Abnormal cVEMP Research Articles

Otolith assessment in elderly using combined vestibular-evoked myogenic potentials and subjective visual vertical test

BackgroundDizziness in elderly patients is classified as a multifactorial geriatric syndrome leading to pathological conditions or changes endemic to the aging process, it is characterized by increased susceptibility to accidents and instability. This is considered a major public health problem. In our study, we assessed age related changes in vestibular function via measurement of combined Vestibular-Evoked Myogenic potentials (VEMPs) as well as Static Subjective Visual Vertical Test (SVVT) for otolith function.MethodsSeventy-five subjects (150 ears) were enrolled in this research. They were categorized into a control group composed of twenty-five adults from 18–40 years and a study group which divided into symptomatic and asymptomatic groups, each group consisted of twenty-five subjects, fifteen subjects aged 55- < 65 years & ten subjects aged 65 to 85 years. All subjects were submitted to combined VEMPs and static SVVT.ResultsDetectability of combined VEMPs decreased with age with significant difference among the older age group (> 65- < 85 years) and the subjects aged (55- < 65 years). Percentage of abnormal cVEMPs & oVEMPs latencies and amplitudes was more detected in the older age group than subjects aged (55- < 65 years). The symptomatic group aged > 65 years showed higher percentage of affection of both cVEMPs & oVEMPs, while the younger group aged 55- < 65 showed higher absence of bilateral oVEMPs. There were no statistically significant differences in the asymmetrical ratio of cVEMPs & oVEMPs between elderly and adults. Static SVV perception does not change with age.ConclusionsThe elderly showed variable degrees of otolith dysfunction with a high percentage of affection in cVEMPs and oVEMPs. Also, they showed symptoms of imbalance and light-headedness. Static SVVT perception doesn’t change with age.

Changes of Otolith and Balance Function Related to Cochlear Implant in Hearing Loss With Inner Ear Malformations Children.

The increase of bilateral cochlear implantation (CI) in recent years has made it essential to comprehend the effects of CI on otolith function. This study aimed to investigate the development of gross motor and otolith function in patients with inner ear malformations (IEMs) using vestibular-evoked myogenic potentials (VEMPs). Overall, 78 patients with sensorineural hearing loss (SNHL) (age 5.7 ± 4.1 years) were divided into two groups based on the presence (IEM group, n = 39) or absence (control group, n = 39) of IEMs. VEMP testing was performed both before and 1-3 months after CI, and the evaluation of gross motor development was carried out. The mean ages for achieving head control and independent walking were delayed in the IEM group compared with the control group (p = 0.02). The preoperative cervical VEMP (cVEMP) and ocular VEMP (oVEMP) response rates were higher in the control group (60% and 86.95%) than in the IEM group (57.69% and 74.35%) (p < 0.05). Additionally, abnormal cVEMP was associated with delayed acquisition of independent walking (p = 0.017). Saccular and utricular functions after CI were lost by 40% and 31.75%, respectively, in patients who elicited preoperative VEMPs waveform (n = 25). Among SNHL patients, balance development is more delayed in patients of IEMs than in patients without IEMs. The cVEMP and oVEMP waveforms differed greatly between the two groups. The otolith-vestibular nerve conduction pathway can be affected by CI, potentially leading to otolith function impairment. Therefore, it is essential to assess otolith and balance functions before CI, and this evaluation should be considered an integral part of clinical practice.

Development of a Subjective Visual Vertical Test System Using a Smartphone With Virtual Reality Goggles for Screening of Otolithic Dysfunction: Observational Study.

The subjective visual vertical (SVV) test can evaluate otolith function and spatial awareness and is performed in dedicated vertigo centers using specialized equipment; however, it is not otherwise widely used because of the specific equipment and space requirements. An SVV test smartphone app was developed to easily perform assessments in outpatient facilities. This study aimed to verify whether the SVV test smartphone app with commercially available virtual reality goggles can be used in a clinical setting. The reference range was calculated for 15 healthy participants. We included 14 adult patients with unilateral vestibular neuritis, sudden sensorineural hearing loss with vertigo, and Meniere disease and investigated the correlation between the SVV test results and vestibular evoked myogenic potential (VEMP) results. The SVV reference range of healthy participants for the sitting front-facing position was small, ranging from -2.6º to 2.3º. Among the 14 patients, 6 (43%) exceeded the reference range for healthy participants. The SVV of patients with vestibular neuritis and sudden sensorineural hearing loss tended to deviate to the affected side. A total of 9 (64%) had abnormal cervical VEMP (cVEMP) values and 6 (43%) had abnormal ocular VEMP (oVEMP) values. No significant difference was found between the presence or absence of abnormal SVV values and the presence or absence of abnormal cVEMP and oVEMP values; however, the odds ratios (ORs) suggested a higher likelihood of abnormal SVV values among those with abnormal cVEMP and oVEMP responses (OR 2.40, 95% CI 0.18-32.88; P>.99; and OR 2, 95% CI 0.90-4.45; P=.46, respectively). The SVV app can be used anywhere and in a short period while reducing directional bias by using virtual reality goggles, thus making it highly versatile and useful as a practical otolith dysfunction screening tool.

Impact of Endolymphatic Hydrops and Semicircular Canal Dysfunction on the Incomplete Recovery of Acute Low-Frequency Sensorineural Hearing Loss.

The reasons for short-term, incomplete recovery of some acute low-frequency sensorineural hearing loss (ALFHL) are unclear. We investigated the impact of endolymphatic hydrops and semicircular canal dysfunction on the incomplete recovery of ALFHL. The impact of electrocochleography (EcochG), caloric test, video head impulse test (vHIT), cervical vestibular-evoked myogenic potential (cVEMP), and ocular vestibular-evoked myogenic potential (oVEMP) results on the incomplete recovery of 86 patients with ALFHL was analyzed. The correlation between a high abnormal rate of vestibular-evoked myogenic potential (VEMP) and aural fullness, dizziness, and level of hearing loss was also examined. Abnormal oVEMP with an odds ratio (OR) of 6.071 (P = .002) and EcochG with an OR of 5.919 (P = .005) were independent risk factors for incomplete recovery in ALFHL, but abnormal cVEMP, caloric test, and vHIT were not independent risk factors for ALFHL. There was no correlation between a high abnormal rate of VEMP and aural fullness, dizziness, or level of hearing loss in ALFHL. Abnormal oVEMP and EcochG values rather than caloric test and vHIT were risk factors for incomplete recovery of ALFHL, which may be related to the difficulty of successfully treating utricular and cochlear hydrops. High abnormal rate of VEMP was not correlated with hearing loss level, aural fullness, or dizziness in ALFHL. Abnormal oVEMP and EcochG values can indicate poor short-term prognosis of ALFHL.

Vestibular Tests Related to Tumor Volume in 137 Patients With Small to Medium-Sized Vestibular Schwannoma.

The video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) are new methods for measuring peripheral vestibular function. The objectives of this study were to compare these tests and the traditionally used caloric test in patients with small and medium-sized untreated vestibular schwannoma (VS) and to measure the correlation between the tests' results and tumor volume. National cross-sectional study. Tertiary university clinic. Prevalence of abnormal cVEMP, oVEMP, caloric test, and 6-canal vHIT results on the tumor side and the nontumor side were compared and related to tumor volume with regression analyses in 137 consecutive VS patients assigned to a wait-and-scan protocol in the period 2017 to 2019. The sensitivity of 6-canal vHIT, caloric test, cVEMP, and oVEMP to detect vestibulopathy in VS patients was 51%, 47%, 39%, and 25%, respectively. Normal tests were found in 21% of the patients. The results of vHIT and caloric test were related to tumor volume, but this was not found for cVEMP and oVEMP. The caloric test and 6-canal vHIT showed the highest sensitivity in detecting vestibulopathy in untreated VS patients. vHIT, and particularly the posterior canal, was limited with a high prevalence of abnormal results on the nontumor side. A combination of cVEMP and caloric test was favorable in terms of a relatively high sensitivity and low prevalence of abnormal results on the nontumor side. Larger tumors had a higher rate of pathology on caloric testing and vHIT.

Clinical features of persistent postural-perceptual dizziness with isolated otolith dysfunction as revealed by VEMP and vHIT findings.

Persistent postural-perceptual dizziness (PPPD) is a relatively new disease entity, with diagnostic criteria published by the Bárány Society. PPPD is often preceded by a peripheral or central vestibular disorder. It is not clear how coexisting deficits due to preceding vestibular disorders affect PPPD symptoms. This study aimed to characterize the clinical features of PPPD with or without isolated otolith dysfunction using vestibular function tests. The study included 43 patients (12 males and 31 females) who were diagnosed with PPPD and completed oculomotor-vestibular function tests. The Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), Niigata PPPD Questionnaire (NPQ), and Romberg test for stabilometry were examined. The 43 patients with PPPD were classified into four categories based on vestibular evoked myogenic potential (VEMP) and video head impulse test (vHIT) results: normal function for both semicircular canals and otoliths (normal), isolated otolith dysfunction (iOtoDys), isolated semicircular canal dysfunction (iCanalDys), and dysfunction of both otoliths and semicircular canals (OtoCanalDys). Among the 43 patients with PPPD, the iOtoDys group was the largest (44.2%), followed by the normal group (37.2%), iCanalDys group (9.3%), and OtoCanalDys group (9.3%). Eight of the 19 iOtoDys patients showed both abnormal cVEMP and oVEMP responses unilaterally or bilaterally (both sacculus and utriculus damage type), whereas 11 showed either an abnormal cVEMP or an abnormal oVEMP response (either sacculus or utriculus damage type). In a three-group comparison of the both sacculus and utriculus damage type, the either sacculus or utriculus damage type, and the normal group, the mean total, functional, and emotional DHI scores were significantly higher for the both sacculus and utriculus damage type than for the either sacculus or utriculus damage type. The Romberg ratio, a measure of stabilometry, was significantly higher for the normal group than for the both sacculus and utriculus damage type and the sacculus or utriculus damage type in the iOtoDys group. The coexistence of sacculus and utriculus damage may exacerbate dizziness symptoms in patients with PPPD. Determining the presence and extent of otolith damage in PPPD may provide useful information on the pathophysiology and treatment strategies of PPPD.

The characteristics of vestibular-evoked myogenic potentials in unilateral Meniere's disease patients at different clinical stages

Objective:This study was to retrospectively analyze the results of vestibular-evoked myogenic potentials（VEMP） in unilateral Meniere's disease（MD） patients. Methods:The clinical assessment results of MD patients who visited the department between January 2016 to February 2022 were reviewed. Unilateral MD patients who met the inclusion and exclusion criteria were divided into three groups according to clinical stages, namely, group 1（stage Ⅰ+ stage Ⅱ）, group 2（stage Ⅲ） and group 3（stage Ⅳ）. The normal value data were used to investigate the incidence of abnormal P1 and N1 latencies, abnormal P1-N1 interwave latency, and abnormal interaural amplitude asymmetry ratio（IAR）. Afterwards, considering all the above mentioned parameters, the VEMP result of each patient was graded into four levels（grade 1 means VEMP result is normal, grade 2, 3 and 4 means the VEMP result is abnormal in different degrees）. The correlation between VEMP result level and pure tone average（PTA） of MD patients in different clinical stages was examined. Results:The prevalence of cVEMP in three groups was 84.2%, 70.0% and 33.3%, respectively（P<0.05）. The prevalence of oVEMP in three groups was 63.2%, 34.0% and 16.7%, respectively（P<0.05）. The incidence of abnormal P1 latency, N1 letancy and P1-N1 interwave latency of cVEMP was 21.1%, 26.3% and 24.6%, respectively. The incidence of abnormal P1 latency, N1 latency and interwave latency of oVEMP was 15.6%, 43.8% and 3.1%, respectively. The incidence of abnormal cVEMP IAR in group 1, group 2 and group 3 was 6.7%, 21.2% and 33.3%, respectively（P>0.05）. The incidence of abnormal IAR of oVEMP in group 1, group 2 and group 3 was 16.7%, 23.1% and 0, respectively（P>0.05）. cVEMP and oVEMP result levels were significantly correlated with PTA（r=0.339, P<0.01; r=0.362, P<0.01 ）, respectively. Conclusion:With the progression of MD, the function of saccule-vestibular inferior nerve pathway and utricle-vestibular superior nerve pathway would deteriorate in the same way as hearing.

Minimally invasive surgical techniques in vestibular function preservation in patients with cochlear implants.

BackgroundCochlear implantation (CI) is an effective and successful method of treating individuals with severe-to-profound sensorineural hearing loss (SNHL). Coupled with it’s great clinical effectiveness, there is a risk of vestibular damage. With recent advances in surgical approach, modified electrode arrays and other surgical techniques, the potential of hearing preservation (HP) has emerged, in order to preserve the inner ear function. These techniques may also lead to less vestibular damage. However, a systematic study on this at different follow-ups after CI surgery has not been documented before.AimsTo investigate changes of vestibular function systematically in recipients at short and long follow-ups after a minimally invasive CI surgery.MethodsIn this retrospective study, 72 patients (72 ears) with minimally invasive CI were recruited. All participants selected had bilateral SNHL and pre-operative residual hearing (RH) and underwent unilateral CI. They were treated to comprehensive care. All patients underwent vestibular function tests 5 days prior to CI. During the post-operative period, follow-up tests were performed at 1, 3, 6, 9, and 12 months. The contemporaneous results of caloric, cervical vestibular-evoked myogenic potential (cVEMP), ocular vestibular-evoked myogenic potential (oVEMP), and video head impulse (vHIT) tests were followed together longitudinally.ResultsOn the implanted side, the percent fail rate of caloric test was significantly higher than that of vHIT at 1, 3, and 9 months post-operatively (p < 0.05); the percent fail rate of oVEMP was higher than vHIT of superior semicircular canal (SSC), posterior semicircular canal (PSC), or horizontal semicircular canal (HSC) at 1, 3, and 9 months (p < 0.05); at 3 and 9 months, the percent fail rate of cVEMP was higher than that of SSC and PSC (p < 0.05). There were no significant differences in the percent fail rates among all tests at 6 and 12 months post-CI (p > 0.05). The percent fail rates showed decreased trends in caloric (p = 0.319) and HSC tested by vHIT (p = 0.328) from 1–3 to 6–12 months post-operatively. There was no significant difference in cVEMP between 1–3 and 6–12 months (p = 0.597). No significant differences on percent fail rates of cVEMP and oVEMP between short- and long-terms post-CI were found in the same subjects (p > 0.05). Before surgery, the abnormal cVEMP and oVEMP response rates were both lower in patients with enlarged vestibular aqueduct (EVA) than patients with a normal cochlea (p = 0.001, 0.018, respectively).ConclusionThe short- and long-term impacts on the vestibular function from minimally invasive CI surgery was explored. Most of the vestibular functions can be preserved with no damage discrepancy among the otolith and three semicircular canal functions at 12 months post-CI. Interestingly, a similar pattern of changes in vestibular function was found during the early and the later stages of recovery after surgery.

Bilateral Dysfunction of Otolith Pathway in Patients With Unilateral Idiopathic BPPV Detected by ACS-VEMPs.

ObjectiveTo observe the functional status of the otolith pathway in patients with unilateral idiopathic benign paroxysmal positional vertigo (BPPV) by combining air-conducted sound elicited cervical vestibular-evoked myogenic potential (ACS-cVEMP) and ocular vestibular-evoked myogenic potential (ACS-oVEMP).MethodsOne hundred and eighty patients with BPPV were recruited for conventional cVEMP and oVEMP tests. The abnormal rates of VEMPs were compared between BPPV patients and control participants.ResultsThe abnormal rates of cVEMP and oVEMP in BPPV patients were 46.7% (84/180) and 57.2% (103/180) in affected ears, respectively, and 45.0% (81/180) and 56.7% (102/180) in unaffected ears, respectively; both were significantly higher than the abnormal rates of cVEMP and oVEMP in normal control ears. Compared with normal subjects, the cVEMP response rate was lower in affected and unaffected ears in BPPV patients. The abnormal rates of cVEMP and oVEMP were 48.1% (76/158) and 57.6% (91/158) in patients with posterior semicircular canal BPPV, and 36.4% (8/22) and 54.5% (12/22) in lateral semicircular canal BPPV. There was no significant difference in VEMP abnormalities between posterior semicircular canal BPPV and lateral semicircular canal BPPV.ConclusionThe prevalence of abnormal cVEMPs and oVEMPs in both affected and unaffected ears of patients with BPPV was significantly higher than that observed in the control group. The pathological mechanism of unilateral idiopathic BPPV may be associated with bilateral degeneration of otolith pathways.

Changes in Measures of Vestibular and Balance Function and Hippocampus Volume in Alzheimer's Disease and Mild Cognitive Impairment.

To test the hypotheses that people with Alzheimer's disease and mild cognitive impairment have increased frequency of vestibular impairments and decreased hippocampal volume compared with healthy age-matched controls. Retrospective, with some historical controls. Out-patient, tertiary care center. People with mild to moderate dementia diagnosed with Alzheimer's disease and with mild cognitive impairment. Main Outcome Measures: A standard clinical battery of objective tests of the vestibular system, and screening for balance; available clinical diagnostic magnetic resonance imaging (MRIs) were reviewed and postprocessed to quantify the left and right hippocampal volumes utilizing both manual segmentation and computer automated segmentation. Study subjects (N = 26) had significantly more vestibular impairments, especially on Dix-Hallpike maneuvers and cervical vestibular evoked myogenic potentials (cVEMP), than historical controls. No differences were found between mild and moderate dementia subjects. Independence on instrumental activities of daily living in subjects with age-normal balance approached statistical differences from subjects with age-abnormal balance. MRI data were available for 11 subjects. Subjects with abnormal cVEMP had significantly reduced left hippocampal MRIs using manual segmentation compared with subjects with normal cVEMP. The data from this small sample support and extend previous evidence for vestibular impairments in this population. The small MRI sample set should be considered preliminary evidence, and suggests the need for further research, with a more robust sample and high-resolution MRIs performed for the purpose of hippocampal analysis.

Description of a New Labyrinthine Dehiscence: Horizontal Semicircular Canal Dehiscence at the Tympanic Segment of the Facial Nerve.

ObjectiveThis report is a case series of patients with findings suspicious for a labyrinthine dehiscence syndrome not previously described in the medical literature. We describe the clinical and test findings in 16 patients with CT findings suspicious for dehiscence of the ampullated end of the horizontal semicircular canal at the tympanic segment of the facial nerve.Study DesignObservational case series.SettingNeurotology vestibular referral center.PatientsTo be included in this study the patients were seen at our center in 2019 and had a high-resolution CT scan with a collimation of 0.6 mm. Patients who were identified as having findings suspicious for dehiscence of bone where the facial nerve crosses the ampullated end of the horizontal semicircular canal (HSC-FND) were identified and further analyzed.InterventionsCase series retrospective record review of patient symptoms, physical findings, audiometry, vestibular testing, and CT scans was performed. CT findings of other dehiscent sites were noted. A comparison to surgically treated perilymph fistula (PLF) patients of the same period was performed.Main Outcome MeasuresHistory and physical exam were reviewed for auditory symptoms, vestibular symptoms, and exacerbating factors. and. Audiometry and vestibular testing were reviewed to determine which tests were most likely to be abnormal. CT scans were independently graded according to degree of suspicion for HSC-FND. Finally, patients with HSC-FND as the sole dehiscence identified were compared to those who had HSC-FND plus other dehiscent sites (HSC-FND+O) and to the group of surgically treated PLF patients.ResultsOf 18 patients, 16 met inclusion criteria. Nine (56%) of those suspicious for HSC-FND had dehiscences in other parts of the labyrinth. Additional dehiscent sites included: six superior semicircular canal dehiscences (SSCD), two cochlear facial dehiscences and one cochlear carotid dehiscence. The most common auditory symptoms were autophony followed by tinnitus and aural fullness. The most common vestibular symptoms were pulsion sensation (feeling of being pushed to one side) followed by vertigo spells. The most common exacerbating factors for vertigo were straining, and sound. The most commonly abnormal vestibular test was nasal Valsalva testing, which was positive in all but one patient. Anamnesis and examination observations were similar in both groups, but the HSC-FND group were less likely to demonstrate a caloric weakness or an abnormal ECOG compared to the HSC-FND+O group. Of note, cVEMP was more often found to have lower thresholds in the HSC-FND group compared to the HSC-FND+O group. An example case is highlighted. Comparison to the PLF patients revealed statistically significant difference in the presenting symptoms of autophony, fullness and pulsion sensation. When comparing testing, HSC-FND patients were more likely to have an abnormal cVEMP and PLF patients were more likely to have asymmetric hearing. The incidence of bilateral disease was also more common among the HSC-FND patients than the PLF patients.ConclusionsA new labyrinthine dehiscence has been described to occur where the tympanic segment of the facial nerve crosses over the ampullated end of the horizontal semicircular canal. HSC-FND patients can present in a similar manner as HSC-FND+O patients with similar test findings except as mentioned above. The identification of one dehiscence such as SSCD does not preclude the presence of another dehiscence such as HSC-FND. HSC-FND could be the source of persistent symptoms post SSCD surgery as illustrated in the case presented. HSC-FND patients seem to identify themselves compared to PLF patients by a much more likely presenting symptoms of autophony, fullness, pulsion, abnormal cVEMP, bilaterality of disease, and symmetric hearing.

Differential Involvement of Lateral Semicircular Canal and Otolith Organs in Common Vestibular Disorders.

Semicircular canal and otolith functions came to be evaluated recently, but comprehensive and comparative analysis of canal and otolith dysfunction in common vestibular disorders is lacking. We aimed to analyze the abnormal rates of canal and otolith function in common vestibular disorders. We enrolled 302 patients who were managed for 2 months in a dizziness clinic. Results of caloric, video head impulse test (vHIT), and cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP) tests were analyzed and compared among various diagnoses. Vestibular disorders diagnosed included recurrent vestibulopathy (RV, 27%), vestibular migraine (VM, 21%), benign paroxysmal positional vertigo (BPPV, 17%), Meniere's disease (MD, 11%), vestibular neuritis (VN, 10%), orthostatic dizziness (7%), and central lesions (3%). Lateral canal dysfunction was found most in VN (100%) and less commonly in definite MD (75%), RV (46%) and definite VM (29%). Abnormal caloric results were more common than abnormal vHIT in all disorders. Otolith dysfunction was found more frequently than lateral canal dysfunction in most vestibular disorders except VN. An abnormal cVEMP was more frequent in definite MD than the other disorders. Isolated otolith dysfunction without lateral canal dysfunction was the most found in BPPV, followed by definite VM, RV, and definite MD in decreasing order. Various patterns of involvement in canal and otoliths were revealed in vestibular disorders, suggesting different pathogenesis.

Vestibular Rehabilitation in Isolated Otolith Dysfunction After Covid-19: A Case Report

A 56-year-old female with dizziness, imbalance, and a slight floating sensation was evaluated. Her symptoms started after infection with the novel coronavirus (SARS-CoV-2). Routine auditory test (pure tone audiometry), vestibular assessment (videonystagmography), and neurologic test results were in the normal range, but the otolith evaluations, such as cervical vestibular evoked myogenic potentials (cVEMP) and subjective visual vertical tests, showed abnormal findings. The patient underwent a ten-session individualized vestibular rehabilitation program (one session per week). After completing rehabilitation sessions, her chief complaints were alleviated, the performance on computerized posturography was improved, and the abnormal cVEMP amplitude asymmetry between ears disappeared. In conclusion, vestibular disorders can happen after COVID-19 infection, presenting exclusively with isolated otolith dysfunction. In these patients, functional integrity assessment of the whole vestibular system is crucial, and vestibular rehabilitation may be beneficial.

ZWIĄZEK MIĘDZY SZYJNYMI I OCZNYMI MIOGENNYMI PRZEDSIONKOWYMI POTENCJAŁAMI WYWOŁANYMI A OBJAWAMI Z PNIA MÓZGU I ZMIANAMI WIDOCZNYMI W MRI U PACJENTÓW ZE STWARDNIENIEM ROZSIANYM

BackgroundIn multiple sclerosis (MS), even in the presence of clinical brainstem symptoms, the brainstem does not always show gross lesions on magnetic resonance imaging (MRI). However, MS may impair vestibular-evoked myogenic potential (VEMP) responses.Material and methodsThis study included 70 participants, 40 who were MS patients and 30 healthy adult volunteers as controls. All participants were subjected to history taking, otological examination, basic audiological evaluation, bedside examination of the dizzy patient, cervical VEMP (cVEMP), and ocular VEMP (oVEMP).ResultsOf the 40 MS patients, 37.5% had abnormal cVEMP and 67.5% had abnormal oVEMP. Some 23% of the 21 MS patients without brainstemlesions on MRI had abnormal cVEMP and oVEMP, including 69% of those who had vertigo. MS patients with brainstem lesions on MRI had significantly greater oVEMP latency than patients without similar MRI findings.ConclusionsMS patients showed dysfunction in the vestibulo-ocular and vestibulo-spinal reflexes. This dysfunction is reflected in impaired oVEMP and cVEMP respectively despite the absence of structural brainstem abnormalities. Thus, VEMP, especially oVEMP, can be used as an early indicator of brainstem involvement in MS before radiological signs appear on MRI.

Vestibular and oculomotor function in patients with vestibular migraine

AimThe purpose of this study was to assess the vestibular and oculomotor function in patients with vestibular migraine (VM). And we also investigate the relationship between testing results and effectiveness of preventive medications in VM. Material and method41 patients with VM were recruited in this study and examined with cervical and ocular vestibular evoked myogenic potential(cVEMP, oVEMP), video head impulse test(vHIT), caloric test and videonystagmography. All patients were treated with preventive medications. We calculated symptomatic improvement and record episodes frequency in patients with VM. Six months later, the effectiveness of preventive medications were evaluated and the relationship between vestibular testing and effectiveness of preventive medications were analyzed further. ResultsIn vestibular function testing, 73% of patients with VM showed abnormal results. Abnormal cVEMP, oVEMP, vHIT, and caloric test were found in 20%, 44%, 32% and 56% respectively. The abnormal rate of oVEMP was significantly higher than that of cVEMP(p < 0.05). And the proportion of abnormal caloric test was obviously higher than that of vHIT (p < 0.05). In oculomotor function testing, 42% of the patients with VM showed pathological results which was significantly lower than that of vestibular function testing(p < 0.05). After 6 months follow-up, the proportion of prophylactic medication effectiveness was significantly higher in normal vestibular function testing group compared with the abnormal group (p < 0.05). ConclusionAbnormal vestibular and oculomotor functions are commonly observed in patients with VM. And these patients with abnormal vestibular function possess a weak effectiveness of preventive medications.

Vestibular Preservation After Cochlear Implantation Using the Round Window Approach.

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique.Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria).Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA.Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.

Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials.

Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients' vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

The clinical utility of the cervical vestibular-evoked myogenic potential (cVEMP) in university-level athletes with concussion

Concussion is defined as a mild traumatic brain injury that can occur in all sport activities. Cervical vestibular-evoked myogenic potentials (cVEMPs) are accepted to demonstrate the vestibulocollic reflex. MAIN: To evaluate subclinical cervical abnormalities in the vestibulospinal pathway in subjects with concussion history with and without related symptoms via evoked vestibular potential. Monaurally air conduction cVEMP (500 Hz tone bursts) at intensity of 100 dBnHL and 200 sweeps. All responses were replicated. One hundred fifty-four participants were initially tested; however, three (03) participants did not produce usable data (no response) and were eliminated for the dataset cutoff values analysis, being considered just as abnormal response. One hundred fifty-one responses consisted of 45 non-athlete individuals without any history of a concussion or concussion symptoms (normative group), 45 athletes without any history of a concussion or concussion symptoms (control group), 33 athletes with a history of at least one concussion but no concussion symptoms related (history group), and 28 athletes with a history of at least one concussion and concussion symptoms (symptoms group). The history and symptoms groups had statistically higher latency scores than the control and the normative groups. The Index Ratio data and Threshold data did not produce a significant effect for four groups. But, a pattern of abnormal cVEMP was found when comparing those without a history of concussion (0% abnormal response) versus the history group (24%) and symptoms group (32.3%). The study provides data which supports the positive impact of cVEMP when evaluating athletes and identifying concussion processes.

Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials.

Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse. To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cervical vestibular-evoked myogenic potentials (cVEMPs), and the v-HIT. Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients' vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

Vestibular function in adults with intellectual disabilities: feasibility and outcome of a vestibular screening protocol in Special Olympics athletes

Objective This study aimed to evaluate the feasibility of a well-adapted vestibular screening battery to objectively examine the (peripheral) vestibular function, and to explore the characteristics of potential vestibular deficits in the adult ID population. Design Cross-sectional study design. Study sample Compared to an age- and gender-weighted control group, a heterogeneous group of forty-five adults with ID participated in the vestibular screening at the National Games of Special Olympics Belgium (2019), which consisted of a bone conduction cervical Vestibular Evoked Myogenic Potential (cVEMP) measurement and video Head Impulse Test (vHIT). Results The screening battery appeared to be feasible in the majority of the participants (cVEMP: 92%; vHIT: 72%). Overall, the occurrence of abnormal cVEMP and vHIT responses was significantly higher in the ID group, with significantly lower corrected peak-to-peak cVEMP amplitudes (p < 0.001), lower vHIT gains (p < 0.001), and higher cVEMP and vHIT asymmetry ratios in the ID group (p = 0.008 and p < 0.001 resp.). Conclusions Vestibular assessment using the cVEMP and vHIT technique shows a promising feasibility in adults with ID. In addition, this study suggests that people with ID exhibit an increased prevalence of (peripheral) vestibular deficits relative to the general population.