Cervical VEMP Research Articles

Effects of Noise Exposure on Video Ocular Counter Roll Measurements.

The purpose of this study was to evaluate the effect of noise exposure on otolith function measures of video ocular counter roll (vOCR), ocular vestibular evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and subjective visual vertical (SVV). Additionally, this study compared the vOCR results with other otolith function measures: cVEMP, oVEMP, and SVV. This was a cross-sectional, between-group prospective study that compared otolith function tests between noise exposure groups. Thirty-three adults between the ages of 40-60 years with no middle ear pathology, history of balance disorder, neurologic pathology, systemic diseases, or receiving ototoxic medications were included in the study. Group 1 included 17 adults (34 ears) with low-risk noise exposure, and Group 2 included 16 adults (32 ears) with high-risk noise exposure. Independent samples t tests were used to assess group mean differences for dependent variables. The independent variable was group with two levels (low risk and high risk). The dependent variables were Noise Exposure Structured Interview (NESI) score, vOCR torsion, cVEMP amplitude, oVEMP amplitude, and SVV angle. Additional analyses were completed using Pearson correlation to evaluate the relationship of vOCR to the other otolith function tests and NESI score to the otolith function tests. The results indicated significantly decreased vOCR torsion, cVEMP amplitude, and oVEMP amplitude in individuals with high-risk noise exposure compared with those in the low-risk group. Significant correlations were found for NESI scores as well as vOCR and oVEMP measures. This study describes the concomitant degeneration of the auditory and vestibular systems from noise exposure affecting otolith function, as measured by audiologic testing and otolith testing. vOCR appears to be sensitive to this degeneration, indicating that vOCR could be used as a vestibular screening measure for patients with noise exposure and/or suspected utricle dysfunction.

Assessment of Sacculocollic and Vestibulomasseteric Reflex Pathways in Individuals With Migraine and Vestibular Migraine.

The study's objective was to evaluate the functioning of sacculocollic and vestibulomasseteric reflex pathways in individuals with vestibular migraine and migraine. Seventy-five participants aged 18-50 years were selected for the study. Participants were divided into three groups. Group 1 consisted of 25 healthy individuals, Group 2 consisted of 25 migraine individuals, and Group 3 consisted of 25 individuals with vestibular migraine. Cervical vestibular-evoked myogenic potential (cVEMP) and masseter vestibular-evoked myogenic potential (mVEMP) were recorded using a 500-Hz tone burst stimulus presented at 125 dB peSPL for all participants. The cVEMP test results showed a delayed p13 and n23 latency for both migraine and vestibular migraine individuals when compared to healthy individuals. Also, the amplitude of the p13-n23 peak was reduced compared to healthy individuals in both migraine and vestibular migraine. Similarly, the mVEMP test results showed a delayed p11 and n21 latency for both migraine and vestibular migraine individuals. No difference was observed in the amplitude of the p11-n21 peak complex between the three groups. Spearman's rho correlation revealed no significant (p > .05) correlation between cervical and masseter VEMP latency and amplitude parameters between healthy, migraine, and vestibular migraine individuals. The results of the study are suggestive of the pathology of the sacullocollic and vestibulomasseteric reflex pathways in individuals with migraine and vestibular migraine. Individuals with migraine and vestibular migraine should undergo a detailed vestibular evaluation.

Concurrent abnormalities in galvanic cervical and ocular vestibular-evoked myogenic potentials as a predictive marker for prolonged dizziness in vestibular neuritis

Background Despite the growing use of cervical (cVEMP) and ocular (oVEMP) VEMP tests, their effectiveness in predicting chronic dizziness in vestibular neuritis (VN) patients remains unclear. Our research examines the link between long-lasting dizziness and inner ear assessments, encompassing VEMPs induced by air-conducted sound (ACS), bone-conducted vibration (BCV), and galvanic vestibular stimulation (GVS). Objectives This study explores prognostic markers by examining the relationship between the persistence of dizziness symptoms and various inner ear test findings in VN patients. Material and methods A retrospective cohort of 60 unilateral VN patients underwent comprehensive audiovestibular tests, including pure tone audiometry, cVEMP and oVEMP induced by ACS, BCV, GVS, and caloric tests. Patient subgroups were established based on dizziness duration: short-term (<3 months) and long-term (≥3 months). Results No substantial correlation existed between the dizziness duration and the outcomes of any particular single inner ear test. However, patients exhibiting concurrent abnormal GVS-cVEMP and GVS-oVEMP were more likely to experience prolonged dizziness, indicating more extensive vestibular system involvement. Conclusions Concurrent abnormalities in GVS-cVEMP and GVS-oVEMP may indicate a higher chance of long-term dizziness in VN. Significance This study identifies concurrent abnormalities in GVS-cVEMP and GVS-VEMP as a potential prognostic marker for prolonged dizziness in VN.

Diagnostic value of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo

ObjectivesVestibular evoked myogenic potentials (VEMPs) are useful for studying the disturbances along nerve pathways implicated in the transmission of neurological information from otolithic organs related to vestibular function. This study aims to determine the differences in VEMPs in patients affected with benign paroxysmal positional vertigo (BPPV). MethodsWe recruited 36 patients, 9 diagnosed with recurrent BPPV (rBPPV), 9 with only one episode of vertigo (iBPPV), and 18 as a control group. We performed cervical and ocular VEMPs (cVEMPs and oVEMPs). ResultsWe observed differences in asymmetry ratio, which was 41.82% in cVEMPs in iBPPV and 68.27% in oVEMPs in rBPPV, while no asymmetry was found in control cases. Also, there was a lack of both VEMP responses in 22.2% of cases and an absence of cVEMP in 11.1% in iBPPV; in rBPPV, 11.1 % presented no responses in cVEMPs or oVEMPs, 22.2% showed no oVEMP, and 11.1% showed no cVEMP. These values were normal in the control group. ConclusionThe value of VEMPs in BPPV demonstrates the implication of vestibular damage, mainly utricle damage. For better sensitivity in detecting otolith abnormalities, we should perform oVEMPs and cVEMPs in recurrent BPPV and early stages of BPPV.

Evaluation of Masseteric Vestibular Evoked Myogenic Potentials in Patients With Migraine.

Masseter vestibular evoked myogenic potentials (mVEMP) involve the connection between the vestibular complex and trigeminal nerve nuclei. Given the theory that migraine is caused by increased activation of the trigeminal nerve, it is believed that mVEMP responses may have influenced in migraine patients. The study included 20 individuals with migraine and 20 healthy controls. Latency, amplitude, and interaural amplitude asymmetry ratio of mVEMP responses recorded in migraine patients were compared with control group. Considering the mVEMP normalization study conducted by Başöz et al. (2021) in a similar age group and in the same clinic, latency prolongation and amplitude decrease were observed in subjects with migraines. Migraine is considered a central pathology, as shown in the cervical and ocular VEMP (cVEMP/oVEMP) literature. No difference was observed in the interaural amplitude asymmetry ratio, which is important in peripheral pathologies. Additionally, when the number of pathological ears was examined in order to understand the total exposure, it was observed that the number of pathological ears was significantly higher in the migraine group. In future studies, using mVEMP together with cVEMP and oVEMP tests, which allow evaluation of otolith organs and vestibular nuclei, will be valuable in determining the lesion location. https://doi.org/10.23641/asha.25607901.

Diagnostic value of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo

ObjectivesVestibular evoked myogenic potentials (VEMPs) are useful for studying the disturbances along nerve pathways implicated in the transmission of neurological information from otolithic organs related to vestibular function. This study aims to determine the differences in VEMPs in patients affected with benign paroxysmal positional vertigo (BPPV). MethodsWe recruited 36 patients, 9 diagnosed with recurrent BPPV (rBPPV), 9 with only one episode of vertigo (iBPPV), and 18 as a control group. We performed cervical and ocular VEMPs (cVEMPs and oVEMPs). ResultsWe observed differences in asymmetry ratio, which was 41.82% in cVEMPs in iBPPV and 68.27% in oVEMPs in rBPPV, while no asymmetry was found in control cases. Also, there was a lack of both VEMP responses in 22.2% of cases and an absence of cVEMP in 11.1% in iBPPV; in rBPPV, 11.1 % presented no responses in cVEMPs or oVEMPs, 22.2% showed no oVEMP, and 11.1% showed no cVEMP. These values were normal in the control group. ConclusionThe value of VEMPs in BPPV demonstrates the implication of vestibular damage, mainly utricle damage. For better sensitivity in detecting otolith abnormalities, we should perform oVEMPs and cVEMPs in recurrent BPPV and early stages of BPPV.

The Validation of a Simultaneous Ocular and Cervical VEMP Recording Protocol to Unilateral AC Stimuli.

A simultaneous recording of cervical and ocular vestibular evoked myogenic potential (sVEMP) to unilateral air-conducted (AC) stimulation reduces the test time and halves the sound load. The sVEMP has been compared with the conventional sequential unilateral AC cervical and ocular VEMP in a consecutive cohort of 120 subjects attending the vestibular laboratory. The stimulus was a 500-Hz 6-ms tone burst, at 130 dB peSPL for sequential recordings but at 125 dB for the added sVEMP, for cumulative sound load containment. Amplitudes, latencies, and amplitude asymmetry ratios (ARs) were the parameters included in analysis. Relevant results were as follows: 1) significantly lower amplitudes in sVEMP versus VEMP (ocular recordings, median = 2.90 [IQR = 0-4.98] vs. 4.15 [1.73-8.98] μV, p < 0.001; cervical, 0.84 [0.30-1.69] vs. 1.36 [0.60-2.30], p < 0.001; electromyography scaled values); 2) 10% lower response rate at cervical recordings and 11% at ocular recordings in sVEMP, particularly in older subjects; 3) significant correlations between cervical amplitudes (rs = 0.88, p < 0.001), ocular amplitudes (rs = 0.71, p < 0.001), peak latencies (rs = 0.36-0.67, p < 0.001), and ARs (ocular, rs = 0.56; cervical, rs = 68, p < 0.001); and 4) good agreement in pathological AR detection (cervical recordings, Cohen's κ = 0.649, p < 0.001; ocular, κ = 0.589, p < 0.001). AC sVEMP showed good correlation/agreement with sequential AC VEMP. Test time containment and halved sound load are clinical adds in sVEMP, opening to its use as laboratory standard. However, AC sVEMP presented reduced amplitudes and response rates, secondary to the reduced AC stimulation used in this study to allow checking of the null responses and the pathological ARs at AC sVEMP with conventional AC VEMP.

Head Orientation Modulates Vestibular Cerebellar Evoked Potentials (VsCEPs) and Reflexes Produced by Impulsive Mastoid and Midline Skull Stimulation

The cerebellum plays a critical role in the modulation of vestibular reflexes, dependent on input from proprioceptive afferents. The mechanism of this cerebellar control is not well understood. In a sample of 11 healthy human subjects, we investigated the effects of head orientation on ocular, cervical, postural and cerebellar short latency potentials evoked by impulsive stimuli applied at both mastoids and midline skull sites. Subjects were instructed to lean backwards with the head positioned straight ahead or held rotated in different degrees of yaw towards the right and left sides. Impulsive mastoid stimulation, a potent method of utricular stimulation, produced localised vestibular cerebellar evoked potentials (VsCEPs: P12-N17) which were strongly modulated by head orientation. The response was larger on the side opposite to the direction of head rotation and with stimulation on the side of rotation. In contrast, ocular VEMPs (oVEMPs: n10-p16) were present but showed little change with head posture, while cervical VEMPs (cVEMPs: p15-n23) were larger with the head held rotated away from the side of the recording. Postural effects with lateral vestibular stimulation were strongly modulated by head rotation, with more powerful effects occurring bilaterally with stimulation on the side of rotation. The duration of the postural EMG changes was similar to the post-excitation inhibition of the electrocerebellogram (ECeG), consistent with cerebellar participation. We conclude that head rotation selectively affects evoked vestibular reflexes towards different targets, consistent with their physiological roles. Changes in VsCEPs may contribute to the modulation of postural reflexes by the cerebellum.

Correlation between cognitive tests with scales, vestibular exam and questionnaires for dizziness in the elderly

AbstractBackgroundThe vestibular system interacts with various cognitive functions, including spatial navigation processes, spatial perception, body representation, mental images, attention, memory, risk perception and social cognition. Studies inform that cognitive impairment is an important risk factor for changes in motor performance and body balance.MethodCross‐sectional, observational and analytical study. The sample consisted of 38 elderly people with vestibular dysfunction confirmed by cervical and ocular VEMP exams and/or Video Head Impulse Test (v‐HIT). The procedures of this research were approved by the Ethics Committee of the University under the number CAAE 49714221.0.0000.5149. All participants signed the Informed Consent Form (FICF). Cognitive tests were applied in a room with the patient seated. Paper and pencil were used and all cognitive tests, scales and vestibular exams were performed by the same trained researcher. Analysis using the SPSS program ‐ version 22.0. The distribution of variables was verified using the Kolmogorov‐Smirnov test. Correlation analysis was performed using the Pearson test. We adopted a significance level of 5% (p&lt;0.05).ResultA positive correlation was found between the MMSE with the gain of the left semicircular canal and negative with the asymmetry of the lateral canals. The Frontal Assessment Battery was negatively correlated with the VAS and positively correlated with the left semicircular canal. The Pfeffer questionnaire showed a positive correlation with the VAS, DHI and its functional and emotional subscales, in addition to a negative correlation with the Berg balance scale. The geriatric depression scale correlated negatively with the VAS and the Berg balance scale and positively correlated with the total DHI and its functional and emotional subscales.ConclusionIn this study, cognitive aspects, depressive symptoms and functionality were correlated with decreased gain of the left semicircular canal, greater asymmetry of the lateral canals, higher scores on the visual analogue scale, greater impact of dizziness on quality of life and greater risk of falls.

Republication de : Positive and negative post stapedotomy effects on cervical VEMP recordings; a STROBE analysis

The primary goal of the present study was to compare the pre- and post-stapedotomy elicitation and waveform characteristics of both air- and bone-conduction (AC-, BC-) cervical vestibular evoked myogenic potentials (cVEMPs) through an individualized approach. A possible association between audiological characteristics, such as AC- and BC- pure tone audiometry thresholds and air-bone gap and the production of cVEMPs before and after stapedotomy was also investigated. Twenty-five ears were subjected to full audiological evaluation as well as AC- and BC-cVEMPs pre- and post-stapedotomy. Four subgroups were studied; consistently present/absent, post-operatively disappeared and restored cVEMPs. Post-stapedotomy changes in cVEMP elicitability did not reach significance for either AC-cVEMP (OR = 5.41, 95% CI 0.88–33.36, P = 0.06) or BC-cVEMP (OR = 2.40, 95% CI 0.42–13.60, P = 0.3). Normal or abnormal AC-cVEMPs were equally subject to post-operative changes (OR = 1.95, 95% CI 0.32–12.01, P = 0.5), as were BC-cVEMPs (OR = 3.75, 95% CI 0.66–21.25, P = 0.1). Neither the audiological characteristics nor the surgical outcome, in terms of ABG results, were relevant to the presence or absence of AC- and BC-cVEMPs before or after stapedotomy. The presumed changes brought to the sacculus by stapedotomy are minor and beyond the diagnostic abilities of either AC-cVEMPs or BC-cVEMPs, both in terms of cVEMPs elicitability and waveform characteristics. In individual cases, however, which may deserve further investigation, cVEMPs may reappear or disappear after stapedotomy probably following minor changes toward a lower or higher vestibular system resistance for pressure and sound transmission.

Vestibular reflexes in essential tremor: abnormalities of ocular and cervical vestibular-evoked myogenic potentials are associated with the cerebellum and brainstem involvement.

This study utilized cervical vestibular-evoked myogenic potentials tests (cVEMP) and ocular vestibular-evoked myogenic potentials tests (oVEMP) to investigate the vestibulocollic and vestibuloocular reflex arcs and to evaluate cerebellar and brainstem involvement) in essential tremor (ET). Eighteen cases with ET and 16 age- and gender-matched healthy control subjects (HCS) were included in the present study. Otoscopic and neurologic examinations were performed on all participants, and both cervical and ocular VEMP tests were performed. Pathological cVEMP results were increased in the ET group (64.7%) compared to the HCS (41,2%; p > 0.05). The latencies of P1 and N1 waves were shorter in the ET group than in HCS (p = 0.01 and p = 0.001). Pathological oVEMP responses were significantly higher in the ET group (72.2%) compared to the HCS (37.5%; p = 0.01). There was no statistically significant difference in oVEMP N1-P1 latencies between groups (p > 0.05). Because the ET group had high pathological responses to the oVEMP, but not the cVEMP, the upper brainstem pathways may be more affected by ET.

Asymmetric Ocular Vestibular Evoked Myogenic Potentials in Pediatric Vestibular Migraine.

Although ocular vestibular evoked myogenic potentials (oVEMP) abnormalities have been associated with vestibular migraine (VM) in adults, no studies have evaluated this in pediatric patients with VM. oVEMP asymmetry with normal cervical VEMP (cVEMP) findings may be a reliable VM biomarker in adults. We characterize VEMP results among pediatric patients with VM and benign recurrent vertigo of childhood (BRVC), a migraine precursor, and compare these results with VEMP findings from pediatric patients with nonmigrainous vestibular diagnoses. Four hundred seventy-four pediatric patients were evaluated over a 3-year period in a multidisciplinary pediatric vestibular clinic, 139 of whom met the inclusion criteria. Records were reviewed for history, audiometry, and vestibular testing results. VEMP testing was performed with a 500-Hz tone burst. Based on adult normative data, oVEMP asymmetry was defined as greater than 33% interaural difference; cVEMP asymmetry was defined as greater than 41%. Eighty subjects had VM or BRVC (mean [standard deviation] 12.8 [3.8] yr; range, 4.3-18.2 yr). Fifty-nine subjects received vestibular diagnoses other than VM or BRVC (nonmigrainous group; mean [standard deviation] age, 13.0 [3.6] yr; range, 5.14-18.9 yr). A greater proportion of the VM/BRVC group demonstrated oVEMP asymmetry with normal cVEMP as compared with the nonmigrainous group (22.5% versus 10.1%; p < 0.05). Zero subjects in the VM/BRVC group demonstrated cVEMP asymmetry versus three subjects (4.9%) of the nonmigrainous group. VM and BRVC are notable causes of migraine-related vertigo among pediatric patients. Of VM/BRVC patients, 22.5% had oVEMP asymmetry with normal cVEMP. Similar to the adult VM population, this finding may be a useful biomarker in the right clinical setting for pediatric VM. 4.

Vestibular Loss in Children Affected by LVAS and IP2 Malformation and Operated with Cochlear Implant.

This is a single center cohort study regarding the prevalence of vestibular loss in hearing impaired children affected by large vestibular aqueduct syndrome (LVAS) with incomplete cochlear partition malformation type II (IP2), fitted with cochlear implant (CI). Twenty-seven children received CI operations at 0.4-13 years on one or both ears and tested for vestibular loss with head impulse test, video head impulse test, mini ice-water test and cervical VEMP. Vestibular loss was found in 19% of operated ears and in 13.9% of non-operated ears. The difference was not statistically significant and was not significantly modified by age at implantation, age at testing, sex, presence of SLC26A4 gene mutation or bilaterality. However, the presence of anatomic anomalies at the level of the vestibulum or semicircular canals was significantly associated with a higher incidence of vestibular loss in CI operated children but not in those non-operated. No other factors, such as the surgical access, the electrode type, the presence of Gusher perioperatively, or post-operative vertigo modified significantly the prevalence of vestibular loss. In conclusion, LVAS/IP2 appears to be the major determinant of vestibular loss in these children, with a less obvious impact of CI, excluding the cases with vestibulum/canal anomalies: this group might have a higher risk for vestibular loss after CI surgery.

Vestibular evoked myogenic and auditory brainstem evoked potentials in a female migraine population.

<p>The purpose&nbsp;of the present study was to evaluate ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), and brainstem auditory evoked potential (BAEP) response characteristics and to understand the pathophy&shy;siology of vestibular dysfunction in female migraineurs with vertigo symptoms. We also aimed to assess the electrophysiological di&shy;&shy;agnostic significance of the VEMP respon&shy;ses in vestibular migraine (VM).&nbsp;</p>. <p>23 patients with migraine without aura (MoA), 23 patients with VM, and 20 sex-and age-matched healthy controls, a total of 66 female participants were enrolled in this study. The outcome parameters were asymmetry ratios (ARs), amplitudes of oVEMP, cVEMP, N1P1, P13N23, and the respective latencies (mean &plusmn; SD). From the BAEP graphs, absolute and interpeak interval latencies of waves were analyzed.&nbsp;</p>. <p>30.4% of the MoA group and 21.7% of the VM group had uni- or bilaterally absent cVEMP responses which were statistically significant only in the MoA group (p=0.035) in comparison to control group. Both groups displayed statistically insignificant absent or asymmetrical responses for oVEMP (13.1%). Cervical VEMP P13 and N23 latency, peak-to-peak amplitude, interaural latencies, and amplitude ARs did not show any significant difference between MoA and VM patients and healthy controls. No significant difference was detected among the three groups in the oVEMP and BAEP parameters.</p>. <p>Although absent cVEMP responses were more common in MoA and VM patients than in healthy individuals, the VEMP and BAEP test results should not be used in the differential diagnosis of VM and MoA.&nbsp;</p>.

Positive and negative post stapedotomy effects on cervical VEMP recordings; a STROBE analysis

AimsThe primary goal of the present study was to compare the pre- and post-stapedotomy elicitation and waveform characteristics of both air- and bone-conduction (AC-, BC-) cervical vestibular evoked myogenic potentials (cVEMPs) through an individualized approach. A possible association between audiological characteristics, such as AC- and BC- pure tone audiometry thresholds and air-bone gap and the production of cVEMPs before and after stapedotomy was also investigated. Material and methodsTwenty-five ears were subjected to full audiological evaluation as well as AC- and BC-cVEMPs pre- and post-stapedotomy. Four subgroups were studied; consistently present/absent, post-operatively disappeared and restored cVEMPs. ResultsPost-stapedotomy changes in cVEMP elicitability did not reach significance for either AC-cVEMP (OR=5.41, 95% CI 0.88–33.36, P=0.06) or BC-cVEMP (OR=2.40, 95% CI 0.42–13.60, P=0.3). Normal or abnormal AC-cVEMPs were equally subject to post-operative changes (OR=1.95, 95% CI 0.32–12.01, P=0.5), as were BC-cVEMPs (OR=3.75, 95% CI 0.66–21.25, P=0.1). Neither the audiological characteristics nor the surgical outcome, in terms of ABG results, were relevant to the presence or absence of AC- and BC-cVEMPs before or after stapedotomy. ConclusionsThe presumed changes brought to the sacculus by stapedotomy are minor and beyond the diagnostic abilities of either AC-cVEMPs or BC-cVEMPs, both in terms of cVEMPs elicitability and waveform characteristics. In individual cases, however, which may deserve further investigation, cVEMPs may reappear or disappear after stapedotomy probably following minor changes toward a lower or higher vestibular system resistance for pressure and sound transmission.

Concordance of vestibular test batteries in patients with vestibular neuritis.

A growing number of vestibular function tests are utilized to differentiate and verify the diagnosis of vestibular neuritis. The aim of this study is to retrospectively investigate the consistency of the results of the objective vestibular test batteries in patients with a preliminary diagnosis of vestibular neuritis. We reviewed a total of 37 adult patients (mean age: 39.03 ± 11.67, 19 females, 18 males) who met the inclusion criteria with a prediagnosis of vestibular neuritis from 379 patients suffering vestibular symptoms. Caloric test (CVT), video head impulse test (vHIT), and ocular and cervical VEMP tests were compared with Cohen's kappa (Κ) analysis according to the likely affected part of the vestibular nerve. The highest statistically significant K value was found between horizontal vHIT and ocular VEMP (K = 0.707; good grade, p < 0.05). All the tests compared with CVT were poorly in agreement (K = 0.288; 0.262; 0.256 for HvHIT, oVEMP, AvHIT, respectively, p < 0.05). VEMP and vHIT tests have prominent diagnostic value and agree with each other for detecting and differentiating the types of vestibular neuritis. Further studies should aim to include cutting-edge technologies such as functional HIT and ocular counter roll test.

Differentiating neurodegenerative parkinsonian syndromes using vestibular evoked myogenic potentials and balance assessment

ObjectiveVestibular evoked myogenic potentials (VEMP) were investigated to differentiate between parkinsonian syndromes. We correlated balance and VEMP parameters to investigate the VEMP brainstem circuits as possible origin for postural instability. MethodsWe assessed clinical status, ocular and cervical VEMP (oVEMP, cVEMP) and conducted a balance assessment (posturography, Activities-specific Balance Confidence Scale, Berg Balance Scale, modified Barthel Index) in 76 subjects: 30 with Parkinson’s disease (PD), 16 with atypical parkinsonism (AP) and 30 healthy controls. VEMP were elicited by using a mini-shaker on the forehead. ResultsPatients with PD had a prolonged oVEMP n10 in comparison to controls and prolonged p15 compared to controls and AP. Patients with AP showed reduced oVEMP amplitudes compared to PD and controls. CVEMP did not differ between groups. Postural impairment was higher in AP compared to controls and PD, particularly in the rating scales. No correlations between VEMP and posturography were found. A support vector machine classifier was able to automatically classify controls and patient subgroups with moderate to good accuracy based on oVEMP latencies and balance questionnaires. ConclusionsBoth oVEMP and posturography, but not cVEMP, may be differentially affected in PD and AP. We did not find evidence that impairment of the cVEMP or oVEMP pathways is directly related to postural impairment. SignificanceOVEMP and balance assessment could be implemented in the differential diagnostic work-up of parkinsonian syndromes.

Audiological and vestibular evaluations in vitiligo patients.

The aim of this paper was to investigate audiological abnormalities and potential vestibular injury in a sample of vitiligo subjects. Thirty-five patients with non-segmental vitiligo (NSV) were enrolled in the study. They underwent pure tonal audiometry (PTA), vestibular Fitzgerald-Hallpike caloric test, C-VEM, and ocular VEMP (O-VEMP) testing. The χ2 test and multiple regression analysis were performed. At PTA, 69% of patients presented with bilateral hearing loss, 8% monaural hearing loss, and 23% normal values. Bilateral caloric stimulations were performed and demonstrated that 14% of patients had a monolateral and 9% had a bilateral pathological response. VEMPs analysis showed that 20% of patients had no O-VEMPs response and 3% had no cervical VEMPS (C-VEMPs) response. Comparison between the normal values of healthy subjects and NSV patients showed an alteration of VEMPs in 44%. Multiple regressions showed no statistical differences. We propose a specific diagnostic protocol employing PTA, bithermal caloric tests, C-VEMP, and O-VEMP testing to evaluate audio-vestibular damage. Our data were concordant with the anatomic-physiological melanocytic distribution and their possible degeneration linked with NSV.

Vestibular‐Evoked Myogenic Potential Outcomes Associated with Pediatric Sports‐Related Concussion

To 1) characterize vestibular-evoked myogenic potential responses in children and young adults with sports-related concussion (SRC) histories as compared with a normal healthy control group, and 2) correlate VEMP characteristics to SRC/sport history outcomes. Prospective cohort study. Seventy-six children and young adults with and without a history of SRC received cervical and ocular VEMP testing using a 500 Hz tone burst air conduction stimuli. VEMP response parameters (response rates, peak latencies, and peak-to-peak amplitudes) were assessed. Other clinical vestibular measures were performed. In the SRC group, sport history outcomes including number of SRC sustained over a lifetime, years of playing contact sports, and length of time playing contact sports were collected via in-person questionnaire. Children and young adults with SRC had significantly reduced oVEMP responses and peak-to-peak amplitudes and greater amplitude response asymmetries between left and right ear. There was no effect of group on cVEMP findings. A greater frequency of SRCs sustained throughout a lifetime, a greater number of contact sports played, and a longer duration of playing a contact sport correlated with significantly poorer VEMP response characteristics. Our results suggest that SRC and repeated subclinical head impact events have an effect on oVEMP outcomes. SRC may affect the utricle, superior vestibular nerve, and/or brainstem-mediated vestibular-ocular-reflex pathway. The prevalence of post-concussion-related dizziness is becoming increasingly common in a pediatric-otology clinic, thus performing VEMP testing in youth post-SRC provides an objective, noninvasive, and cost-effective method for monitoring the effects of sports-related impact on the vestibular system and related neural pathways. 3 Laryngoscope, 132:436-442, 2022.

SY2.7. Evaluation of the vestibular system: cVEMP and oVEMP

The vestibular system makes strong connections with the oculomotor nuclei, the neck, the cerebellum and also projects to the cortex. Over- or under-activity of vestibular afferents causes disturbances of posture, vision and perception. While methods have been available for some time for assessing some of the properties of the vestibular system, these have had limitations. These methods have been difficult to apply widely, either being indirect and not always well tolerated (rotating chairs, centrifuges and caloric testing) or poorly standardised, such as galvanic stimulation in standing subjects. Relatively simple methods of assessing short latency vestibular projections have become available. The best known of these require averaging of muscle activity thus are termed “vestibular evoked myogenic potentials” or VEMPs. Short latency potentials can be recorded from the sternocleidomastoid muscle in the neck (cervical VEMPs) or from the inferior oblique (ocular VEMPs). Both can be evoked by either air conducted sound (AC) or bone conducted sound (BC). The AC-evoked cVEMP mainly reflects saccular function and the oVEMP mainly utricular. Most recently it has been possible to record an evoked potential from the cerebellum (VsCEP). The VEMP techniques are well tolerated and have been widely applied in vestibular diagnosis. They have also been used in investigations of central disorders such as multiple sclerosis, Parkinson’s disease and progressive supranuclear palsy (PSP).