaf patients. The fifty participants (100 ears) included twenty healthy controls and thirty other subjects selected from patients who presented with bilateral prelingual deafness to Department of Audiology of Hamadan University of Medical Sciences and Health Services (Hamadan, Iran). Assessments comprised of audiological evaluations, cVEMPs, and computerized tomography scans. Twenty deaf patients (forty affected ears) with bilateral decreased vestibular excitability as detected by abnormal cVEMPs revealed that BClf hearing thresholds were completely absent. Ten deaf patients (twenty unaffected ears) with normal cVEMPs reported a sensation of the sound at BClf hearing thresholds (the mean for 250 Hz=41 dBHL and for 500 Hz=57.75 dBHL). Multiple comparisons of mean p 13 latencies, mean n23 latencies and peak-to-peak amplitudes between three groups were significant (P = 0.01 for all, one-way ANOVA test). Multiple Comparisons of mean BClf between three groups were significant (P = 0.00, One-way ANOVA test). Conclusion. Hypersensitivity of vestibular system to sound augments BClf hearing thresholds in deaf patients. The sensation of the sound at low frequencies may be present in patients with total deafness and normal vestibular function (predominantly saccule). This improvement disappears when saccular function is lost.
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Affiliation(s)
- Seyede Faranak Emami
- Department of Audiology, Faculty of Rehabilitation, Hamadan University of Medical Sciences and Health Services, Hamadan 16657-696, Iran
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Singh NK, Sinha SK, Govindaswamy R, Kumari A. Are cervical vestibular evoked myogenic potentials sensitive to changes in the vestibular system associated with benign paroxysmal positional vertigo? HEARING BALANCE AND COMMUNICATION 2014. [DOI: 10.3109/21695717.2014.883208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tramontani O, Gkoritsa E, Ferekidis E, Korres SG. Contribution of Vestibular-Evoked Myogenic Potential (VEMP) testing in the assessment and the differential diagnosis of otosclerosis. Med Sci Monit 2014; 20:205-13. [PMID: 24509900 PMCID: PMC3930677 DOI: 10.12659/msm.889753] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background The aim of this prospective clinical study was to evaluate the clinical importance of Vestibular-Evoked Myogenic Potentials (VEMPs) in the assessment and differential diagnosis of otosclerosis and otologic diseases characterized by “pseudo-conductive” components. We also investigated the clinical appearance of balance disorders in patients with otosclerosis by correlating VEMP results with the findings of caloric testing and pure tone audiometry(PTA). Material/Methods Air-conducted(AC) 4-PTA, bone-conducted(BC) 4-PTA, air-bone Gap(ABG), AC, BC tone burst evoked VEMP, and calorics were measured preoperatively in 126 otosclerotic ears. Results The response rate of the AC-VEMPs and BC-VEMPs was 29.36% and 44.03%, respectively. Statistical differences were found between the means of ABG, AC 4-PTA, and BC 4-PTA in the otosclerotic ears in relation to AC-VEMP elicitability. About one-third of patients presented with disequilibrium. A statistically significant interaction was found between calorics and dizziness in relation to PTA thresholds. No relationship was found between calorics and dizziness with VEMPs responses. Conclusions AC and BC VEMPs can be elicited in ears with otosclerosis. AC-VEMP is more vulnerable to conductive hearing loss. Evaluation of AC-VEMP thresholds can be added in the diagnostic work-up of otosclerosis in case of doubt, enhancing differential diagnosis in patients with air-bone gaps. Otosclerosis is not a cause of canal paresis or vertigo.
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Affiliation(s)
| | | | | | - Stavros G Korres
- ENT Department of Athens National University, Hippokration Hospital, Athens, Greece
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Papathanasiou ES, Murofushi T, Akin FW, Colebatch JG. International guidelines for the clinical application of cervical vestibular evoked myogenic potentials: an expert consensus report. Clin Neurophysiol 2014; 125:658-666. [PMID: 24513390 DOI: 10.1016/j.clinph.2013.11.042] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/15/2013] [Accepted: 11/20/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cervical vestibular evoked myogenic potentials (cVEMPs) are electromyogram responses evoked by high-level acoustic stimuli recorded from the tonically contracting sternocleidomastoid (SCM) muscle, and have been accepted as a measure of saccular and inferior vestibular nerve function. As more laboratories are publishing cVEMP data, there is a wider range of recording methods and interpretation, which may be confusing and limit comparisons across laboratories. OBJECTIVE To recommend minimum requirements and guidelines for the recording and interpretation of cVEMPs in the clinic and for diagnostic purposes. MATERIAL AND METHODS We have avoided proposing a single methodology, as clinical use of cVEMPs is evolving and questions still exist about its underlying physiology and its measurement. The development of guidelines by a panel of international experts may provide direction for accurate recording and interpretation. RESULTS cVEMPs can be evoked using air-conducted (AC) sound or bone conducted (BC) vibration. The technical demands of galvanic stimulation have limited its application. For AC stimulation, the most effective frequencies are between 400 and 800 Hz below safe peak intensity levels (e.g. 140 dB peak SPL). The highpass filter should be between 5 and 30 Hz, the lowpass filter between 1000 and 3000 Hz, and the amplifier gain between 2500 and 5000. The number of sweeps averaged should be between 100 and 250 per run. Raw amplitude correction by the level of background SCM activity narrows the range of normal values. There are few publications in children with consistent results. CONCLUSION The present recommendations outline basic terminology and standard methods. Because research is ongoing, new methodologies may be included in future guidelines.
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Affiliation(s)
| | - Toshihisa Murofushi
- Department of Otolaryngology, Teikyo University School of Medicine, Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Japan
| | - Faith W Akin
- Audiology 126, VA Medical Center, Mountain Home, TN 37684, USA
| | - James G Colebatch
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Sydney NSW 2052, Australia
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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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Lee JS, Lee SK, Shin IH, Yeo SG, Park MS, Byun JY. Vestibular evoked myogenic potential according to middle ear condition in chronic otitis media with tympanic membrane perforation. Acta Otolaryngol 2014; 134:34-40. [PMID: 24102226 DOI: 10.3109/00016489.2013.836756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Vestibular evoked myogenic potential (VEMP) function results can vary between individuals with different middle ear conditions. Therefore, by analyzing VEMP results after paper patching, we can predict the condition of the middle ear in chronic otitis media (COM) patients. OBJECTIVES VEMP responses decrease with impairment of sound transmission, such as in conductive hearing loss (CHL). COM with tympanic membrane (TM) perforation is a common disorder that causes various degrees of CHL. The aim of this study was to evaluate and clarify the VEMP responses in patients with COM with different middle ear pathology. METHODS This study included 50 patients with unilateral COM with TM perforation. Initial pure-tone audiometry (PTA) and VEMP responses were recorded. After paper patching, PTA and VEMP were re-performed. Each VEMP response was compared with those of the healthy controls. Moreover, VEMP responses between pre- and post-paper patching were compared. RESULTS There was a positive correlation between normalizing of VEMP parameters, such as p13 and VEMP asymmetry ratio (VAR), and reduction of air-bone gap in patients with COM after paper patching. The VEMP response in patients with COM with intact ossicle and clean mucosa was more normalized compared with those in patients with COM with different middle ear conditions.
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Affiliation(s)
- Jun Seok Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University , Seoul , Korea
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Vestibular evoked myogenic potentials: The fuzzy picture of different stimulation types is beginning to come into focus. Clin Neurophysiol 2013; 124:1926-7. [DOI: 10.1016/j.clinph.2013.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022]
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Mahdi P, Amali A, Pourbakht A, Karimi Yazdi A, Bassam A. Vestibular Evoked Myogenic Potential Produced by Bone-Conducted Stimuli: A Study on its Basics and Clinical Applications in Patients with Conductive and Sensorineural Hearing Loss and a Group with Vestibular Schawannoma. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2013; 25:141-6. [PMID: 24303434 PMCID: PMC3846226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 10/07/2012] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Vestibular evoked myogenic potential (VEMP) has recently been broadly studied in vestibular disorders. As it is evoked by loud sound stimulation, even mild conductive hearing loss may affect VEMP results. Bone-conducted (BC) stimulus is an alternative stimulation for evoking this response. This study aims to assess the characteristics of BC-VEMP in different groups of patients. MATERIALS AND METHODS We performed a cross sectional analysis on 20 healthy volunteers with normal pure-tone audiometry as a control group; and on a group of patients consisted of 20 participants with conductive hearing loss, five with bilateral sensorineural hearing loss and four with vestibular schawannoma. AC and BC-VEMP were performed in all participants. RESULTS In control group the VEMP responses to both kinds of stimuli had an acceptable morphology and consisted of p13 and n23 waves. Latency value of these main components in each type of stimulus was not significantly different (P>0.05). However, the mean amplitude was larger in BC modality than AC stimulation (P=0.025). In the group with conductive hearing loss, the VEMP response was absent in fifteen (46.87%) of the 32 ears using the AC method, whereas all (100%) displayed positive elicitability of VEMP by BC method. Normal VEMP responses in both stimuli were evoked in all patients with sensorineural hearing loss. In patients with unilateral vestibular schwannomas (VS), 2 (50.00%) had neither AC-VEMP nor BC-VEMP. CONCLUSION Auditory stimuli delivered by bone conduction can evoke VEMP response. These responses are of vestibular origin and can be used in vestibular evaluation of patients with conductive hearing loss.
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Affiliation(s)
- Parvane Mahdi
- Department of Audiology, Faculty of Rehabilitation. Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Nezam Alley, Shahid Shahnazari Street, Madar Square, Mirdamad Boulevard, Tehran, Iran. Tel: +98-912-5253686, Fax: +98-21-22220946, E-mail:
| | - Amin Amali
- Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Educational Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Akram Pourbakht
- Rehabilitation Research Center, Department of Audiology, Tehran University of Medical Sciences, Tehran, Iran.
| | - Alireza Karimi Yazdi
- Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Educational Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Bassam
- Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Educational Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
OBJECTIVE To develop a reliable, easy to use bedside, office, or field system that allows the rapid measurement of cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) using a bone-conduction stimulus. STUDY DESIGN Prospective bioengineering design and proof of concept of the test system with saccular and utricular otolith response studies in human subjects. SETTING Private practice, tertiary neurotology referral center. SUBJECTS Twenty healthy adult controls without history of auditory or vestibular dysfunction and 5 preoperative and postoperative patients with confirmed superior canal dehiscence (SCD) participated. INTERVENTIONS The subjects underwent auditory stimuli-based cVEMP and oVEMP studies using a commercially available system as well as testing with a novel bone-conduction cVEMP and oVEMP head striker system. MAIN OUTCOME MEASURES Duration of each study, healthy subject and patient comfort, reproducibility, latency, and amplitude of auditory and striker evoked cVEMP and oVEMP responses. RESULTS The mean age of the healthy controls was 43.8, with a range of 19 to 69 years (10 male and 10 female subjects). The mean age of the SCD patient group was 46, with a range of 25 to 54 years; all female subjects. Although the cVEMP responses were similar using either the auditory or head strike stimuli, the healthy subjects preferred the latter, but the SCD patients became more symptomatic. The oVEMP data showed more consistent responses using the striker system. A statistically significant reduction in latency for the striker-evoked cVEMP occurred compared with the auditory cVEMP evoked response in the 5 SCD preoperative patients. All normalized postoperatively. CONCLUSION Recording the cVEMP and oVEMP responses using the striker system was much more rapid than with auditory stimuli and was more comfortable for the healthy subjects. The striker system and the acoustic method elicited strong otolithic receptor dysfunction symptoms in all SCD patients; however, they preferred the shorter striker studies. The striker system, because of the statistically shorter latency of p13 during the striker evoked cVEMP, which normalized after SCD closure, suggests that this method may be useful in identifying SCD patients before imaging studies. In addition, based on our biomechanical data, the striker was able to reliably produce a consistent and defined head striker impact.
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