Abnormal Vestibular Evoked Myogenic Potentials Research Articles

Otolithic Damage Study in Patients With Benign Paroxysmal Positional Vertigo With Vestibular Evoked Myogenic Potentials

IntroductionBenign paroxysmal positional vertigo (BPPV) pathophysiology is based on otoconia migration from the utricle and saccule to the semicircular canals, however, the role of the saccule is still under study. Our aim is to study the otolith damage in these patients with vestibular evoked myogenic potentials (VEMPS) and correlate the results with those of computerised dynamic posturography (CDP). Material and MethodsWe present 79 patients diagnosed with BPPV between March and June 2017. VEMPS and CDP studies were performed. We selected 67 patients with posterior semi-circular canal BPPV and we compared them with 60 healthy subjects. ResultsBPPV group had abnormal cervical VEMPS in 49.25% of patients compared to 16.67% in the control group. Ocular VEMPS were altered in 61.19% of the patients and 6.67% of the healthy subjects. Abnormal ocular VEMPS in patients with recurrent BPPV was statistically significant. There was no significant correlation with CDP results. ConclusionsUtricular and saccular dysfunction in BPPV patients proved by VEMPS is higher than in healthy individuals. This result may be related to symptoms of instability experienced by these patients occasionally.

Vestibular evoked myogenic potentials and their clinical utility in patients with amyotrophic lateral sclerosis

ObjectiveTo evaluate the diagnostic value of vestibular evoked myogenic potentials (VEMPs) in the assessment of brainstem function integrity in patients with amyotrophic lateral sclerosis (ALS). MethodsThis was a prospective case-control study including 30 definite or probable ALS patients divided into two groups (with or without brainstem involvement) and 30 healthy controls. Cervical (c-), masseter (m-) and ocular VEMP (o-VEMP) measurements were obtained for all the participants. ResultsThe c-VEMP mean p13 and n23 were significantly prolonged in the ALS patients. The interside peak differences in p13 and n23 of c-VEMP and in n10 and p15 of o-VEMP were significantly prolonged. The rates of alteration in c-VEMP, m-VEMP and o-VEMP in the ALS patients were 67%, 40%, and 45%, respectively. The ALS patients with brainstem involvement had a significantly higher percentage of VEMP abnormalities than did those without brainstem involvement (p = 0.027). Conclusionsc-VEMP is a sensitive tool to detect lower levels of brainstem involvement. Impairments in o-VEMP and m-VEMP indicate involvement of the upper brainstem. The use of combined VEMPs may provide useful insights into the pathophysiological mechanism of ALS. SignificanceVEMPs may be useful in the evaluation of brainstem dysfunction in ALS patients.

Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo.

VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix-Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.

Vestibular Evoked Myogenic Potentials (VEMP) in patients with Multiple Sclerosis

Background: multiple sclerosis (MS) is a chronic demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged and this damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms. Objective: this study aimed to assess cervical vestibular evoked myogenic potentials (cVEMP) in patient with multiple sclerosis and to demonstrate the value of cVEMP as a good method for the assessment of vestibulospinal tract in patients with MS. Patients and Methods: to achieve this target, we enrolled 50 subject: 30 patients diagnosed as MS in addition to 20 healthy control. The cVEMP response was evaluated for the presence of positive (p1) and negative (n1) peaks of the first biphasic wave complex; latency (p1 and n1 latency) and peak to peak amplitude. The bilateral otoscopy was normal in cases and controls, with no middle or outer ear disease that could bias the study results being found. The pure tone audiometry showed levels of hearing compatible with normal hearing in the 20 healthy subjects, with hearing thresholds that did not exceed 25 dB for any individual. Results: the present results showed that 60 % of MS patients had VEMP abnormalities (absent responses and/or prolonged latencies). In the present study, patients with absent VEMP wave were found to have significantly higher disease duration. In the present study, the absence of P13–N23 waves were more frequent in patients with greater EDSS score, and also absence of P13–N23 waves were more frequent in patients with MS with vestibular symptoms and greater disability. Conclusion: we can say that in patients with MS in which demyelination has extended to the vestibulospinal tract, there is going to be a prolongation of the p13 and n23 wave. In fact, this increase in the p13 and n23 latencies is clear in the patients with MS in comparison to the control group.

Vestibular Evoked Myogenic Potentials (VEMP) in patients with Multiple Sclerosis

Background: multiple sclerosis (MS) is a chronic demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged and this damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms. Objective: this study aimed to assess cervical vestibular evoked myogenic potentials (cVEMP) in patient with multiple sclerosis and to demonstrate the value of cVEMP as a good method for the assessment of vestibulospinal tract in patients with MS. Patients and Methods: to achieve this target, we enrolled 50 subject: 30 patients diagnosed as MS in addition to 20 healthy control. The cVEMP response was evaluated for the presence of positive (p1) and negative (n1) peaks of the first biphasic wave complex; latency (p1 and n1 latency) and peak to peak amplitude. The bilateral otoscopy was normal in cases and controls, with no middle or outer ear disease that could bias the study results being found. The pure tone audiometry showed levels of hearing compatible with normal hearing in the 20 healthy subjects, with hearing thresholds that did not exceed 25 dB for any individual. Results: the present results showed that 60 % of MS patients had VEMP abnormalities (absent responses and/or prolonged latencies). In the present study, patients with absent VEMP wave were found to have significantly higher disease duration. In the present study, the absence of P13–N23 waves were more frequent in patients with greater EDSS score, and also absence of P13–N23 waves were more frequent in patients with MS with vestibular symptoms and greater disability. Conclusion: we can say that in patients with MS in which demyelination has extended to the vestibulospinal tract, there is going to be a prolongation of the p13 and n23 wave. In fact, this increase in the p13 and n23 latencies is clear in the patients with MS in comparison to the control group.

Estudio del daño otolítico en pacientes con vértigo posicional paroxístico benigno mediante potenciales vestibulares miogénicos evocados

IntroductionBenign paroxysmal positional vertigo (BPPV) pathophysiology is based on otoconia migration from the utricle and saccule to the semicircular canals, however, the role of the saccule is still under study. Our aim is to study the otolith damage in these patients with vestibular evoked myogenic potentials (VEMPS) and correlate the results with those of computerised dynamic posturography (CDP). Material and methodsWe present 79 patients diagnosed with BPPV between March and June 2017. VEMPS and CDP studies were performed. We selected 67 patients with posterior semi-circular canal BPPV and we compared them with 60 healthy subjects. ResultsBPPV group had abnormal cervical VEMPS in 49.25% of patients compared to 16.67% in the control group. Ocular VEMPS were altered in 61.19% of the patients and 6.67% of the healthy subjects. Abnormal ocular VEMPS in patients with recurrent BPPV was statistically significant. There was no significant correlation with CDP results. ConclusionsUtricular and saccular dysfunction in BPPV patients proved by VEMPS is higher than in healthy individuals. This result may be related to symptoms of instability experienced by these patients occasionally.

91. Asymmetry of vestibular myogenic evoked potentials in Parkinson disease

Degeneration of several brainstem nuclei occurs in Parkinson disease (PD). Vestibular-evoked-myogenic-potentials (VEMPs) represent a valuable tool to assess the function of these structures. VEMPs abnormalities have been reported in PD. We used this tool to assess the asymmetry between the two sides and the difference between anterior and posterior muscles in patients with PD. VEMPs were recorded simultaneously and bilaterally from sternocleidomastoideus (SCM), splenius (SPL), trapezius (TRP) and orbicularis oculi (OO) muscles in 20 idiopathic PD patients (mean age 63.1 ± 9.4 years) with normal BAEPs. Stimulation was binaural and recordings were performed with flexed neck in clinostatic position. SCM VEMPs asymmetry (amplitude difference > 30%) was found in 11/20 patients (55%) and was concordant with the most clinically affected side in 9/11. All muscles showed a concordant side asymmetry. Potential amplitudes from posterior muscles were lower (SPL: 6.8 ± 12.7, TRP: 6.0 ± 11.6) than anterior ones (SCM: 26.9 ± 39.5). VEMPs were absent more frequently in posterior muscles (17/40 traces in both SPL and TRP; 3/40 in SCM). VEMPs alterations confirmed the involvement of vestibule-spinal system in PD. Side to side and anterior-posterior asymmetry of vestibulo-spinal reflex impairment could contribute to camptocormia, postural instability and gait imbalance in PD.

Evaluation of Vestibular Functions in Patients with Vogt-Koyanagi-Harada Disease

Vogt-Koyanagi-Harada (VKH) disease is an idiopathic, multisystem autoimmune disorder characterized by bilateral, diffuse granulomatous uveitis associated with neurological, audiovestibular, and dermatological manifestations. The purpose of this study is to investigate vestibular functions in patients with VKH disease. A total of 43 patients with VKH disease in Hokkaido University Hospital were enrolled in this study. Subjective symptoms such as dizziness or vertigo and the results of various vestibular examinations including nystagmus testing, caloric testing, and vestibular-evoked myogenic potential (VEMP) testing were investigated. Eight of 42 patients (19.0%) complained of subjective vestibular symptoms. On the other hand, 12 of 28 patients (42.9%) showed nystagmus, and 7 of 15 patients (46.7%) showed unilateral or bilateral weakness in the caloric test. VEMP testing was performed for 16 patients. Seven (43.8%) and 8 (50.0%) patients were evaluated as abnormal in cervical VEMP and ocular VEMP testing, respectively. The rate of detection of nystagmus was significantly higher than that of subjective symptoms. As vestibular dysfunction in patients with VKH disease cannot be detected through history taking alone, nystagmus testing, caloric testing, and VEMP testing should be performed to evaluate vestibular functions associated with VKH disease. It is considered that abnormal VEMP findings are associated with otolith organ dysfunction.

Visual vestibular mismatch: is it a vestibular disorder?

BackgroundVisual vestibular mismatch (VVM) is a group of symptoms rather than a disease. All are exaggerated by introducing any visual conflict. For such reason, there is no adequate tools to investigate or to diagnose and limited research studies were done to explore such group of people.AimTo identify VVM disorder among dizzy patients and to study the vestibular function in them.Patients and methodsThis study was conducted on 30 patients suffering from VVM (out of 153 patients) who were selected by a questionnaire modified by the authors based on the original questionnaire. All patients were subjected to objective testing including: full neuro-otological history, office vestibular tests including dynamic visual test (DVA), modified clinical test of sensory integration of balance (MCTSIB), Fukuda stepping test, functional reach test, videonystagmography and vestibular evoked myogenic potentials (VEMPs).ResultsVVM symptomatology was found in 19 patients (subjectively by Mallison questionnaire) and reached 30 patients using a modified questionnaire. 23.33% patients had abnormal Fukuda test, 26.6% had abnormal functional reach test, while 97.6% of patients had abnormal MCTSIB test scores and 50% had abnormal DVA test scores. Abnormal cervical VEMP test results were present in 50% of cases, while only 10% suffered from videonystagmography abnormalities reflecting minor affection of semicircular canals as compared with the saccule.ConclusionThis study showed that VVM is a fairly common complain among the dizzy population and it can be easily picked up using a simple questionnaire. Office tests as DVA and MCTSIB were highly sensitive tests for VVM patients but more research is needed to find the correlations between these tests and VVM. The study pointed out to the importance of cervical VEMP test to be routinely enrolled in testing of patients with suggestive symptoms of VVM. Further researches should be conducted for knowing the underlying cause and the exact role of saccule in VVM.

Auditory- and Vestibular-Evoked Potentials Correlate with Motor and Non-Motor Features of Parkinson's Disease.

Degeneration of several brainstem nuclei has been long related to motor and non-motor symptoms (NMSs) of Parkinson’s disease (PD). Nevertheless, due to technical issues, there are only a few studies that correlate that association. Brainstem auditory-evoked potential (BAEP) and vestibular-evoked myogenic potential (VEMP) responses represent a valuable tool for brainstem assessment. Here, we investigated the abnormalities of BAEPs, ocular VEMPs (oVEMPs), and cervical VEMPs (cVEMPs) in patients with PD and its correlation to the motor and NMSs. Fifteen patients diagnosed as idiopathic PD were evaluated by Unified Parkinson’s Disease Rating Scale and its subscores, Hoehn and Yahr scale, Schwab and England scale, and Non-Motor Symptoms Scale. PD patients underwent pure-tone, speech audiometry, tympanometry, BAEP, oVEMPs, and cVEMPs, and compared to 15 age-matched control subjects. PD subjects showed abnormal BAEP wave morphology, prolonged absolute latencies of wave V and I–V interpeak latencies. Absent responses were the marked abnormality seen in oVEMP. Prolonged latencies with reduced amplitudes were seen in cVEMP responses. Rigidity and bradykinesia were correlated to the BAEP and cVEMP responses contralateral to the clinically more affected side. Contralateral and ipsilateral cVEMPs were significantly correlated to sleep (p = 0.03 and 0.001), perception (p = 0.03), memory/cognition (p = 0.025), and urinary scores (p = 0.03). The oVEMP responses showed significant correlations to cardiovascular (p = 0.01) and sexual dysfunctions (p = 0.013). PD is associated with BAEP and VEMP abnormalities that are correlated to the motor and some non-motor clinical characteristics. These abnormalities could be considered as potential electrophysiological biomarkers for brainstem dysfunction and its associated motor and non-motor features.

Do Vestibular-Evoked Myogenic Potential Abnormalities in Patients with Cochlear Implant Only Reflect Saccular Dysfunction?

The objective of this study was to explore the usefulness of 1000-Hz tone burst (TB) stimuli for detecting cervical vestibular-evoked myogenic potential (cVEMP) abnormalities in patients with a cochlear implant (CI). Thirty asymptomatic patients who received unilateral CI because of severe bilateral sensorineural hearing loss were assessed for cVEMP produced by TB stimuli at two frequencies (500 and 1000 Hz) in the airway. VEMPs were recorded when the devices were switched to the on (CI-on) and off (CI-off) positions. At the CI-on position, the surgical side (SS) 500-Hz response rates (15/30) were significantly higher than the SS 1000-Hz response rates (9/30) (p=0.031), while the non-operated control side (CS) 500-Hz response rates (20/30) were higher than the CS 1000-Hz response rates (18/30), but the difference was not significant (p=0.50). At the CI-on position, the SS 500-Hz response rates (15/30) were lower than the CS 500-Hz response rates (20/30), but the difference was not significant (p=0.063). However, the SS 1000-Hz response rates (9/30) were significantly lower than the CS 1000-Hz response rates (18/30) (p=0.004). When there was no significant difference between the 500-Hz amplitudes on either side, the SS 1000-Hz amplitudes were found to be significantly lower (p=0.04). CIs have the potential to cause mechanical damage and electrical stimulation to the vestibular system. Possible implant-mediated mechanical damage and electrical stimulation in the high-frequency region affecting the cVEMP response could be found by a 1000-Hz stimulus.

Vestibular Function Tests for Vestibular Migraine: Clinical Implication of Video Head Impulse and Caloric Tests.

Vestibular migraine (VM) is one of the most common causes of episodic vertigo. We reviewed the results of multiple vestibular function tests in a cohort of VM patients who were diagnosed with VM according to the diagnostic criteria of the Barany Society and the International Headache Society and assessed the efficacy of each for predicting the prognosis in VM patients. A retrospective chart analysis was performed on 81 VM patients at a tertiary care center from June 2014 to July 2015. Patients were assessed by the video head impulse test (vHIT), caloric test, vestibular-evoked myogenic potentials (VEMPs), and sensory organization test (SOT) at the initial visit and then evaluated for symptomatic improvement after 6 months. Complete response (CR) was defined as no need for continued medication, partial response (PR) as improved symptoms but need for continued medication, and no response (NR) as no symptomatic improvement and requiring increased dosage or change in medications. At the initial evaluation, 9 of 81 patients (11%) exhibited abnormal vHIT results, 14 of 73 (19%) exhibited abnormal caloric test results, 25 of 65 (38%) exhibited abnormal SOT results, 8 of 75 (11%) exhibited abnormal cervical VEMP results, and 20 of 75 (27%) exhibited abnormal ocular VEMP results. Six months later, 63 of 81 patients (78%) no longer required medication (CR), while 18 (22%) still required medication, including 7 PR and 11 NR patients. Abnormal vHIT gain and abnormal caloric results were significantly related to the necessity for continued medication at 6-month follow-up (OR = 5.67 and 4.36, respectively). Abnormal vHIT and caloric test results revealed semicircular canal dysfunction in VM patients and predicted prolonged preventive medication requirement. These results suggest that peripheral vestibular abnormalities are closely related to the development of vertigo in VM patients.

Vestibular function disorders and potential mechanisms in irradiation nasopharyngeal carcinoma patients

Conclusions: Vestibular function disorders were widespread among nasopharyngeal carcinoma (NPC) patients. The radiation doses to the inner ears were associated with the incidence of vestibular function disorders, but the correlations were mild. The inflammatory responses and possible resolution obstacles of inflammation participated in persistent vestibular function disorders after irradiation. Objectives: To investigate the incidence of vestibular function disorders in NPC patients after irradiation and potential mechanisms. Methods: Patients who received radical intensity-modulated radiotherapy for their NPC were recruited. The serum levels of IL-6 and IL-17 were detected by ELISA method. Vestibular evoked myogenic potential (VEMP) tests were used to evaluate vestibular function and correlation analyses were used to analyze the potential mechanisms of vestibular function disorders. Results: Thirty-eight patients were included. The incidences of abnormal ocular VEMP (oVEMP) and cervical VEMP (cVEMP) were 65.79% and 80.26% at the time of completion of radiotherapy, and 61.84% and 71.05% at 3 months after radiotherapy. The mean and maximum radiation doses to the inner ears were both significantly associated with abnormal oVEMP and cVEMP (p < 0.05, all), but the correlations were all mild. The serum levels of IL-6 and IL-17 were both significantly associated with abnormal oVEMP and cVEMP after irradiation (p < 0.05, all).

Vestibular migraine: A correlation study between clinical findings and vestibular evoked myogenic potentials (VEMPs)

ObjectivesVestibular migraine (VM) is one of the most common causes of episodic vertigo. Several studies have reported abnormal cervical vestibular evoked myogenic potentials (cVEMPs) in VM patients. Recent studies have investigated the diagnostic values of ocular vestibular myogenic evoked potentials (oVEMPs) in VM patients. However, they were few and rarely attempted to correlate the finding with the results of other vestibular tests. So this study aimed to investigate both cVEMPs and oVEMPs in VM patients and to correlate their results with other clinical findings. Subjects and methodsThe study group consisted of twenty adult patients with criteria of definite VM. The control group included age and gender matched twenty healthy subjects. For all subjects detailed history and basic audiologic evaluation were done. Vestibular evaluation included clinical office tests and VEMPs (cVEMPs and oVEMPs). Patients were examined during interictal period and in the absence of vertigo. ResultsTrue vertigo was experienced in 60% of patients, while 40% patients had sense of unsteadiness. Office tests for vestibulo-spinal reflex were abnormal in 5 patients (25%). Abnormal oVEMPs responses were more frequent (No.=19 “95%”) than cVEMPs (No=15 “75%”). The main abnormality was prolonged latency and/or decreased amplitude. Affection was more bilateral while absent response was less frequently encountered. Significant correlation was found between abnormal office tests and VEMPs abnormalities. ConclusionsBoth cVEMPs and oVEMPs abnormalities were detected in VM patients. Abnormal office tests were among patients with severe VEMPs affection during interictal period.

The change of hippocampal volume and its relevance with inner ear function in Meniere's disease patients.

To reveal the relationship between the disease progression and the hippocampal volume in Meniere's disease, which may indirectly reflect the degree of patients' chronic exposure to stress. Retrospective review of medical records and brain magnetic resonance image (MRI) of Meniere's disease patients and healthy controls from 2008 to 2013. Age- and sex-matched consecutive 38 definite Meniere's disease patients and 76 healthy controls where brain MRIs, hearing, and vestibular function tests were available. We divided the patients into normal and abnormal groups according to the results functional tests such as pure tone audiometry (PTA), vestibular evoked myogenic potential (VEMP), and bithermal caloric test. Absolute hippocampal volume of Meniere's disease patients was significantly smaller than that of controls (3.33±0.84cm(3) for left side vs. 3.82±0.37cm(3) for right side, p<0.001). Mean left hippocampal volume of patients with abnormal VEMP and bithermal caloric test on lesion side was significantly smaller than that of the patients with the normal test result (all p<0.05). Average hearing thresholds of the patients showed strong correlation with left hippocampal volumes (p-value<0.001). Those with decreased left hippocampal volume were also more likely to experience augmented emotional stress reactivity. Meniere's disease patients had significantly decreased hippocampal volume and the volume was significantly correlated with severity of hearing and vestibular function of affected side. This may represent that Meniere's disease patients are exposed to chronic stress for unpredictable vertigo and hearing fluctuation, which finally cause hippocampus atrophy.

Vestibular-evoked myogenic potentials in central vestibular disorders.

Vestibular-evoked myogenic potentials (VEMPs) are short latency manifestations of vestibulo-ocular and vestibulocollic reflexes that originate from the utricle and saccule. Although cervical and ocular VEMPs have mostly been applied to peripheral vestibular disorders, the characteristics and the diagnostic values of VEMPs have been expanded to assess the function of the central otolithic pathways. In the central nervous system, the cervical VEMPs (cVEMPs) are mediated by the vestibular nuclei and uncrossed medial vestibulospinal tract descending in the lower brainstem and spinal cord. In contrast, the ocular VEMPs (oVEMPs) reflect the function of the vestibular nuclei and the crossed vestibulo-ocular reflex (VOR) pathways, mostly contained in the medial longitudinal fasciculus (MLF). Therefore, lesions involving the vestibular nuclei can present abnormalities of both cVEMPs and oVEMPs. The medullary lesions involving the descending MLF or the spinal accessory nucleus impair cVEMPs. In contrast, the lesions involving the MLF, the crossed ventral tegmental tract, oculomotor nuclei and the interstitial nucleus of Cajal can impair oVEMPs. Patients with unilateral cerebellar infarctions may show abnormal VEMPs especially when they have the ocular tilt reaction. Delayed responses of VEMPs are characteristic of multiple sclerosis (MS). Reduced VEMP responses can be observed in patients with vestibular migraine. VEMPs are useful in evaluating central as well as peripheral otolithic function that are not readily defined by conventional vestibular function tests, and can aid in detecting and localizing central lesions, especially silent brainstem lesions such as tiny infarctions or MS plaques.

Otolith function assessment in patients with systemic sclerosis

IntroductionAudiovestibular dysfunction has been reported in connective tissue disease patients. Evaluation of the otolith organ function as a part of the vestibular system of the inner ear in systemic sclerosis (SSc) patients is still greatly uncovered in the literature. Aim of workTo assess otolith function in SSc patients and to correlate the findings with the clinical characteristics and disease severity. Patients and methodsThirty SSc patients and 30 matched controls were included in this work. All patients were subjected to full history taking, clinical examination, assessment disease severity by modified Rodnan skin score (mRss), relevant laboratory and radiological tests. All patients had otolith function assessment using Vestibular Evoked Myogenic Potentials (VEMP) and auditory assessment done using pure tone audiometry (PTA), speech audiometry and tympanometry. ResultsAuditory assessment revealed bilateral sensorineural hearing loss (SNHL) in 11 (36.6%) patients an abnormal VEMP response was found in 24 (80%). The mean latencies of P13 and N23 were significantly prolonged than in the controls (p<0.001). Sine scleroderma subtype was significantly more frequent in SSc patients with normal VEMP (p=0.04). Skin thickening was significantly more frequent in those with abnormal VEMP (p=0.04) and the mRss score was also significantly increased (p=0.007). Those with hearing loss were significantly older in age (p=0.03) and had a significantly longer disease duration (p=0.01) and had a significantly increased frequency of digital pitting (p=0.02) and ulcers (p=0.03) compared to those with normal hearing. ConclusionOur results showed an evidence of inner ear involvement in SSc causing audiovestibular abnormalities.

Prognostic significance of vestibulospinal abnormalities in patients with vestibular migraine.

We evaluated vestibular function test results in vestibular migraine (VM) patients, including caloric, vestibular evoked myogenic potential (VEMP), and dynamic posturography measurements and assessed their relationship with treatment responses. Retrospective case series review. Tertiary referral center. We investigated a cohort of 80 VM patients who had suffered recurrent vertigo attacks for more than 6 months. A combination of lifestyle modifications and prophylactic medications were used to treat these subjects. The patients were asked to score the treatment success by ranking symptom score from 0% to 100% for the improvement in overall severity of headache and vertigo. Patients were then classified as complete remission, symptomatic improvement 50% or more, or less than 50% improvement after 6 months of treatment. The periods needed for symptomatic improvement in the 50% or more patient group were recorded, and the responsiveness to medications and the vestibular test result metrics were analyzed to identify clinical outcome predictors. A symptomatic improvement of 50% or more in vertigo and headache was observed in 71% and 75% of the study subjects across mean periods of 2.3 and 2.2 months, respectively. Improvements in vertigo and headache did not coincide in all. Abnormal caloric, VEMP, and vestibular ratio measurements were found in 25%, 29%, and 58%, respectively. Abnormal vestibular ratios on posturography showed a significant correlation with a poor treatment response of vertigo, and a normal VEMP was significantly related to complete remission from headache, although abnormal caloric results showed no significant correlation with treatment responses. A poor response of vertigo symptoms was observed in 6% of patients with a normal vestibular ratio and 48% of patients with abnormal vestibular ratio. Complete remission from headache was observed in 61% of patients with a normal VEMP and 30% in patients with an abnormal VEMP. More than 70% of the patients with VM experienced improvements in both headache and vertigo through a combination of lifestyle changes and prophylactic medications. Abnormal vestibular ratios on posturography and abnormal VEMP responses were frequent findings in VM patients with recurrent attacks for more than 6 months and were indicators of a poor prognosis. The pathophysiology of VM appears to be closely related to vestibular abnormalities, especially in vestibulospinal pathways. Further study with a large population is needed to establish the relationship exactly. 2b Individual retrospective cohort study.

Vestibular-evoked myogenic potentials and subjective visual vertical testing in patients with vitamin D deficiency/insufficiency.

Otolith function in subjects with vitamin D deficiency/insufficiency is investigated through vestibular-evoked myogenic potentials (VEMP) and subjective visual vertical (SVV) testing. The study group included 62 patients with vitamin D deficiency/insufficiency (30 females, 32 males), with age range 24-56 years (40.6 ± 9.1). The control group included 44 healthy volunteers of similar age and gender distribution. The entire study group had: (1) serum level of 25-hydroxyvitamin D <30 ng/ml; (2) normal bone mineral density as indicated by dual-energy X-ray absorptiometry with T-score >-1; (3) normal middle ear function; (4) Age is ≤60 years. All subjects enrolled in the current study underwent audiovestibular evaluation consisting of pure-tone audiometry, immittancemetry, cervical VEMP (cVEMP), ocular VEMP (oVEMP), and SSV. The entire control group had normal cVEMP, two subjects had abnormal oVEMP. Thirty-three subjects (53%) in the study group had abnormal oVEMP and 31 subjects (50%) had abnormal cVEMP. Forty-one (66%) had abnormal VEMP when abnormal VEMP was considered as either abnormal oVEMP or cVEMP. The entire control and study groups had normal SSV test results. Vitamin D deficiency may be associated with development of otolith dysfunction affecting both the utricle and saccule. This was suggested by the high prevalence of abnormal ocular vestibular-evoked myogenic potentials (oVEMP) and cervical vestibular-evoked myogenic potentials (cVEMP) in the study group.

Vestibular evoked myogenic potentials in children after cochlear implantation.

The aim of this study was to report the effect of unilateral cochlear implantation to vestibular system using vestibular evoked myogenic potentials (VEMPs) by air-conduction in a sample of children aged less than 5 years. This study consisted of 10 children (6 boys and 4 girls), who underwent cochlear implantation surgery at our clinic, and 8 normal hearing children (5 boys and 3 girls) matched for age. The VEMPs were performed before, 10 days, and 6 months after surgery. Both the implanted and unimplanted ears of each child were evaluated, with the cochlear implant both off and on. Preoperatively, six (60%) children had abnormal VEMPs responses on both ears. In the postoperative sessions, no child showed any VEMPs response on the implanted side. The VEMPs were not recorded on the unimplanted side either, except for one case. At 6 months, the VEMPs response on the unimplanted side of three children became normal when the cochlear implant was on, and in two children with the device off. In the postoperative 6-month-period, the disappearance of VEMPs suggests that the saccule of children can be extensively damaged following cochlear implantation. A recovery of VEMPs can take place on the unimplanted side, with the cochlear implant both on and off. Despite this saccular injury, the absence of clinical signs in children could be explained by their ability to effectively compensate for such vestibular deficits.