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Ismail NM, Kabil SE, Abdel-Hamid EF. Otolithic functions in patients with residual dizziness after successful repositioning manoeuvres for unilateral posterior canal BPPV. J Int Med Res 2024; 52:3000605241249095. [PMID: 38726874 PMCID: PMC11089943 DOI: 10.1177/03000605241249095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/04/2024] [Indexed: 05/15/2024] Open
Abstract
OBJECTIVE To evaluate otolithic functions in patients with residual dizziness after successful canalith repositioning procedures (CRPs) for unilateral posterior canal benign paroxysmal positional vertigo (BPPV), and to investigate possible risk factors. METHODS This case-control observational study included healthy controls and patients with residual dizziness after improvement following CRP for BPPV. All participants were subjected to full history taking, otoscopy, audiological basic evaluation, Dix-Hallpike test to search for posterior canal BPPV, residual dizziness screening, and vestibular evoked myogenic potential (VEMP) testing. Between-group differences were assessed and possible factors associated with residual dizziness were identified by univariate analysis. RESULTS A total of 50 patients with residual dizziness (mean age, 56.53 ± 7.46 years [29 female: 21 male]) and 50 healthy controls (mean age, 58.13 ± 7.57 years [20 female: 30 male]) were included. A significant difference in VEMP latencies was found between the patient and control group (delayed in the patient group), with no significant between-group difference in amplitude in both ears. Aging, female sex, long duration of BPPV, number of CRPs, cervical VEMP and ocular VEMP abnormalities, and winter onset, were significantly associated with the risk of residual dizziness. CONCLUSIONS Residual dizziness is a frequent sequel of BPPV that may relate to otolithic dysfunction. VEMP changes were revealed in the form of delayed latencies.
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Affiliation(s)
- Naema M Ismail
- ENT Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Shaimaa E Kabil
- ENT Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
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Scherer F, Beule AG, Lütkenhöner B, Heitkötter F, Rudack C. Measurement of Ocular Vestibular Evoked Myogenic Potentials: Nasion Reference Montage as an Alternative to the Clinical Standard Montage. Otol Neurotol 2024; 45:e57-e65. [PMID: 38085768 DOI: 10.1097/mao.0000000000004046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To compare two novel electrode montages for ocular, vestibular evoked myogenic potential using single-nasion reference electrodes with the clinical standard montage. STUDY DESIGN Randomized crossover experiment. SETTING Tertiary referral center. PARTICIPANTS Sixty healthy participants. INTERVENTION Normal hearing and vestibular function were confirmed with an extensive test-battery. All ocular, vestibular evoked myogenic potential settings were measured with air-conducted tone bursts at 100-dB normal hearing level and a frequency of 500 Hz. Three electrode montages were measured in randomized order: the clinical standard montage ("S"), the nasion reference montage ("N"), and the nasion reference montage with a more lateral active electrode ("L"). Upgaze was standardized to 35 degrees. MAIN OUTCOME MEASURES Detection rate, latency of N1 and P1, peak-to-peak amplitude of N1 and P1, signal-to-noise ratio (SNR), asymmetry ratio (AR), concordance of expert assessment, and reliability. RESULTS All electrode montages showed detection rates greater than 90%. Latencies for "L" were shorter than for "S" and "N." Amplitudes and SNR for "S" and "N" were higher than for "L," whereas the values for "S" and "N" did not differ significantly. For AR, no significant differences between the montages were assessed. Concordance of experts ranged from 78% for "L" and 89.8% for "N." All montages provided excellent day-to-day reliability (intraclass correlation coefficient ≥0.9) for amplitudes and SNR. CONCLUSIONS Montage N could be a useful alternative to the clinical standard montage: although results are roughly equivalent, montage N requires one less electrode to do so.
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Affiliation(s)
- Florian Scherer
- Department of Otorhinolaryngology, University Hospital Münster, Münster
| | | | - Bernd Lütkenhöner
- Department of Otorhinolaryngology, University Hospital Münster, Münster
| | - Felix Heitkötter
- Department of Otorhinolaryngology, University Hospital Münster, Münster
| | - Claudia Rudack
- Department of Otorhinolaryngology, University Hospital Münster, Münster
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Reddy TM, Heinze B, Biagio-de Jager L, Maes L. Chirp-Evoked VEMPs: A Test-Retest Reliability Study. Ear Hear 2024; 45:207-218. [PMID: 37580858 DOI: 10.1097/aud.0000000000001416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To determine the test-retest reliability of cervical and ocular vestibular-evoked myogenic potentials (c&oVEMP) evoked by 500 Hz narrowband (NB) CE-Chirp and broadband (BB) CE-Chirp stimuli. DESIGN Twenty healthy participants (10 female) were tested twice on the same day to determine the within-session reliability and 1 week later to determine the between-session reliability. The latency, amplitude, and asymmetry ratio of c&oVEMPs elicited by 95 dB nHL air-conducted (AC) 500 Hz NB CE-Chirp and BB CE-Chirp were recorded bilaterally. RESULTS A moderate to good between-session reliability with intraclass correlation coefficient (ICC) values ranging from 0.52 to 0.82 was observed for cVEMP latency, amplitude, and asymmetry ratio evoked by 500 Hz NB CE-Chirp, as well as for the BB CE-Chirp cVEMP amplitude (ICC of 0.70 and 0.84). In contrast, an overall poor reliability ICC values between 0.30 and 0.42 for cVEMP latency and asymmetry ratio were observed for BB CE-Chirp. For the oVEMP, overall poor between-session reliability for all response parameters evoked by the 500 Hz NB CE-Chirp and the BB CE-Chirp was observed. CONCLUSIONS The 500 Hz NB CE-Chirp was more reliable than the BB CE-Chirp in terms of cVEMP latency, amplitude, and asymmetry ratio. Further investigation using the standard electrode montage is necessary to assess the test-retest reliability of the chirp-evoked oVEMP.
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Affiliation(s)
- Tarryn Marisca Reddy
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Barbara Heinze
- Ear Science Implant Clinic, Ear Science Institute Australia, Western Australia
| | - Leigh Biagio-de Jager
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Belgium
- Department of Ear Nose Throat, Ghent University Hospital, Belgium
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Raveendran RK, Singh NK. Electrode Montage Induced Changes in Air-Conducted Ocular Vestibular-Evoked Myogenic Potential. Ear Hear 2024; 45:227-238. [PMID: 37608435 DOI: 10.1097/aud.0000000000001419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Stimulus and recording parameters are pivotal for shaping the ocular vestibular-evoked myogenic potential (oVEMP). In the last decade, several attempts were made to identify the optimum electrode placement site to improve the oVEMP responses. A vast majority of these found larger response amplitudes for alternate electrode montages like belly-tendon (BT), chin-referenced (CR), and/or sternum-referenced montages than the clinically used infra-orbital montage. However, no study has yet compared all alternate electrode montages in a simultaneous recording paradigm to eliminate other confounding factors. Also, no study has compared all of them for their test-retest reliability, waveform morphology, and signal-to-noise ratio. Therefore, the decision on which among these electrode montages is best suited for oVEMP acquisition remains opaque. The present study aimed to investigate the effects of various electrode montages on oVEMP's response parameters and to determine the test-retest reliability of each of these in clinically healthy individuals using a simultaneous recording paradigm. DESIGN This study had a within-subject experimental design. Fifty-five young healthy adults (age range: 20-30 years) underwent contralateral oVEMP recording using infra-orbital, BT, chin-referenced, and sternum-referenced electrode montages simultaneously using a four-channel evoked potential system. RESULTS BT montage had a significantly shorter latency, larger amplitude, higher signal-to-noise ratio, and better morphology than other alternate montages ( p < 0.008). Further, all electrode montages of the current study showed fair/moderate to excellent test-retest reliability. CONCLUSIONS By virtue of producing significantly better response parameters than the other electrode montages, BT montage seems better suited to the recording of oVEMP than the known electrode montages thus far.
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Affiliation(s)
- Rajesh Kumar Raveendran
- Department of Audiology, All India Institute of Speech and Hearing, Manasagangothri, Mysore, Karnataka, India
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Hong JP, Lee JY, Kim MB. Vestibular mapping in Ramsay-Hunt syndrome and idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2023; 280:5251-5258. [PMID: 37210462 DOI: 10.1007/s00405-023-08029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE To observe vestibular impairment patterns in patients with Ramsay Hunt syndrome with dizziness (RHS_D) and sudden sensorineural hearing loss with dizziness (SSNHL_D) using hierarchical cluster analysis (HCA) to interpret results with possible mechanisms. METHODS The data of 30 RHS_D and 81 SSNHL_D patients from January 2017 to August 2022 in a single tertiary referral center were retrospectively analyzed. Video head impulse test (vHIT) and vestibular evoked myogenic potential (VEMP) were used for vestibular analysis of peripheral vestibular organs, and the results of vHIT and VEMP were analyzed. HCA was used to analyze vestibular impairment patterns. RESULTS In RHS_D patients, the lateral semicircular canal (LSCC) was the most impaired semicircular canal (SCC), followed by the anterior semicircular canal (ASCC) and the posterior semicircular canal (PSCC), and the utricle was more impaired than the saccule. In SSNHL_D patients, the PSCC was the most impaired SCC, followed by the LSCC and the ASCC, and the utricle was more impaired than the saccule. In HCA of RHS_D patients, the ASCC and utricle were initially clustered, followed by the LSCC, PSCC and saccule in order. In the HCA of SSNHL_D patients, the PSCC was solely merged and independently clustered. CONCLUSION There were different patterns of vestibular impairments between RHS_D and SSNHL_D patients. The vestibular analysis and HCA results of SSNHL_D showed tendency of skip lesion, which could be explained by vascular pathophysiology.
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Affiliation(s)
- Joon-Pyo Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Jung-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Min-Beom Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
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Michanski S, Henneck T, Mukhopadhyay M, Steyer AM, Gonzalez PA, Grewe K, Ilgen P, Gültas M, Fornasiero EF, Jakobs S, Möbius W, Vogl C, Pangršič T, Rizzoli SO, Wichmann C. Age-dependent structural reorganization of utricular ribbon synapses. Front Cell Dev Biol 2023; 11:1178992. [PMID: 37635868 PMCID: PMC10447907 DOI: 10.3389/fcell.2023.1178992] [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: 03/03/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
In mammals, spatial orientation is synaptically-encoded by sensory hair cells of the vestibular labyrinth. Vestibular hair cells (VHCs) harbor synaptic ribbons at their presynaptic active zones (AZs), which play a critical role in molecular scaffolding and facilitate synaptic release and vesicular replenishment. With advancing age, the prevalence of vestibular deficits increases; yet, the underlying mechanisms are not well understood and the possible accompanying morphological changes in the VHC synapses have not yet been systematically examined. We investigated the effects of maturation and aging on the ultrastructure of the ribbon-type AZs in murine utricles using various electron microscopic techniques and combined them with confocal and super-resolution light microscopy as well as metabolic imaging up to 1 year of age. In older animals, we detected predominantly in type I VHCs the formation of floating ribbon clusters, mostly consisting of newly synthesized ribbon material. Our findings suggest that VHC ribbon-type AZs undergo dramatic structural alterations upon aging.
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Affiliation(s)
- Susann Michanski
- Molecular Architecture of Synapses Group, Institute for Auditory Neuroscience, InnerEarLab and Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany
- Collaborative Research Center 889, University of Göttingen, Göttingen, Germany
- Multiscale Bioimaging Cluster of Excellence (MBExC), University of Göttingen, Göttingen, Germany
| | - Timo Henneck
- Biology Bachelor Program, University of Göttingen, Göttingen, Germany
| | - Mohona Mukhopadhyay
- Experimental Otology Group, InnerEarLab, Department of Otolaryngology, Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
| | - Anna M. Steyer
- Electron Microscopy-City Campus, Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Center Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), University of Göttingen, Göttingen, Germany
| | - Paola Agüi Gonzalez
- Department for Neuro-and Sensory Physiology, University Medical Center Göttingen, Center for Biostructural Imaging of Neurodegeneration (BIN), Göttingen, Germany
| | - Katharina Grewe
- Department for Neuro-and Sensory Physiology, University Medical Center Göttingen, Center for Biostructural Imaging of Neurodegeneration (BIN), Göttingen, Germany
| | - Peter Ilgen
- Clinic of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Department of NanoBiophotonics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Translational Neuroinflammation and Automated Microscopy TNM, Göttingen, Germany
| | - Mehmet Gültas
- Faculty of Agriculture, South Westphalia University of Applied Sciences, Soest, Germany
| | - Eugenio F. Fornasiero
- Department for Neuro-and Sensory Physiology, University Medical Center Göttingen, Center for Biostructural Imaging of Neurodegeneration (BIN), Göttingen, Germany
| | - Stefan Jakobs
- Clinic of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Department of NanoBiophotonics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Translational Neuroinflammation and Automated Microscopy TNM, Göttingen, Germany
| | - Wiebke Möbius
- Multiscale Bioimaging Cluster of Excellence (MBExC), University of Göttingen, Göttingen, Germany
- Electron Microscopy-City Campus, Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Christian Vogl
- Collaborative Research Center 889, University of Göttingen, Göttingen, Germany
- Presynaptogenesis and Intracellular Transport in Hair Cells Group, Institute for Auditory Neuroscience and InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience Group, Institute of Physiology, Medical University Innsbruck, Innsbruck, Austria
| | - Tina Pangršič
- Collaborative Research Center 889, University of Göttingen, Göttingen, Germany
- Multiscale Bioimaging Cluster of Excellence (MBExC), University of Göttingen, Göttingen, Germany
- Experimental Otology Group, InnerEarLab, Department of Otolaryngology, Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
| | - Silvio O. Rizzoli
- Department for Neuro-and Sensory Physiology, University Medical Center Göttingen, Center for Biostructural Imaging of Neurodegeneration (BIN), Göttingen, Germany
| | - Carolin Wichmann
- Molecular Architecture of Synapses Group, Institute for Auditory Neuroscience, InnerEarLab and Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany
- Collaborative Research Center 889, University of Göttingen, Göttingen, Germany
- Multiscale Bioimaging Cluster of Excellence (MBExC), University of Göttingen, Göttingen, Germany
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Hernon EE, Patterson JN, Fitzpatrick D, Janky KL. Effect of Real-Ear Adjusted Stimuli on Vestibular Evoked Myogenic Potential Variability in Children and Young Adults. Ear Hear 2023; 44:854-864. [PMID: 36648319 PMCID: PMC10350648 DOI: 10.1097/aud.0000000000001333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES There is large variability in cervical and ocular vestibular evoked myogenic potential (c- and oVEMP) amplitudes. One potential source of variability is differences in ear canal shape and size. Real ear-to-coupler difference (RECD) values are used to measure the acoustic environment of an individual's ear canal. RECD may be a useful measure to calibrate air conducted VEMP stimuli, which are elicited at high intensities and may put patients at risk of unsafe sound exposure. A recommendation for avoiding unsafe exposure is to use a 125 dB SPL stimulus for individuals with an equivalent ear canal volume (ECV) ≥ 0.9 mL and a 120 dB SPL stimulus for individuals with a smaller ECV. The purpose of this project was to determine if using a stimulus calibrated in the ear using RECD values significantly reduces intra-subject and inter-subject VEMP amplitude variability. We hypothesized that using a RECD-calibrated stimulus would significantly reduce inter-subject amplitude variability but not significantly reduce intra-subject variability. We further hypothesized that an RECD-adjusted VEMP stimulus would better protect against delivering unsafe sound exposure compared to the method of using ECV alone. DESIGN Eleven children (4 to 9 years), 10 adolescents (10 to 18 years), and 10 young adults (20 to 40 years) with normal hearing, tympanometry, vestibular and neurological function participated. On all subjects, RECD was measured twice per ear to account for test-retest reliability. cVEMP and oVEMP were then recorded bilaterally with a 500 Hz tone burst at a traditional and an adjusted VEMP intensity level. The traditional intensity level was 125 dB SPL for individuals with ≥ 0.9 mL ECV and 120 dB SPL for individuals with ≤ 0.8 mL ECV. The adjusted intensity level was calculated by subtracting the average 500 Hz RECD measured values from the 500 Hz normative RECD value. This value was applied as a correction factor to a 125 dB SPL stimulus. Peak to peak amplitudes were recorded and used to calculate asymmetry ratios. RESULTS Young children had significantly smaller ECVs compared to adolescents and young adults. Young children had larger RECDs; however, this was not significant in post hoc analyses. The method of calibration had no significant effect on intra-subject variability for cVEMP [ F (1, 27)= 0.996, p = 0.327] or oVEMP [ F (1, 25)= 1.679, p = 0.206]. The method of calibration also had no significant effect on inter-subject amplitude variability for cVEMP [ F (1, 120)= 0.721, p = 0.397] or oVEMP [ F (1, 120)= 0.447, p = 0.505]. Both methods of calibration adequately protected against unsafe exposure levels. However, there were subjects with ECVs ≥ 0.9 mL who approached unsafe exposure levels from the ECV-calibrated stimulus, suggesting there may be rare cases in which a 125 dB SPL stimulus is unsafe, even for patients with larger ECVs. CONCLUSIONS The calibration method made no significant difference in intra- or inter-subject variability, indicating that the acoustic environment of the outer ear is not significantly contributing to VEMP amplitude variability. The RECD-adjusted stimulus is effective in protecting against unsafe exposure levels for two trials of both c- and oVEMPs. There may be instances where more than two trials of each test are required, which increases the effective stimulation level. Clinicians should be cautious when delivering VEMPs and not unnecessarily expose patients to unsafe levels of sound.
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Affiliation(s)
- Erin E. Hernon
- Boys Town National Research Hospital, Department of Audiology, Omaha, NE, 68131
- James Madison University, Department of Communication Sciences and Disorders, Harrisonburg, VA, 22807
| | - Jessie N. Patterson
- Boys Town National Research Hospital, Department of Audiology, Omaha, NE, 68131
| | - Denis Fitzpatrick
- Boys Town National Research Hospital, Department of Audiology, Omaha, NE, 68131
| | - Kristen L. Janky
- Boys Town National Research Hospital, Department of Audiology, Omaha, NE, 68131
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Mat Q, Deggouj N, Duterme JP, Tainmont S, Lelubre C, Manto M. Influence of the Electrode Montage to Detect Ocular Vestibular Evoked Myogenic Potentials. Otol Neurotol 2023; 44:e412-e418. [PMID: 37231530 PMCID: PMC10289211 DOI: 10.1097/mao.0000000000003897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To compare ocular vestibular evoked myogenic potentials (oVEMPs) obtained with three different electrode montages (infra-orbital vs belly-tendon vs chin) in a group of healthy subjects. To assess the electrical activity recorded at the level of the reference electrode in the belly-tendon and chin montages. STUDY DESIGN Prospective study. SETTING Tertiary referral center. PATIENTS Twenty-five healthy adult volunteers. INTERVENTIONS Each ear was tested separately via air-conducted sound (500 Hz Narrow Band CE-Chirps at 100 dB nHL) for recording contralateral myogenic responses. Recording conditions were randomized. MAIN OUTCOME MEASURES n1-p1 amplitudes values, interaural amplitude asymmetry ratios (ARs) and response rates. RESULTS The belly-tendon electrode montage (BTEM) produced larger amplitudes than the chin ( p = 0.008) and the IOEM (infra-orbital electrode montage; p < 0.001). The chin montage displayed larger amplitudes than the IOEM ( p < 0.001). The interaural amplitude asymmetry ratios (ARs) were not affected by the different electrode montages ( p = 0.549). In 100% of cases, oVEMPs were detected bilaterally with the BTEM which is higher than with the chin and the IOEM ( p < 0.001; p = 0.020, respectively). We did not record any VEMP when placing the active electrode on the contralateral internal canthus or the chin and the reference electrode on the dorsum of the hand. CONCLUSIONS The BTEM increased the amplitudes recorded and response rate in healthy subjects. No positive or negative reference contamination was observed with the belly-tendon or chin montages.
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Affiliation(s)
- Quentin Mat
- Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi 6042, Belgium
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons 7000, Belgium
| | - Naïma Deggouj
- Department of Otorhinolaryngology and Head and Neck Surgery, Cliniques Universitaires Saint-Luc, UCLouvain (UCL), Brussels 1200, Belgium
| | - Jean-Pierre Duterme
- Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi 6042, Belgium
| | - Sophie Tainmont
- Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi 6042, Belgium
| | - Christophe Lelubre
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons 7000, Belgium
- Department of Internal Medicine, C.H.U. Charleroi, Charleroi 6042, Belgium
| | - Mario Manto
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons 7000, Belgium
- Department of Neurology, Médiathèque Jean Jacquy, C.H.U. Charleroi, Charleroi 6042, Belgium
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Patterson JN, Chen S, Janky KL. Stability of Vestibular Testing in Children With Hearing Loss. Am J Audiol 2022; 31:1155-1166. [PMID: 36095287 PMCID: PMC9907441 DOI: 10.1044/2022_aja-21-00257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the stability of rotary chair, video head impulse test (vHIT), and vestibular evoked myogenic potential (VEMP) responses in children with normal hearing (NH) and children with cochlear implants (CIs). METHOD Retrospective analysis of 66 children (33 males, M age = 11.4 years, range: 3-18 years) seen in a tertiary clinic and/or research laboratory who completed rotary chair, VEMP, and vHIT across two test sessions between 2012 and 2019. The stability of these measures was compared between two groups: children with NH (n = 35) and children with CI (n = 31). For each outcome, the session difference was calculated by subtracting Session 1 from Session 2. RESULTS For rotary chair (gain and phase) and vHIT (gain), linear mixed-effects models revealed that there were no significant interactions or main effects for group (CI vs. NH), time between session, gender, or age on the session difference, suggesting that the outcomes of these measures are stable across sessions. For cervical and ocular VEMP amplitude, there was a significant interaction between group and time between sessions on the session difference. Specifically, children with NH demonstrated larger amplitudes at Session 2, whereas children with CI demonstrated smaller amplitudes at Session 2. Next, test findings were classified as normal, unilaterally abnormal, or bilaterally abnormal for Sessions 1 and 2. Misclassification was defined as a mismatch of classification between sessions. Rotary chair and vHIT had the fewest misclassifications, whereas cervical VEMPs had the most misclassifications in children with CI and ocular VEMPs had the most misclassifications in children with NH. Misclassifications in children with CI were mostly consistent with progressive vestibular loss, whereas misclassifications in children with NH were mostly consistent with improved vestibular function. CONCLUSIONS Stability and misclassification rates varied between tests and groups. Overall, rotary chair and vHIT outcomes were stable in both groups; however, VEMPs differentially changed between groups, improving in children with NH and declining in children with CI. Furthermore, despite relative stability, some children with CI evidenced progressive vestibular loss on all measures suggesting that vestibular testing should be completed serially due to the possibility of progression.
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Affiliation(s)
| | - Su Chen
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | - Kristen L. Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE
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Suman NS, Poovaiah PP, Rangarajan A, Tiwari R, Nashi S, Yuvraj P, Rajasekaran AK. Cervical and Ocular Vestibular Evoked Myogenic Potential Recovery in Susac Syndrome: A Case Report. Am J Audiol 2022; 31:1059-1066. [DOI: 10.1044/2022_aja-22-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose:
Susac syndrome (SS) is a rare autoimmune disorder that affects the brain and the retina and causes unilateral or bilateral sensorineural hearing loss. Although vestibular dysfunction is reported in SS, limited information is available underlying the vestibular pathophysiology.
Method:
The diagnosis of SS was established based on symptoms and diagnostic tools such as magnetic resonance imaging and fundus fluorescein angiography. The audiovestibular evaluation was done on the seventh day of admission (Session 1) into the emergency unit, whereas the second and third evaluations were done at 3-month (Session 2) and 8-month (Session 3) follow-ups after discharge, respectively. The audiovestibular test battery consisted of routine audiological tests, auditory brainstem response, and vestibular evoked myogenic potentials (VEMPs; both cervical and ocular).
Results:
We found unilateral sensorineural hearing loss and absent cervical VEMPs(cVEMPs) when testing the left ear during Session 1. In the following sessions, the unilateral hearing loss did not recover; however, cVEMPs were present bilaterally. The ocular VEMPs showed an increase in amplitude during Sessions 2 and 3.
Conclusions:
SS can selectively disrupt auditory and vestibular structures. It may present with unique findings of audiovestibular tests. A detailed audiovestibular evaluation may be essential in patients with SS.
Supplemental Material:
https://doi.org/10.23641/asha.21513843
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Affiliation(s)
- Narayana Swamy Suman
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Prashasti P. Poovaiah
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anush Rangarajan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ravindu Tiwari
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pradeep Yuvraj
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Aravind Kumar Rajasekaran
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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11
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Reddy TM, Heinze B, Biagio-de Jager L, Maes L. Cervical and ocular vestibular evoked myogenic potential: A comparison of narrowband chirp, broadband chirp, tone burst and click stimulation. Int J Audiol 2022:1-8. [PMID: 35471921 DOI: 10.1080/14992027.2022.2064924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To compare the response rate and response parameters of cervical and ocular vestibular evoked myogenic potentials (c&oVEMP) elicited by narrowband (NB) and broadband (BB) CE-Chirp, with the more classical tone burst (TB) and click VEMPs. DESIGN The response rate, latency, amplitude and asymmetry ratio of c&oVEMPs elicited by 95 dB nHL air conducted (AC) 500 Hz NB CE-chirp, BB CE-chirp, 500 Hz TB and click stimuli were recorded bilaterally. STUDY SAMPLE 20 male and 38 female participants (19-39 years). RESULTS For the cVEMP, the highest response rate was found for NB chirp (100%), followed by TB (91%), BB chirp (87%) and finally click (85%). A similar order was seen for oVEMP with percentages of 100%; 57%, 57%, and 43%. The 500 Hz NB CE-Chirp elicited significantly shorter cVEMP P1 and N1 latencies and significantly larger c&oVEMP amplitudes compared to all other stimuli. BB CE-Chirp elicited significantly shorter c&oVEMP P1 and N1 latencies with smaller amplitudes compared to TB. Asymmetry ratios were not statistically significant for all comparisons. CONCLUSION The 500 Hz NB CE-chirp provides the highest response rates, shorter latencies and larger amplitudes, and therefore seem a promising stimulus for reliably measuring c&oVEMPs in clinical practice.
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Affiliation(s)
- Tarryn Marisca Reddy
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | | | - Leigh Biagio-de Jager
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Ear Nose Throat, Ghent University Hospital, Ghent, Belgium
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12
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Coto J, Alvarez CL, Cejas I, Colbert BM, Levin BE, Huppert J, Rundek T, Balaban C, Blanton SH, Lee DJ, Loewenstein D, Hoffer M, Liu XZ. Peripheral vestibular system: Age-related vestibular loss and associated deficits. J Otol 2021; 16:258-265. [PMID: 34548873 PMCID: PMC8438634 DOI: 10.1016/j.joto.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Given the interdependence of multiple factors in age-related vestibular loss (e.g., balance, vision, cognition), it is important to examine the individual contributions of these factors with ARVL. While the relationship between the vestibular and visual systems has been well studied (Bronstein et al., 2015), little is known about the association of the peripheral vestibular system with neurodegenerative disorders (Cronin et al., 2017). Further, emerging research developments implicate the vestibular system as an opportunity for examining brain function beyond balance, and into other areas, such as cognition and psychological functioning. Additionally, the bidirectional impact of psychological functioning is understudied in ARVL. Recognition of ARVL as part of a multifaceted aging process will help guide the development of integrated interventions for patients who remain at risk for decline. In this review, we will discuss a wide variety of characteristics of the peripheral vestibular system and ARVL, how it relates to neurodegenerative diseases, and correlations between ARVL and balance, vision, cognitive, and psychological dysfunction. We also discuss clinical implications as well as future directions for research, with an emphasis on improving care for patients with ARVL.
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Affiliation(s)
- Jennifer Coto
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | | | - Ivette Cejas
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Brett M. Colbert
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
- Medical Scientist Training Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie E. Levin
- University of Miami Miller School of Medicine, Department of Neurology and the Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Joshua Huppert
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Tatjana Rundek
- University of Miami Miller School of Medicine, Department of Neurology and the Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Carey Balaban
- University of Pittsburgh, Departments of Otolaryngology, Neurobiology, Communication Sciences & Disorders, and Bioengineering, Pittsburgh, PA, USA
| | - Susan H. Blanton
- University of Miami Miller School of Medicine, Dr. John T. Macdonald Department of Human Genetics, Miami, FL, USA
| | - David J. Lee
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL, USA
| | - David Loewenstein
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA
| | - Michael Hoffer
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Xue Zhong Liu
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
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13
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Hoppes CW, Lambert KH, Zalewski C, Pinto R, Burrows H, McCaslin D. The Supine Superior Semicircular Canal Dehiscence Test. Am J Audiol 2021; 30:475-480. [PMID: 34153201 DOI: 10.1044/2021_aja-21-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this clinical focus article is to describe a new method for assessment of superior semicircular canal dehiscence by laying the patient supine during Valsalva-induced nystagmus testing. Method The traditional Valsalva-induced nystagmus test is described, followed by a new method for assessment of superior semicircular dehiscence conducted by laying the patient supine during testing. A case study is presented to illustrate this new testing technique known as the Supine Superior Semicircular Canal Dehiscence Test. Results It is hypothesized that during Valsalva-induced nystagmus testing performed in the upright, seated position, the dura mater could potentially seal the superior semicircular canal fistula, thereby concealing a defect in the bony labyrinth and yielding a false-negative test. To circumvent this, the patient should be placed in the supine position during Valsalva-induced nystagmus testing in order to prevent the dura mater from inadvertently sealing itself against the petrous portion of the temporal bone. The Supine Superior Semicircular Canal Dehiscence Test may reveal the defect in the bony labyrinth and improve the sensitivity of the Valsalva-induced nystagmus test. Conclusions The Supine Superior Semicircular Canal Dehiscence Test may be more sensitive for identifying superior semicircular canal dehiscence in patients with traditional symptoms and a negative Valsalva-induced nystagmus test in the seated position. While a case study is presented to illustrate the potential benefits of including the Supine Superior Semicircular Canal Dehiscence Test in the battery of diagnostic tests, further research is needed in larger samples.
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Affiliation(s)
- Carrie W. Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, TX
| | - Karen H. Lambert
- Hearing Center of Excellence, Lackland Air Force Base, San Antonio, TX
| | - Chris Zalewski
- Otolaryngology Branch, Audiology Unit, National Institute on Deafness and Other Communication Disorders (NIDCD), Bethesda, MD
| | - Robin Pinto
- Audiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD
| | - Holly Burrows
- Audiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD
| | - Devin McCaslin
- Michigan Medicine, Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
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Sosna-Duranowska M, Tacikowska G, Gos E, Krupa A, Skarzynski PH, Skarzynski H. Vestibular Function After Cochlear Implantation in Partial Deafness Treatment. Front Neurol 2021; 12:667055. [PMID: 34093414 PMCID: PMC8175845 DOI: 10.3389/fneur.2021.667055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Cochlear implantation is a fully accepted method of treating individuals with profound hearing loss. Since the indications for cochlear implantation have broadened and include patients with low-frequency residual hearing, single-sided deafness, or an already implanted ear (meaning bilateral cochlear implantation), the emphasis now needs to be on vestibular protection. Materials and Methods: The research group was made up of 107 patients operated on in the otorhinolaryngosurgery department: 59 females and 48 males, aged 10.4–80.2 years (M = 44.4; SD = 18.4) with hearing loss lasting from 1.4 to 56 years (M = 22.7; SD = 13.5). The patients underwent cVEMP, oVEMP, a caloric test, and vHIT assessment preoperatively, and, postoperatively, cVEMP and oVEMP at 1–3 months and a caloric test and vHIT at 4–6 months. Results: After cochlear implantation, there was postoperative loss of cVEMP in 19.2% of the patients, oVEMP in 17.4%, reduction of caloric response in 11.6%, and postoperative destruction of the lateral, anterior, and posterior semicircular canal as measured with vHIT in 7.1, 3.9, and 4% respectively. Conclusions: Hearing preservation techniques in cochlear implantation are connected with vestibular protection, but the risk of vestibular damage in never totally eliminated. The vestibular preservation is associated with hearing preservation and the relation is statistically significant. Informed consent for cochlear implantation must include information about possible vestibular damage. Since the risk of vestibular damage is appreciable, preoperative otoneurological diagnostics need to be conducted in the following situations: qualification for a second implant, after otosurgery (especially if the opposite ear is to be implanted), having a history of vestibular complaints, and when there are no strict audiological or anatomical indications on which side to operate.
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Affiliation(s)
| | | | - Elzbieta Gos
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Anna Krupa
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Piotr Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Medical University of Warsaw, Warsaw, Poland
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TBC1D24 emerges as an important contributor to progressive postlingual dominant hearing loss. Sci Rep 2021; 11:10300. [PMID: 33986365 PMCID: PMC8119487 DOI: 10.1038/s41598-021-89645-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/29/2021] [Indexed: 11/08/2022] Open
Abstract
Several TBC1D24 variants are causally involved in the development of profound, prelingual hearing loss (HL) and different epilepsy syndromes inherited in an autosomal recessive manner. Only two TBC1D24 pathogenic variants have been linked with postlingual progressive autosomal dominant HL (ADHL). To determine the role of TBC1D24 in the development of ADHL and to characterize the TBC1D24-related ADHL, clinical exome sequencing or targeted multigene (n = 237) panel were performed for probands (n = 102) from multigenerational ADHL families. In four families, TBC1D24-related HL was found based on the identification of three novel, likely pathogenic (c.553G>A, p.Asp185Asn; c.1460A>T, p. His487Leu or c.1461C>G, p.His487Gln) and one known (c.533C>T, p.Ser178Leu) TBC1D24 variant. Functional consequences of these variants were characterized by analyzing the proposed homology models of the human TBC1D24 protein. Variants not only in the TBC (p.Ser178Leu, p.Asp185Asn) but also in the TLDc domain (p.His487Gln, p.His487Leu) are involved in ADHL development, the latter two mutations probably affecting interactions between the domains. Clinically, progressive HL involving mainly mid and high frequencies was observed in the patients (n = 29). The progression of HL was calculated by constructing age-related typical audiograms. TBC1D24-related ADHL originates from the cochlear component of the auditory system, becomes apparent usually in the second decade of life and accounts for approximately 4% of ADHL cases. Given the high genetic heterogeneity of ADHL, TBC1D24 emerges as an important contributor to this type of HL.
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16
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Shahnaz N, David EA. Normal values for cervical and ocular vestibular-evoked myogenic potentials using EMG scaling: effect of body position and electrode montage. Acta Otolaryngol 2021; 141:440-448. [PMID: 33641604 DOI: 10.1080/00016489.2021.1887517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The clinical utility of cervical and ocular vestibular-evoked myogenic potential (cVEMP and oVEMP) is limited by variability of testing protocols and a dearth of normative data using contemporary methods for amplitude scaling. AIMS/OBJECTIVES To investigate the effect of body position and electrode montage on VEMP responses and to establish normative values. MATERIAL AND METHODS This is a repeated measures study of 44 healthy young adult subjects (22 men and 22 women). RESULTS The highest response rate (99%) for cVEMP was achieved in the supine position with the head elevated and turned. For oVEMP, the highest response rate (90%) was achieved using nasal alar electrode montage with the subject in a sitting position. Scaled peak-to-peak amplitude was higher in males than in females for both cVEMP and oVEMP. CONCLUSION Normative data for 44 young healthy adults was successfully collected for two body positions for cVEMP and two head positions and two electrode montages for oVEMP. SIGNIFICANCE Our findings describe VEMP protocols that efficiently detect VEMP responses, and we provide normative VEMP response data for young healthy subjects. We describe a potential difference in response between males and females, which may be clinically important.
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Affiliation(s)
- Navid Shahnaz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Eytan A. David
- Department of Surgery, University of British Columbia, Vancouver, Canada
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17
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Predictive Value of Vestibular Evoked Myogenic Potentials in the Diagnosis of Menière's Disease and Vestibular Migraine. Otol Neurotol 2021; 41:828-835. [PMID: 32271263 DOI: 10.1097/mao.0000000000002636] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the usefulness of vestibular evoked myogenic potentials (VEMPs) in the diagnosis of Menière's disease (MD) and vestibular migraine (VM). STUDY DESIGN Retrospective cohort. SETTING Multidisciplinary neurotology clinic. PATIENTS Definite MD and definite VM patients between January, 2015 and May, 2017, as well as healthy volunteers. INTERVENTIONS Cervical and ocular VEMP (cVEMP and oVEMP) testing. MAIN OUTCOME MEASURES VEMP response, amplitude, and latency. RESULTS Twenty five definite MD, 34 definite VM, and 13 control subjects were analyzed. MD affected ears had significantly lower cVEMP (p = 0.007) and oVEMP (p < 0.001) amplitudes than control ears. VM ears had significantly lower oVEMP (p = 0.001), but not cVEMP (p = 0.198) amplitudes than control ears. MD affected ears, but not VM ears, had significantly more absent cVEMP (25.9% versus 0%, p = 0.005) and oVEMP responses (40.7% versus 0%, p < 0.001) than control ears. oVEMP latency was significantly shorter for both MD affected (p < 0.001) and VM ears (p < 0.001) than control ears. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated using a neurotology clinic MD prevalence of 7.9% in dizzy patients. A present cVEMP or oVEMP both have more than 93% chance of ruling MD out in the tested ear, while a cVEMP amplitude more than 54.9 μV or oVEMP amplitude more than 5.1 μV both have more than 94% of ruling out MD in the tested ear. CONCLUSIONS Despite some overlap in VEMP results between MD and VM, when the diagnosis is uncertain between the two disorders due to symptomatic overlap and nonspecific audiometric data, VEMPs can be helpful in guiding treatment toward one disease entity or the other until more evidence points to a definitive diagnosis.
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18
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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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Abstract
OBJECTIVES To evaluate the effects of narrow band CE-Chirp (NB CE-Chirp) on the amplitudes and latencies in ocular vestibular evoked myogenic potentials (oVEMPs) at 500 and 1000 Hz in comparison with tone burst (TB). DESIGN Twenty-one healthy volunteers were included in the study and tested in air conduction with a "belly-tendon" montage. Recording conditions were randomized for each participant and each modality was tested twice to check the reproducibility of the procedure. RESULTS NB CE-Chirps at 500 Hz revealed larger n1-p1 amplitudes than 500 Hz TBs (p = .001), which were also larger than NB CE-Chirps and TBs at 1000 Hz (p = .022, p < .001, respectively). Besides, n1 and p1 latencies were shorter in NB CE-Chirp than in TB at 500 Hz (p < .001) and 1000 Hz (p < .001). The older the participants, the lower the amplitudes (p = .021, p = .031) and the longer the n1 (p = .030, p = .025) and p1 latencies (p < .001, p < .001) in 500 Hz NB CE-Chirps and 500 Hz TBs. Interaural asymmetry ratios were slightly higher in 500 Hz NB CE-Chirps as compared to 500 Hz TBs (p = .013). CONCLUSIONS NB CE-Chirps at 500 Hz improved the amplitudes of waveforms in oVEMPs. As for TBs with clicks before, enhancing oVEMPs amplitudes is an essential step to distinguish a healthy person from a patient with either utricular or its related pathways disorder and potentially minimize the risk of cochlear damages. Additional studies including a higher number of healthy participants and patients with vestibular disorders are required to confirm this hypothesis. The large interindividual variability of interaural asymmetry ratios in NB CE-Chirp and in TB at 500 Hz could be explained by the selected montage.
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Liu X, Ren L, Li J, Ji F, Liu X, Du Y, Guo W, Wu Z, Yang S. Air and bone-conducted vestibular evoked myogenic potentials in children with large vestibular aqueduct syndrome. Acta Otolaryngol 2021; 141:50-56. [PMID: 32964775 DOI: 10.1080/00016489.2020.1815836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There are few studies focused on vestibular symptoms and function of the children with LVAS. OBJECTIVES This study aimed to find the characteristics of air and bone-conducted VEMPs among children with LVAS, and to investigate the relationship between VEMPs and vestibular symptoms. MATERIAL AND METHODS A total of 44 children with LVAS and 10 healthy children were recruited as the case group and control group. Air and bone-conducted VEMP were performed to the participants. RESULTS For air-conducted measurement, there was elevated amplitude of cVEMP in case group than control group. There was no significant difference at oVEMP parameters between the case group and control group. For bone-conducted measurement, significantly longer P1 latency and shorter P1-N1 latency of cVEMP were observed among the case group; there were a series of changes in oVEMP parameters among the case group. Logistic regression model revealed that air-conducted oVEMP asymmetric ratio was valuable to predict vestibular symptoms' development among the kids with LVAS. CONCLUSION Asymmetric ratio of oVEMP could be used as one predictor of developing vestibular symptoms of the children with LVAS. Applying bone-conducted VEMP as one alternative parameter of vestibular syndrome is novel and will certainly remain an area of continued investigation.
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Affiliation(s)
- Xuhui Liu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lili Ren
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Jianan Li
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Fei Ji
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Xingjian Liu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Yi Du
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Weiwei Guo
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Ziming Wu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Shiming Yang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
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21
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Tran ED, Swanson A, Sharon JD, Vaisbuch Y, Blevins NH, Fitzgerald MB, Steenerson KK. Ocular Vestibular-Evoked Myogenic Potential Amplitudes Elicited at 4 kHz Optimize Detection of Superior Semicircular Canal Dehiscence. Front Neurol 2020; 11:879. [PMID: 32982915 PMCID: PMC7477389 DOI: 10.3389/fneur.2020.00879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/09/2020] [Indexed: 02/04/2023] Open
Abstract
Introduction: High-resolution temporal bone computed tomography (CT) is considered the gold standard for diagnosing superior semicircular canal dehiscence (SCD). However, CT has been shown over-detect SCD and provide results that may not align with patient-reported symptoms. Ocular vestibular-evoked myogenic potentials (oVEMPs)—most commonly conducted at 500 Hz stimulation—are increasingly used to support the diagnosis and management of SCD. Previous research reported that stimulation at higher frequencies such as 4 kHz can have near-perfect sensitivity and specificity in detecting radiographic SCD. With a larger cohort, we seek to understand the sensitivity and specificity of 4 kHz oVEMPs for detecting clinically significant SCD, as well as subgroups of radiographic, symptomatic, and surgical SCD. We also investigate whether assessing the 4 kHz oVEMP n10-p15 amplitude rather than the binary n10 response alone would optimize the detection of SCD. Methods: We conducted a cross-sectional study of patients who have undergone oVEMP testing at 4 kHz. Using the diagnostic criteria proposed by Ward et al., patients were determined to have SCD if dehiscence was confirmed on temporal bone CT by two reviewers, patient-reported characteristic symptoms, and if they had at least one positive vestibular or audiometric test suggestive of SCD. Receiver operating characteristic (ROC) analysis was conducted to identify the optimal 4 kHz oVEMP amplitude cut-off. Comparison of 4 kHz oVEMP amplitude across radiographic, symptomatic, and surgical SCD subgroups was conducted using the Mann-Whitney U test. Results: Nine hundred two patients (n, ears = 1,804) underwent 4 kHz oVEMP testing. After evaluating 150 temporal bone CTs, we identified 49 patients (n, ears = 61) who had radiographic SCD. Of those, 33 patients (n, ears = 37) were determined to have clinically significant SCD. For this study cohort, 4 kHz oVEMP responses had a sensitivity of 86.5% and a specificity of 87.8%. ROC analysis demonstrated that accounting for the inter-amplitude of 4 kHz oVEMP was more accurate in detecting SCD than the presence of n10 response alone (AUC 91 vs. 87%). Additionally, using an amplitude cut-off of 15uV reduces false positive results and improves specificity to 96.8%. Assessing 4 kHz oVEMP response across SCD subgroups demonstrated that surgical and symptomatic SCD cases had significantly higher amplitudes, while radiographic SCD cases without characteristic symptoms had similar amplitudes compared to cases without evidence of SCD. Conclusion: Our results suggest that accounting for 4 kHz oVEMP amplitude can improve detection of SCD compared to the binary presence of n10 response. The 4 kHz oVEMP amplitude cut-off that maximizes sensitivity and specificity for our cohort is 15 uV. Our results also suggest that 4 kHz oVEMP amplitudes align better with symptomatic SCD cases compared to cases in which there is radiographic SCD but no characteristic symptoms.
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Affiliation(s)
- Emma D Tran
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Austin Swanson
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Yona Vaisbuch
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States.,Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew B Fitzgerald
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Kristen K Steenerson
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
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22
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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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The vestibulo-masseteric reflex and the acoustic-masseteric reflex: a reliability and responsiveness study in healthy subjects. Exp Brain Res 2020; 238:1769-1779. [PMID: 32280998 DOI: 10.1007/s00221-020-05804-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
The vestibulo-masseteric reflex (VMR or p11 wave), the acoustic-masseteric reflex (AMR or p1/n21 wave) and the mixed vestibulo-cochlear p11/n21 potential are responses of masseter muscles to sound that can be employed to evaluate brainstem function. This study was aimed at establishing the test-retest reliability and responsiveness of these reflex parameters according to the type of electrode configuration. Twenty-two healthy volunteers (M:F = 11:11; mean age 25.3 ± 5.2 years) participated in two testing sessions separated by one week. Zygomatic and mandibular montages were compared following unilateral and bilateral stimulations. For reliability purposes, intraclass correlation coefficient (ICC), coefficient of variation of the method error (CVME) and standard error of measurement (SEM) were calculated. The minimal detectable difference (MDD) was also determined as a measure of responsiveness. Both VMR (p11 wave) and AMR could be consistently evoked from test to retest, although the frequency rate was significantly higher (all p values ≤ 0.009) with zygomatic (VMR: 97.7-100%; AMR: 86.9-97.6%) than mandibular montage (VMR: 84.7-89.8%; AMR: 65.0-67.8%), with no significant differences between unilateral and bilateral stimulations. Good-to-excellent reliability and responsiveness (high ICC, low CVME, SEM and MDD scores) were detected for corrected amplitudes and peak latencies for all reflex responses, whereas raw amplitudes were associated to poor reliability. The reliability of the zygomatic montage proved superior to the mandibular montage for all reflex responses. Given their high test-retest consistency and capability to study different features of the reflex arch, both peak latencies and corrected amplitudes should be reported and considered in the interpretation of reflex testing results.
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Bilodeau M, Jacobson GP, Roberts RA, Hatton K. Short Communication: The Belly-Tendon Derivation Yields Superior Ocular Vestibular Evoked Myogenic Potential Amplitudes in a Normal Pediatric Sample. Am J Audiol 2020; 29:88-93. [PMID: 31841353 DOI: 10.1044/2019_aja-19-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of the investigation was to determine whether the "belly-tendon" electrode derivation produced ocular vestibular evoked myogenic potentials (oVEMPs) in children that were superior to those recorded with the infraorbital-chin electrode derivation. Method This was a prospective observational study using a sample of convenience at a tertiary care medical center. Subjects were 13 children between the ages of 5 and 12 years. We compared the latency of the N1 wave and the N1-P1 peak-to-peak amplitude for the belly-tendon electrode derivation to the infraorbital-chin electrode derivation. Results The belly-tendon electrode derivation was associated with superior N1-P1 amplitudes compared to the infraorbital-chin electrode derivation. However, the large amplitude was also associated with greater variability compared to the infraorbital-chin derivation. There were no significant electrode derivation-based differences in N1 latency. Additionally, there was no predictable relationship between age and oVEMP amplitude. Conclusion As shown previously in adults, the belly-tendon electrode derivation produces significantly larger oVEMP amplitudes compared to the infraorbital-chin electrode derivation.
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Affiliation(s)
- Megan Bilodeau
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Gary P Jacobson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Richard A Roberts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Kelsey Hatton
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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The Medial Canthus Reference Electrode Is not Electrically Indifferent to the Ocular Vestibular Evoked Myogenic Potential. Otol Neurotol 2019; 39:e1069-e1077. [PMID: 30212429 DOI: 10.1097/mao.0000000000001978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether a reference electrode placed over the contralateral medical canthus is electrically indifferent to the ocular vestibular evoked myogenic potential (oVEMP). STUDY DESIGN Prospective observational study. SETTING Tertiary academic center. PARTICIPANTS Nineteen otologically normal subjects. METHODS oVEMPs were recorded using a 500 Hz tone burst at 125 dB pSPL using both a conventional dual infra-orbital derivation and contralateral infraorbital electrode referenced to a medial canthus electrode known as the "belly-tendon" derivation. RESULTS The belly-tendon derivation produced significantly larger oVEMP amplitudes. This appears to be due to a polarity inversion of the first negative peak that occurs when the reference electrode is placed over the medial canthus. Thus, the belly-tendon derivation was associated with reference contamination, but in this instance the reference contamination produced an augmented oVEMP amplitude. CONCLUSIONS Neither the dual infra-orbital nor belly-tendon electrode montages are electrically neutral. Reference contamination is the source of both a decrease in amplitude using conventional recording techniques and increased amplitude using the belly-tendon montage. The results support the contention that the belly-tendon montage generates a reversed polarity response, i.e., algebraically subtracted (i.e., added in the differential amplifier) from the response recorded at the infraorbital midline enhancing the oVEMP amplitude. It should be noted that the amplitude gained when using the belly-tendon montage may also be due to electromyographic (EMG) generated by extraocular muscles other than the inferior oblique generator, resulting in a loss of specificity. The authors recommend the belly-tendon montage be used in clinical situations where the oVEMP is absent or low in amplitude.
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De Natale E, Ginatempo F, Mercante B, Manca A, Magnano I, Ortu E, Pilurzi G, Melis F, Rothwell J, Deriu F. Vestibulo masseteric reflex and acoustic masseteric Reflex. Normative data and effects of age and gender. Clin Neurophysiol 2019; 130:1511-1519. [DOI: 10.1016/j.clinph.2019.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/17/2019] [Accepted: 05/03/2019] [Indexed: 12/13/2022]
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Singh NK, Kumar P, Jha RH. A Novel Stimulation Paradigm for Obtaining Interfrequency Amplitude Ratio of Ocular Vestibular Evoked Myogenic Potentials. Am J Audiol 2019; 28:422-427. [PMID: 31461335 DOI: 10.1044/2019_aja-ind50-18-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Interfrequency amplitude ratio (IFAR), the ratio of amplitude between ocular vestibular evoked myogenic potentials (oVEMPs) for tone bursts of 500 and 1000 Hz, aids in identification of Ménière's disease with high sensitivity and specificity. However, it requires recording of oVEMP for 2 frequencies, which doubles the time of recording. Use of simultaneous recording of responses for both frequencies could potentially bring down testing time. Simultaneous recording might be possible by modifying the oddball paradigm and using a ratio of 1:1 for the 2 frequencies. This might also reduce variation in oVEMP amplitude between frequencies due to changes in gaze angle between the recordings. However, it remains to be explored whether or not the use of modified oddball paradigm to record oVEMP (MoVEMP) will produce comparable responses to conventional sequential recording of oVEMP (CoVEMP) for obtaining IFAR. Hence, the study aimed to compare MoVEMP and CoVEMP on various measures of oVEMP. Method The study included 29 healthy adults in the age range of 18-30 years, 23 of which were used for validation and 6 for finding test-retest reliability. All participants underwent contralateral oVEMP recording using 500- and 1000-Hz tone bursts presented using MoVEMP and CoVEMP paradigms. Results Comparable outcomes on latencies, amplitude, and IFAR were obtained between CoVEMP and MoVEMP. Furthermore, MoVEMP took significantly lesser time per ear and also produced better test-retest reliability than CoVEMP. Conclusion MoVEMP is a quicker and more reliable clinical stimulation paradigm for obtaining IFAR than CoVEMP.
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Affiliation(s)
- Niraj Kumar Singh
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, Karnataka
| | - Prawin Kumar
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, Karnataka
| | - Raghav Hira Jha
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, Karnataka
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E. A, Kumar K. Test-Retest Reliability of Cervical and Ocular Vestibular Evoked Myogenic Potential With Simultaneous and Sequential Recording. Am J Audiol 2019; 28:414-421. [PMID: 31461337 DOI: 10.1044/2019_aja-ind50-18-0087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose Simultaneous recording of cervical (cVEMP) and ocular (oVEMP) vestibular evoked myogenic potentials aids in reducing the testing time when compared to conventional sequential recordings. The purpose of this study was to examine the test-retest reliability of sequential and simultaneous acquisitions of cVEMP and oVEMP. Method cVEMP and oVEMP were recorded in 35 normal-hearing individuals. The cVEMP and oVEMP were obtained using sequential and simultaneous methods. The VEMP recordings were performed across 3 sessions. The 1st 2 recording sessions were consecutive with a gap of 5 min between sessions. The 3rd recording session was after a gap of 3-5 days. Results Both simultaneous and sequential recordings showed fair-to-good test-retest reliability for latencies and amplitude of cVEMP and oVEMP. Conclusion Simultaneous cVEMP and oVEMP recordings can be used to obtain fast VEMP recording with test-retest reliability comparable with that of sequential recording.
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Affiliation(s)
- Anupriya E.
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kaushlendra Kumar
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Kharkheli E, Japaridze S, Kevanishvili Z, Oz I, Ozluoglu LN. Correlation between Vestibular Evoked Myogenic Potentials and Disease Progression in Ménière's Disease. ORL J Otorhinolaryngol Relat Spec 2019; 81:193-201. [PMID: 31390639 DOI: 10.1159/000496088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the relationship between ocular (oVEMPs) and cervical (cVEMPs) vestibular evoked myogenic potentials and audiometrically determined clinical stage in Ménière's disease (MD). METHODS Thirty-four unilateral MD patients and 30 healthy volunteers were included in the study. Pure-tone hearing levels, oVEMPs, cVEMPs, and videonystagmography results were analyzed and compared between the groups. RESULTS Both oVEMPs and cVEMPs were highly reproducible in the control group. At the early stages of MD, cVEMPs were particularly disturbed, while at the advanced stages both oVEMPs and cVEMPs were altered pathologically. In the study group, oVEMP and cVEMP amplitudes and interaural amplitude difference (IAD) statistically differed from those in the control sample. oVEMPs were absent in 7.7% of stage III and in 44.5% of stage IV MD patients, while cVEMPs were absent in 15.4% of stage III and in 54.5% of stage IV MD patients, respectively. In stage III and IV MD patients in whom oVEMPs and cVEMPs were obtained, IADs were increased. Caloric asymmetry was found in 64.7% of MD patients. Caloric weakness was more prominent in cases with advanced MD. CONCLUSION VEMPs can be used for objective validation of the stage of MD.
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Affiliation(s)
| | - S Japaridze
- National Centre of Otorhinolaryngology, Tbilisi, Georgia
| | | | - Isilay Oz
- Baskent University School of Medicine, Ankara, Turkey,
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Yacovino DA, Akly MP, Luis L, Zee DS. The Floccular Syndrome: Dynamic Changes in Eye Movements and Vestibulo-ocular Reflex in Isolated Infarction of the Cerebellar Flocculus. THE CEREBELLUM 2019; 17:122-131. [PMID: 28844105 DOI: 10.1007/s12311-017-0878-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The cerebellar flocculus is a critical structure involved in the control of eye movements. Both static and dynamic abnormalities of the vestibulo-ocular reflex (VOR) have been described in animals with experimental lesions of the flocculus/paraflocculus complex. In humans, lesions restricted to the flocculus are rare so they can become an exceptional model to contrast with the clinical features in experimental animals or in patients with more generalized cerebellar diseases. Here, we examined a 67-year-old patient with an acute vestibular syndrome due to an isolated infarct of the right flocculus. We evaluated him multiple times over 6 months-to follow the changes in eye movements and vestibular function-with caloric testing, video-oculography and head-impulse testing, and the anatomical changes on imaging. Acutely, he had an ipsilateral-beating spontaneous nystagmus, bilateral gaze-evoked nystagmus, borderline impaired smooth pursuit, and a complete contraversive ocular tilt reaction. The VOR gain was reduced for head impulses directed contralateral to the lesion, and there was also an ipsilesional caloric weakness. All abnormalities progressively improved at follow-up visits but with a considerable reduction in volume of the affected flocculus on imaging. The vestibular and ocular motor findings, qualitatively similar to a previously reported patient, further clarify the "acute floccular syndrome" in humans. We also add new information about the pattern of recovery from such a lesion with corresponding changes in the size of the affected flocculus on imaging.
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Affiliation(s)
- Dario Andres Yacovino
- Department of Neurology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina.
- Memory and Balance Clinic, Buenos Aires, Argentina.
| | - Manuel Perez Akly
- Department of Neuroradiology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina
- Department of Radiology, Italian Hospital, Buenos Aires, Argentina
| | - Leonel Luis
- Department of Otolaryngology, Hospital Santa Maria, CHLN, Lisbon, Portugal
| | - David S Zee
- Departments of Neurology, Otolaryngology-Head and Neck Surgery, Ophthalmology and Neuroscience, Johns Hopkins Hospital, Baltimore, MD, USA
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Air-Conducted Vestibular Evoked Myogenic Potential Testing in Children, Adolescents, and Young Adults: Thresholds, Frequency Tuning, and Effects of Sound Exposure. Ear Hear 2019; 40:192-203. [PMID: 29870520 DOI: 10.1097/aud.0000000000000607] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pediatric vestibular evaluations incorporate cervical and ocular vestibular evoked myogenic potential (c- and oVEMP, respectively) testing; however, in children, c- and oVEMP thresholds have been minimally investigated and frequency tuning is unknown. Children are also at risk for unsafe sound exposure secondary to VEMP. While it is unknown if VEMP threshold testing leads to cochlear changes, it is possible that this risk increases due to the increased number of trials needed to obtain a threshold. Obtaining VEMP thresholds at various frequencies in children provides further information for pediatric normative VEMP data. Assessing for cochlear changes after VEMP threshold testing would provide information on the safety of threshold VEMP testing in children. The objectives of this study were to (1) characterize c- and oVEMP thresholds in children, adolescents, and young adults with normal hearing using 500 and 750 Hz tone burst (TB) stimuli, (2) compare frequency tuning of 500 and 750 Hz TB, and (3) assess whether cochlear changes exist after VEMP threshold testing. It is hypothesized that children, adolescents, and young adults would not show age-related changes to the vestibular system. Therefore, reliable VEMP thresholds would be seen below maximum acoustical stimulation levels (e.g., <125 dB SPL) and frequency tuning will be similar for 500 and 750 Hz TB stimuli. DESIGN Ten children (age 4-9), 10 adolescents (age 10-19), and 10 young adults (age 20-29) with normal hearing and tympanometry participated. All subjects received c- and oVEMP testing at maximum stimulation and threshold. To address frequency tuning, but not exceed recommended sound exposure allowance, subjects received a 500 Hz TB stimulus in one ear and a 750 Hz TB stimulus in the other ear. Subjects completed tympanometry pre-VEMP, and audiometric threshold testing, distortion product otoacoustic emission testing, and subjective questionnaire pre- and post-VEMP to study the effect of VEMP exposure on cochlear function for each stimulus frequency. RESULTS (1) cVEMP thresholds were determined for both stimulus frequencies for children (500 Hz = 106 dB SPL; 750 Hz = 106 dB SPL), adolescents (500 Hz = 107.5 dB SPL; 750 Hz = 109.5 dB SPL), and young adults (500 Hz = 111.5 dB SPL; 750 Hz = 112 dB SPL). oVEMP thresholds were also obtained in response to both stimulus frequencies for children (500 Hz = 111.1 dB SPL; 750 Hz = 112.2 dB SPL), adolescents (500 Hz = 112.5 dB SPL; 750 Hz = 114.5 dB SPL), and young adults (500 Hz = 116 dB SPL; 750 Hz = 117 dB SPL). Similar thresholds were found between groups except for children who had significantly lower thresholds compared with adults for cVEMP (500 Hz: p = 0.002; 750 Hz: p = 0.004) and oVEMP (500 Hz: p = 0.01; 750 Hz: p = 0.02). In addition, equivalent ear-canal volume and VEMP thresholds were linearly correlated. (2) There was no significant effect of stimulus frequency on VEMP response rates, latencies, peak to peak amplitudes, or thresholds, suggesting similar frequency tuning for 500 and 750 Hz. (3) There were no significant effects of VEMP threshold testing on cochlear function for either stimulus frequency. CONCLUSIONS Children, adolescents, and young adults show VEMP thresholds below high stimulation levels and had similar frequency tuning between 500 and 750 Hz. Use of 750 Hz could be regarded as the safer stimuli due to its shorter duration and thus reduced sound exposure. Children with smaller ear-canal volume had present responses at maximum stimulation and lower thresholds, suggesting that VEMP testing could be initiated at lower acoustic levels to minimize sound exposure and optimize testing.
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Zalewski CK, Ackley RS, McCaslin DL, Clark MD, Hanks WD, Brewer CC. Examination of Utricular Response Using oVEMP and Unilateral Centrifugation Rotation Testing. Ear Hear 2019; 39:910-921. [PMID: 29432406 PMCID: PMC6425474 DOI: 10.1097/aud.0000000000000552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Significant advancements have been made toward the clinical assessment of utricular function through ocular vestibular-evoked myogenic potentials (oVEMP) and unilateral centrifugation (UCF) testing. To date, no study has examined intrasubject relationships between these measures. The study hypothesis was that intrasubject responses from oVEMP and UCF testing would be correlated inasmuch as both tests have been reported to assess utricular function. DESIGN UCF rotations and oVEMP testing were performed on healthy volunteers, aged 18 to 62 years. A within-subject study design compared and correlated UCF outcome measures of ocular counterroll, subjective visual vertical, and ocular counterroll-gravitational inertial acceleration slope against peak to peak oVEMP N1-P1 amplitude. RESULTS Correlational analyses failed to reveal any significant relationships between oVEMP amplitude and UCF responses suggesting that these tests may be inciting different response properties within the utricular system. CONCLUSIONS Various anatomical and physiological differences within the utricle, in addition to the fundamental differences in stimulus properties between the oVEMP and UCF tests, could explain the lack of significant correlations between these measures and suggest that oVEMP and UCF testing may be complimentary in their evaluation of the utricular system. These data reinforce the complexities of the utricular system and provide further insight into the difficulties encountered in its clinical assessment.
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Affiliation(s)
- Christopher K Zalewski
- Audiology Unit, Otolaryngology Branch, National Institutes of Health (NIH), National Institute on Deafness and Other Communication Disorders (NIDCD), Bethesda, Maryland, USA
| | - R Steven Ackley
- Department of Hearing, Speech, and Language Sciences (HSLS), Gallaudet University, Washington, DC, USA
| | - Devin L McCaslin
- Department of Otorhinolaryngology, Vestibular and Balance Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - M Diane Clark
- Department of Deaf Studies and Deaf Education, College of Fine Arts and Communication, Lamar University, Beaumont, Texas, USA
| | - Wendy D Hanks
- College of Health Professions, School of Audiology, Pacific University, Hillsboro, Oregon
| | - Carmen C Brewer
- Audiology Unit, Otolaryngology Branch, National Institutes of Health (NIH), National Institute on Deafness and Other Communication Disorders (NIDCD), Bethesda, Maryland, USA
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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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Singh NK, Barman A. Inter-frequency amplitude ratio of oVEMP for differentiating Meniere’s disease from BPPV: clinical validation using a double-blind approach. Int J Audiol 2018; 58:21-28. [DOI: 10.1080/14992027.2018.1529440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Niraj Kumar Singh
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, India
| | - Animesh Barman
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, India
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Performing and analysing tone-induced cervical and ocular vestibular-evoked myogenic potentials in traumatic and non-traumatic vestibular pathology. The Journal of Laryngology & Otology 2018; 132:896-900. [PMID: 30296951 DOI: 10.1017/s0022215118001706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This paper discusses our technique of carrying out cervical and ocular vestibular-evoked myogenic potential testing in a single position. The described technique allows for a symmetrical, natural flexion of the neck muscles, which is helpful as many of our patients have suffered traumatic deceleration injures. METHODS Patients with suspected vestibular pathology referred by specialists were sequentially assessed in a tertiary referral neuro-otology unit within a teaching hospital using our technique and our previously established normative database. All patients underwent standardised vestibular assessment in addition to cervical and ocular vestibular-evoked myogenic potential assessment. Our normative data are in keeping with that reported by other centres. RESULTS Many of the patients had abnormal vestibular-evoked myogenic potentials, which is in line with a history suggesting otolithic disease. CONCLUSION Both cervical and ocular vestibular-evoked myogenic potentials offer several parameters for detecting abnormalities. The technique reported enables us to assess patients in an accurate fashion whether or not they have suffered traumatic neck injuries.
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Behtani L, Maheu M, Delcenserie A, Nooristani M, Champoux F. State-of-the-art assessment allows for improved vestibular evoked myogenic potential test-retest reliability. Audiol Res 2018; 8:212. [PMID: 30505423 PMCID: PMC6218692 DOI: 10.4081/audiores.2018.212] [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: 04/19/2018] [Accepted: 09/12/2018] [Indexed: 11/23/2022] Open
Abstract
The goal of the present study was to evaluate the test-retest reliability values of myogenic responses using the latest guidelines for vestibular assessment. Twenty-two otologically and neurologically normal adults were assessed twice, on two different days. The analyses were carried out using interclass correlations. The results showed that the latest recommendations for vestibular assessment lead to test-retest reliability values that are as high, or greater, than those reported in previous studies. The results suggest that state-of-the-art testing, using the latest recommendations as well as electromyography control, improves reliability values of myogenic responses, more specifically for the cervical vestibular evoked myogenic potentials. The impact of small differences in experimental procedures on the reliability values of myogenic responses is also addressed.
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Affiliation(s)
- Lydia Behtani
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal
| | - Maxime Maheu
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal.,CIUSSS Centre-Sud-de-l'île-de-Montréal/Institut Raymond-Dewar
| | - Audrey Delcenserie
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal.,Departement of Psychology, University of Montreal, Québec, Canada
| | - Mujda Nooristani
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal
| | - François Champoux
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, University of Montreal.,CIUSSS Centre-Sud-de-l'île-de-Montréal/Institut Raymond-Dewar
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Ocular and Cervical Vestibular Evoked Myogenic Potentials in Patients With Vestibular Migraine. Otol Neurotol 2018; 39:e561-e567. [DOI: 10.1097/mao.0000000000001880] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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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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Janky KL, Rodriguez AI. Quantitative Vestibular Function Testing in the Pediatric Population. Semin Hear 2018; 39:257-274. [PMID: 30038454 DOI: 10.1055/s-0038-1666817] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Quantitative tests of vestibular function include the caloric test, cervical and ocular vestibular evoked myogenic potential (VEMP), rotary chair, and head impulse test, either at the bedside or utilizing video head impulse test (vHIT). The purpose of this article is to provide an overview of how to perform these tests in children, including which tests are recommended based on the child's age and any modifications or considerations that can be made. A variety of clinical measures have been recommended as screening measures for vestibular loss, which will be reviewed. Symptom questionnaires designed to assess the functional impact of dizziness and vestibular loss in children will also be discussed. If a child complains of dizziness or if vestibular loss is suspected (either by case history or positive screening measure), vestibular function testing is warranted. For vestibular function testing, children aged 0 to 2 years typically receive rotary chair, cervical VEMP, and vHIT if a remote system is available. For children aged 3 to 7 years, vHIT, cervical VEMP, and ocular VEMP are completed, and for children aged 8+ years, vHIT, caloric testing if vHIT is normal, and cervical and ocular VEMP are completed. For all children, modifications to testing can be made, as needed.
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Affiliation(s)
- Kristen L Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, Nebraska
| | - Amanda I Rodriguez
- Department of Audiology, Boys Town National Research Hospital, Omaha, Nebraska
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Handelsman JA. Vestibulotoxicity: strategies for clinical diagnosis and rehabilitation. Int J Audiol 2018; 57:S99-S107. [DOI: 10.1080/14992027.2018.1468092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Jaynee A. Handelsman
- Department of Otolaryngology Head and Neck Surgery, Pediatric Audiology and Otolaryngology, Michigan Medicine, Ann Arbor, MI, USA
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Bayram A, Kalkan M, Ünsal N, Kale A, Küçük B, Mutlu C. Does blindness affect ocular vestibular evoked myogenic potentials? Am J Otolaryngol 2018. [PMID: 29525138 DOI: 10.1016/j.amjoto.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the influence of blindness on ocular vestibular evoked myogenic potentials (oVEMP) responses. METHODS Thirty-one subjects with unilateral blindness (UB group) and 25 age and sex-matched healthy subjects (control group) were recruited for the present study. The oVEMP responses including latency, amplitude and amplitude asymmetry ratio (AR) were measured and compared between the blind side, the contralateral eye of the UB group and the control subjects. RESULTS Ocular VEMP recordings were obtained from 29 of 31 patients (93.5%) for the blind side of the UB group. There was no significant difference in terms of latency, amplitude and AR value between the blind side and the contralateral eye of the UB group and the control subjects. CONCLUSION Clear oVEMP recordings can be elicited as long as the eyeball and extraocular muscles are preserved in a blind eye.
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Affiliation(s)
- Ali Bayram
- Department of ENT, Kayseri Training and Research Hospital, Kayseri, Turkey.
| | - Mehmet Kalkan
- Department of ENT, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Nuri Ünsal
- Department of ENT, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ahmet Kale
- Department of Audiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Bekir Küçük
- Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Cemil Mutlu
- Department of ENT, Kayseri Training and Research Hospital, Kayseri, Turkey
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Characterizing the Age and Stimulus Frequency Interaction for Ocular Vestibular-Evoked Myogenic Potentials. Ear Hear 2018; 39:251-259. [DOI: 10.1097/aud.0000000000000482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
OBJECTIVES This study was performed to compare three electrode configurations for the ocular vestibular evoked myogenic potentials (oVEMPs)-"standard," "sternum," and "nose"-by making use of bone-conducted stimuli (at the level of Fz with a minishaker). In the second part, we compared the test-retest reliability of the standard and nose electrode configuration on the oVEMP parameters. DESIGN This study had a prospective design. Fourteen healthy subjects participated in the first part (4 males, 10 females; average age = 23.4 (SD = 2.6) years; age range 19.9 to 28.3 years) and second part (3 males, 11 females; average age = 22.7 (SD = 2.4) years; age range 20.0 to 28.0 years) of the study. OVEMPs were recorded making use of a hand-held bone conduction vibrator (minishaker). Tone bursts of 500 Hz (rise/fall time = 2 msec; plateau time = 2 msec; repetition rate = 5.1 Hz) were applied at a constant stimulus intensity level of 140 dB FL. RESULTS PART 1: The n10-p15 amplitude obtained with the standard electrode configuration (mean = 15.8 μV; SD = 6.3 μV) was significantly smaller than the amplitude measured with the nose (Z = -3.3; p = 0.001; mean = 35.0 μV; SD = 19.1 μV) and sternum (Z = -3.3; p = 0.001; mean = 27.1 μV; SD = 12.2 μV) electrode configuration. The p15 latency obtained with the nose electrode configuration (mean = 14.2 msec; SD = 0.54 msec) was significantly shorter than the p15 latency measured with the standard (Z = -3.08; p = 0.002) (mean = 14.9 msec; SD = 0.75 msec) and sternum (Z = -2.98; p = 0.003; mean = 15.4 msec; SD = 1.07 msec) electrode configuration. There were no differences between the n10 latencies of the three electrode configurations. The 95% prediction intervals (given by the mean ± 1.96 * SD) for the different interocular ratio values were [-41.2; 41.2], [-37.2; 37.2], and [-25.9; 25.9] for standard, sternum, and nose electrode configurations, respectively. PART 2: Intraclass correlation (ICC) values calculated for the oVEMP parameters obtained with the standard electrode configuration showed fair to good reliability for the parameters n10-p15 amplitude (ICC = 0.51), n10 (ICC = 0.52), and p15 (ICC = 0.60) latencies. The ICC values obtained for the parameters acquired with the nose electrode configuration demonstrated a poor reliability for the n10 latency (ICC = 0.37), a fair to good reliability for the p15 latency (ICC = 0.47) and an excellent reliability for the n10-p15 amplitude (ICC = 0.85). CONCLUSIONS This study showed the possible benefits from alternative electrode configurations for measuring bone-conducted-evoked oVEMPs in comparison with the standard electrode configuration. The nose configuration seems promising, but further research is required to justify clinical use of this placement.
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The vestibulocochlear bases for wartime posttraumatic stress disorder manifestations. Med Hypotheses 2017; 106:44-56. [DOI: 10.1016/j.mehy.2017.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 06/28/2017] [Indexed: 11/23/2022]
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Makowiec K, McCaslin DL, Jacobson GP, Hatton K, Lee J. Effect of Electrode Montage and Head Position on Air-Conducted Ocular Vestibular Evoked Myogenic Potential. Am J Audiol 2017; 26:180-188. [PMID: 28520834 DOI: 10.1044/2017_aja-16-0108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/16/2017] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The purpose of this investigation was to identify the optimal recording parameters for evoking the ocular vestibular evoked myogenic potential (oVEMP) using air-conduction stimuli. METHOD Subjects were 17 otologically and neurologically intact adults (age: M = 24.18 years, SD = 1.91 years). The oVEMP responses were elicited using a 500-Hz tone burst air-conduction stimulus presented at an intensity of 95 dB nHL. The setting was a balance function laboratory that was part of a large tertiary care otology clinic. RESULTS The oVEMP electrode montage and body position that yielded the largest oVEMP amplitude was the belly-tendon montage (Sandhu, George, & Rea, 2013), recorded with the subject in the sitting position. The N1 latency recorded with the belly-tendon montage was significantly shorter than that recorded for the infraorbital montage in both the sitting and supine positions. CONCLUSION The belly-tendon recording montage with the subject sitting yields significantly larger oVEMP amplitudes and shorter N1 latencies than do traditional bipolar infraorbital recordings.
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Affiliation(s)
- Kathryn Makowiec
- Division of Vestibular Sciences, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Devin L. McCaslin
- Division of Vestibular Sciences, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Gary P. Jacobson
- Division of Vestibular Sciences, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Kelsey Hatton
- Division of Vestibular Sciences, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - John Lee
- Division of Vestibular Sciences, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Hunter JB, Patel NS, O'Connell BP, Carlson ML, Shepard NT, McCaslin DL, Wanna GB. Cervical and Ocular VEMP Testing in Diagnosing Superior Semicircular Canal Dehiscence. Otolaryngol Head Neck Surg 2017; 156:917-923. [PMID: 28168887 DOI: 10.1177/0194599817690720] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine the sensitivity and specificity of ocular and cervical vestibular evoked myogenic potentials (VEMPs) in the diagnosis of superior semicircular canal dehiscence (SCD) and to describe the VEMP response characteristics that are most sensitive to SCD and compare the findings to previous reports. Study Design Case series with chart review. Setting Two tertiary neurotologic referral centers. Subjects and Methods Cervical and ocular VEMP peak-to-peak amplitudes and thresholds from 39 adult patients older than 18 years with surgically confirmed SCD were compared with 84 age-matched controls. Results Using receiver operating characteristic (ROC) curves, cervical VEMP (cVEMP) amplitudes, cVEMP thresholds, and ocular VEMP (oVEMP) amplitudes had areas under the curve of 0.731, 0.912, and 0.856, respectively, all of which were statistically significant ( P < .0001). For cVEMP thresholds, at the clinical equivalent ≤85-dB normalized hearing level (nHL) threshold, the sensitivity and specificity were 97.3% and 31.3%, respectively. At the ≤70-dB nHL threshold, the sensitivity and specificity were 73.0% and 94.0%, respectively. For oVEMP amplitudes >12.0 µV, the sensitivity and specificity were 78.6% and 81.7%, respectively. Conclusion Data from this multicenter study suggest that both cVEMP thresholds and oVEMP amplitudes remain good diagnostic tests for identifying SCD, with each test dependent on a number of factors. The sensitivity and specificity of these individual tests may vary slightly between centers depending on testing parameters used.
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Affiliation(s)
- Jacob B Hunter
- 1 The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Neil S Patel
- 2 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Brendan P O'Connell
- 1 The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew L Carlson
- 2 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Neil T Shepard
- 2 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Devin L McCaslin
- 1 The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George B Wanna
- 1 The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Leyssens L, Heinze B, Vinck B, Van Ombergen A, Vanspauwen R, Wuyts FL, Maes LK. 'Standard' versus 'nose reference' electrode placement for measuring oVEMPs with air-conducted sound: Test-retest reliability and preliminary patient results. Clin Neurophysiol 2016; 128:312-322. [PMID: 28042997 DOI: 10.1016/j.clinph.2016.11.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 11/21/2016] [Accepted: 11/25/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study compared two electrode placements ('standard' versus 'nose reference' placement) for measuring oVEMPs, elicited by air-conducted 500Hz tone bursts. The test-retest reliability of both positions was evaluated and additionally both electrode placements were applied on a group of vestibular patients. METHODS Eighteen healthy volunteers (range of 20-25years) participated in the first part and were retested after one week for evaluation of the test-retest reliability. Eleven patients (range of 41-74years) with a variety of vestibular pathologies were tested once. RESULTS In the normal group, the nose reference electrode placement resulted in significantly larger peak-to-peak amplitudes (p<0.001), shorter n10 (p=0.001) and p15 (p<0.001) latencies and smaller 95% prediction intervals for the Inter-Ocular Ratio (IOR) ([-68, 68] for the standard position versus [-32, 32] for the nose reference position). Furthermore, an excellent amplitude and IOR test-retest reliability was observed with the nose reference configuration, as shown by the intraclass correlation coefficient (ICC), the coefficient of variation of the method error (CVME) and the minimal detectable differences (MDD). In the patient group, the same significant amplitude difference was found. Moreover, three patients presented with absent oVEMPs when recorded with the standard placement, whereas the nose reference placement could evoke a detectable oVEMP response. CONCLUSIONS This study demonstrated that a nose reference electrode position results in larger oVEMP amplitudes and achieves a better reliability for the most important clinical parameters (amplitude and IOR). Our patient data substantiate the possible clinical benefit of this position, but further systematic patient verification is required. SIGNIFICANCE The nose reference electrode position facilitates the detection of generally very small oVEMP responses and shows a high test-retest reliability, showing promising potential for future use in the vestibular clinic.
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Affiliation(s)
- Laura Leyssens
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Barbara Heinze
- Faculty of Humanities, Department of Speech-Language Pathology and Audiology, Pretoria University, Pretoria, South Africa
| | - Bart Vinck
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Humanities, Department of Speech-Language Pathology and Audiology, Pretoria University, Pretoria, South Africa
| | - Angelique Van Ombergen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Antwerp University Research Center for Equilibrium and Aerospace (AUREA), ENT Department, University Hospital Antwerp, Antwerp, Belgium; Faculty of Sciences, Department of Biomedical Physics, University of Antwerp, Antwerp, Belgium
| | - Robby Vanspauwen
- ENT Department, Sint-Augustinus Hospital Antwerp, European Institute for ORL-HNS, Antwerp, Belgium
| | - Floris L Wuyts
- Antwerp University Research Center for Equilibrium and Aerospace (AUREA), ENT Department, University Hospital Antwerp, Antwerp, Belgium; Faculty of Sciences, Department of Biomedical Physics, University of Antwerp, Antwerp, Belgium
| | - Leen K Maes
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Sciences, Department of Biomedical Physics, University of Antwerp, Antwerp, Belgium
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Silva TR, Resende LMD, Santos MAR. Ocular and cervical vestibular evoked myogenic potential simultaneous in normal individuals. Codas 2016; 28:34-40. [PMID: 27074187 DOI: 10.1590/2317-1782/20162015040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 06/01/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To characterize the recording and analyze the results of the combined cervical and ocular vestibular evoked myogenic potential in individuals without hearing and vestibular complaints. METHODS In this study, 30 individuals without hearing complaints and hearing within normal limits were evaluated. Data were collected through the simultaneous recording of cervical and ocular vestibular evoked myogenic potential. RESULTS Differences were observed between the right and left ears for the amplitude of waves P13 and N23 of the cervical vestibular evoked myogenic potential and the latency of wave N10 of the ocular vestibular evoked myogenic potential. For female subjects, there was no difference between the right and left ears for the amplitude of waves P13, N23, N10, and P15; interamplitude in cervical vestibular evoked myogenic potential and interamplitude in ocular vestibular evoked myogenic potential; and latency in waves P13, N23, N10, and P15. For male subjects, there was a difference between the right and left ears for the amplitude of wave P13. CONCLUSION The results of the combined cervical and ocular vestibular evoked myogenic potentials were consistent, because the responses generated by the vestibular evoked myogenic potentials presented an adequate morphology, latency, and amplitude, allowing for the evaluation of the ipsilateral descending vestibular pathways and the contralateral ascending vestibular pathways.
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Affiliation(s)
- Tatiana Rocha Silva
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luciana Macedo de Resende
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Govender S, Cheng PY, Dennis DL, Colebatch JG. Electrode montage and gaze effects on ocular vestibular evoked myogenic potentials (oVEMPs). Clin Neurophysiol 2016; 127:2846-2854. [PMID: 27417061 DOI: 10.1016/j.clinph.2016.05.365] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 04/30/2016] [Accepted: 05/09/2016] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the properties of lateral electrode locations compared to the conventional ones and to bipolar compared to chin-referenced montages for recording ocular vestibular evoked myogenic potentials (oVEMPs). METHODS A total of 18 subjects were studied using 5 electrode locations around the eye, including the conventional location and more lateral ones (i.e. M, ML and L electrodes near the orbital margin, R1 and R2 electrodes below the two more medial ones). Unilateral air-conducted (AC) sound, bone-conducted (BC) impulses at the mastoid and BC vibration (500Hz) at the forehead were used. These were applied while the subjects looked in neutral gaze and with 4 levels of increasing elevation. A subset of 10 subjects were also studied when looking downwards at 4 levels. Five bipolar montages were created offline by subtraction. RESULTS The M and ML electrodes had the largest responses but responses were seen for all 5 electrodes. The chin reference was associated with substantial pickup from the contralateral side (as judged using unilateral AC stimulation). The M-R1 (conventional) montage showed a significantly non-linear response to gaze angle, unlike the ML montages. The ML-R1 montage gave the largest responses. There was a clear change in latency for the conventional montage with downgaze for the AC and BC impulsive stimuli. CONCLUSIONS The ML active electrode has a more stable n1 latency, a larger and a more linear response to gaze angle than the conventional recording site, probably due to contamination by pickup of inferior rectus activity when using the conventional site. SIGNIFICANCE The ML location is a better site for the active pickup for recording oVEMPs if the main object of study is the inferior oblique muscle and particularly if subjects have difficulty with upgaze.
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Affiliation(s)
- Sendhil Govender
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, NSW 2031, Australia
| | - Petrina Y Cheng
- Prince of Wales Clinical School, University of New South Wales, Randwick, Sydney, NSW 2031, Australia
| | - Danielle L Dennis
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, NSW 2031, Australia
| | - James G Colebatch
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, NSW 2031, Australia.
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Vestibular migraine: A correlation study between clinical findings and vestibular evoked myogenic potentials (VEMPs). ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ejenta.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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