Cervical Vestibular-evoked Myogenic Potential Tests Research Articles

Effects of otosclerosis and stapedotomy on vestibular-evoked myogenic potentials.

Limited data are available on the effects of otosclerosis and otosclerosis surgery on the utricle and saccule. This study aimed to determine the effect of otosclerosis and stapedotomy on vestibular-evoked myogenic potentials. This retrospective study included 16 otosclerosis patients and 18 controls. Thirty-two ears of 16 patients with otosclerosis were divided into 2 groups based on whether the ear had been operated on or not. All patients and subjects underwent 500 Hz air- and bone-conducted ocular and cervical vestibular-evoked myogenic potentials testing. Overall comparison of response rates showed a significant difference among the groups. Further statistical tests showed that this difference arose from differences between both operated and unoperated groups and the control group, for air-conducted cervical and ocular vestibular-evoked myogenic potentials. Otosclerosis and stapedotomy may affect the elicitability of vestibular-evoked myogenic potentials. Otosclerosis is associated with lower response rates for air-conducted ocular and cervical vestibular-evoked myogenic potentials, regardless of whether operated on. Having been operated on does not significantly increase the response rate of air-conducted vestibular-evoked myogenic potentials.

Vestibular mapping assessment in idiopathic sudden sensorineural hearing loss.

The aim of this study was to investigate patterns of semicircular canal (SCC) and otolith organ dysfunction by vestibular mapping, and to determine the clinical implications of treatment outcomes in idiopathic sudden sensorineural hearing loss (ISSNHL). We retrospectively reviewed 135 consecutive patients diagnosed with ISSNHL from January 2016 to December 2020. Patients underwent video-head impulse tests (vHIT) for each SCC, cervical vestibular-evoked myogenic potential test for the saccules, ocular vestibular-evoked myogenic potential test for the utricles, and hearing tests. Hearing outcomes were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery criteria and factors associated with prognosis were assessed. We also conducted vestibular mapping assessments and hierarchical cluster analysis. Overall, utricular impairment (76, 56.3%) was the most frequent diagnosis in the 135 ISSNHL patients, followed by saccular impairment (59, 43.7%) and posterior SCC impairment (30, 22.2%). The mean number of affected end organs was 1.37 ± 1.24, with higher numbers in the complete recovery group than in the partial/no recovery groups. In a multivariate analysis, higher initial hearing level and abnormal vHIT results in the posterior SCC were associated with poor prognosis in ISSNHL. In hierarchical cluster analysis, horizontal SCC and anterior SCC showed the highest similarity but were in different clusters than posterior SCC, and the saccule and utricle were in separate clusters from the three SCCs. The vestibular end organ showed various patterns of dysfunction in patients with ISSNHL. Of the five vestibular end organs, only abnormal posterior SCC was associated with poor prognosis for hearing recovery.

Utriculo-ocular pathway dysfunction is more frequent in vestibular migraine than probable vestibular migraine.

Abnormal vestibular function has been reported in patients with vestibular migraine (VM). However, it is unclear whether the proportion of patients with vestibular dysfunction differs between the diagnoses of VM and probable VM (PVM). We reviewed the medical records of 1736 patients who underwent cervical vestibular-evoked myogenic potential testing to air-conducted sound (ACS cVEMP), ocular VEMP testing to bone-conducted vibration (BCV oVEMP), and caloric testing. We used the diagnostic criteria for VM provided in the appendix of the International Classification of Headache Disorders 3 Beta, and the diagnostic criteria consensus published by the Barany Society and the International Headache Society for PVM. Twenty-two VM patients and a further 22 PVM patients were included. Binomial logistic regression analyses were performed to see whether the subjects' age, sex, or the diagnostic certainty of VM (i.e., VM vs. PVM) have an association with the presence of vestibular dysfunction. There was no significant association between the diagnostic certainty of VM and abnormality in caloric or ACS cVEMP testing. On the other hand, VM had a significant positive association with abnormality in BCV oVEMPs compared with PVM. VM is associated with dysfunction of the utriculo-ocular pathway more frequently than PVM, suggesting that the pathophysiology of VM involves the utriculo-ocular pathway.

Posterior Semicircular Canal Dehiscence and Auditory Neuropathy in a 22-month-old Male Baby

Semicircular canal dehiscence (SCD) is usually seen in children, but it rarely occurs in adults. Posterior SCD in children is scarcely reported in the literature. This study reports the presence of posterior SCD and comorbid auditory neuropathy in a 22-month-old male baby. The video head impulse test was normal, but cervical vestibular-evoked myogenic potential test supported SCD on the left side. Also, temporal CT of the patient revealed posterior SCD. Cochlear microphonic was detected bilaterally by the Auditory Brainstem Response test. Posterior SCD may cause different audio-vestibular signs. Early vestibular assessment in children with congenital hearing loss, especially auditory neuropathy, is suggested because knowing the additional problems associated with the vestibular function will ease the prognosis of vestibular disorder and protect the children's balance functions.

Ocular Tilt Reaction in Compensated Vestibular Schwannoma

Ocular Tilt Reaction in Compensated Vestibular Schwannoma

Vestibular profile of type 1 versus type 2 chronic diabetes mellitus

Objective: The present study aimed to describe and compare the vestibular profile of a random sample of patients with type 1 and type 2 diabetes mellitus (DM).Study design: Forty-five adult patients with DM were divided into three groups; group I: type 1 DM (n = 15), group II: type 2 DM treated with oral hypoglycaemic (n = 15), and group III: type 2 DM treated with insulin (n = 15). Diagnosis of vestibular disorders based on detailed history, Dizziness Handicap Inventory, clinical, and laboratory vestibular evaluation using videonystagmography test battery, electrocochleography, and cervical vestibular-evoked myogenic potential test. The study addressed the vestibular test results of the three diabetic groups and compared them. It also clarified the effect of different diabetic characteristics (clinical and laboratory) on the outcome of vestibular testing.Results: Vestibular disorders prevalence of 64.4% was estimated in diabetic patients with a higher prevalence was found in diabetic group III (86.7%) followed by group I (66.7%) then group II (40%). Vestibular function was significantly impaired in the insulin controlled DM compared to the orally controlled, and in the dizziness complainers compared to the non-complainers.Conclusions: A relatively high prevalence of vestibular dysfunctions were detected in DM. Diabetic patients treated with insulin, mainly those with type 2 DM, exhibited more involvement of the vestibular system owing to the long standing hyperglycemia with subsequent degenerative insults, microvascular lesions, and electrolyte imbalance. These changes could happen longtime prior to the onset of vestibular manifestations. Thus, early and routine vestibular assessment in diabetic patients is recommended even in absence of dizziness.

Evolution of postirradiated sudden deafness in nasopharyngeal carcinoma survivors during the past two decades.

The beneficial effect of intensity-modulated radiotherapy (IMRT) on reducing the prevalence of postirradiated sudden deafness (PISD) in nasopharyngeal carcinoma (NPC) survivors has never been mentioned. This study investigated the evolution of PISD in NPC survivors during the past two decades. Retrospective study. Of the 3,206 NPC patients who underwent radiotherapy during the past two decades, 32 patients (34 ears) had PISD. Twenty-nine patients (30 ears) received two-dimensional radiotherapy (2DRT) and were assigned to group A, whereas three patients (4 ears) undergoing IMRT were assigned to group B. An inner ear test battery including audiometry, vestibular-evoked myogenic potential (VEMP) test, and caloric test was performed for comparison between the two groups. Group B (0.2%) showed significantly lower prevalence of PISD than group A (2%). Percentages of abnormal pursuit, saccade, and optokinetic nystagmus test results revealed nonsignificant difference between groups A and B. Likewise, both groups did not differ significantly in the percentages of abnormal pure tone average, cervical VEMP test, and caloric test. However, significant hearing improvement after treatment was identified in group B (P < 0.01) but not in group A (P > 0.05), probably because mean radiation dosage to the cochela of group B (35.0 ± 0.4 gray units [Gy]) was less than group A (50 ± 3 Gy). Compared to 2DRT, both radiation dosages to the cochlea and radiation damage to tissues surrounding the inner ear are lessened by IMRT. Therefore, NPC survivors who received IMRT have a low prevalence of PISD, with significant hearing improvement after treatment. 4. Laryngoscope, 126:2016-2021, 2016.

Bilateral simultaneous sudden sensorineural hearing loss

ObjectiveThis study adopted an inner ear test battery and MR imaging in patients with bilateral sudden sensorineural hearing loss (SSNHL) to investigate their causes, disease extent, and evaluate hearing outcome. Patients and methodsFrom 1995 to 2014, 16 patients with bilateral SSNHL received audiometry, caloric test and MR imaging. Vestibular-evoked myogenic potential (VEMP) test was added to the test battery after 2000. ResultsPercentages of abnormal mean hearing level (MHL), cervical VEMP test, ocular VEMP test, and caloric test in patients with bilateral SSNHL were 100% (32/32), 100% (12/12), 100% (4/4), and 81% (26/32), respectively, implying that not only the cochlear part but also the vestibular part was severely affected in both ears. Causes of bilateral SSNHL were neoplasm in 5 patients, stroke in 5, meningitis in 1, and unknown in 5. Post-treatment MHL did not significantly differ from pre-treatment MHL indicating poor hearing outcome. Seven patients (44%) had passed away within 5years after onset, 2 patients were lost, and 7 patients survived. ConclusionVia MR imaging, causes of bilateral SSNHL were identified for 69% of cases. Both cochlear and vestibular endorgans/afferents were identified to be severely affected bilaterally by the vestibular test battery and resulted in poor hearing outcome. A high mortality rate (44%) indicates that bilateral SSNHL is an ominous sign for a more sinister underlying disease.

Role of cervical vestibular-evoked myogenic potentials testing in vestibular migraine

BackgroundVestibular dysfunction has been long described in patients with migraine; this relation has been addressed as vestibular migraine. The pathophysiology as well as the peripheral or central localization of this deficit is unclear. Cervical vestibular evoked myogenic potential (cVEMP) is a validated method to test saccular function and vestibulocollic pathway. ObjectivesThe current work was designed to assess the characteristics of cVEMP response in patients with vestibular migraine and compare them with the results of healthy controls, and to find out if the cVEMP could be useful as a complementary tool for testing vestibular function in vestibular migraine. MethodsTwenty five patients with definite vestibular migraine were involved as a study group. Twenty healthy volunteers of comparable age and sex were taken as a control group. The amplitude and latency of cVEMP were measured. Electronystagmography (ENG) test battery including caloric testing was done. ResultsOur study demonstrated significant reduction in cVEMP amplitudes, and more frequently absent response in patients with vestibular migraine compared to healthy controls. There was no correlation between cVEMP amplitudes and caloric testing. ENG tests showed peripheral vestibular lesion in 36% of patients, central lesion in 16%, mixed lesion in 4%. ConclusioncVEMP is a useful complementary tool for testing vestibular function in vestibular migraine. Reduced cVEMP amplitude or absent response were the most frequent features in vestibular migraine. The saccule and or the sacculo-collic pathway are affected in vestibular migraine, with more tendencies for peripheral vestibular dysfunction in our patient group.

Air Conducted Cervical and Ocular Vestibular Evoked Myogenic Potentials in Peudotumor Cerebri Patients

Objective : Pseudotumor cerebri is a disorder of unknown etiology that results in raised intracranial pressure (ICP) and characterized by attendant signs and symptoms of increased ICP in an alert and oriented patient but without localizing neurologic findings. Vestibular evoked myogenic potentials (VEMPs) are short latency reflex responses produced by stimulation of the vestibular apparatus. The purpose of this study was to determine whether group of pseudotumor cerebri patients have abnormal changes in VEMPs (cervical and ocular) and to analyze the results and compare them with matched group of normal subjects. Design : Ocular and cervical VEMPs were performed to the entire study groups. The responses were obtained from thirteen pseudotumor cerebri patients and compared to fifteen age matched normal subjects. All participants were subjected to audiological assessments that include pure tone audiometry, tympanometry and acoustic reflexes. Results : Ocular and cervical VEMPs amplitudes were reduced in response in pseudotumor cerebri patients than normal but still of non-statistical significant difference p>0.05. Discussion and Conclusion : The results of this study suggest that patients with pseudotumor cerebri do not have statistically significant changes in comparison with the normal control as regard ocular and cervical VEMPs testing. Hence, asserting a query whether there is affection of VEMPs in pseudotumor cerebri patients.

Clinical uses of cervical vestibular-evoked myogenic potential testing in pediatric patients.

To demonstrate the feasibility and clinical significance of cervical vestibular-evoked myogenic potential (cVEMP) test in pediatric patients.Retrospective review study was conducted in a pediatric tertiary care facility. A total of 278 patients were identified with adequate data, including medical notes, results of cVEMP, and imaging studies.Among the total of 278 pediatric patients, only 3 children were not able to finish the cVEMP test successfully. In about 90% of the cases, the cVEMP test was requested to investigate a patient’s hearing loss and/or vestibular complaints. Over 90% of the cVEMP tests were ordered by specialists such as pediatric otolaryngologists or otologists. Obtained cVEMP results provided useful information in clinical diagnosis and management in all cases.It is feasible to conduct cVEMP testing in children, including infants, and cVEMP testing can provide valuable information in the diagnosis and management of hearing loss and vestibular impairment. This simple and noninvasive test should be embraced by pediatric professionals.

An analysis of vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo.

Vestibular evoked myogenic potentials (VEMPs) selectively test the vestibular end-organ. The aim of this study was to analyze how the site of the diseased canal, type of particulate deposition, duration of symptoms, severity of nystagmus, recurrence, and age affect the VEMP in patients with benign paroxysmal positional vertigo (BPPV). One hundred two patients were enrolled in the study between 2009 and 2012. There were 36 men and 66 women with ages ranging from 16 to 71 years (mean age, 42.28 ± 11.29 years). Patients with BPPV were tested with roll-on and head-hanging maneuvers under video-electronystagmography monitoring and with air conduction cervical VEMP testing. Patients were grouped for duration, severity, recurrence, age, site of canal involvement, and so on, and the results were compared in each subgroup. Kruskal-Wallis and Mann-Whitney U tests were used for the comparative analysis. Twenty-four patients (23.5%) had a gross VEMP abnormality (absence of VEMP in 6 and greater than 25% depression of the amplitude in 18). Abnormality of VEMPs was not correlated with factors including age, severity of nystagmus, number of maneuvers applied, and the site of canal involvement (P < .05). However, persistence or recurrence of symptoms has an effect on VEMP results (P = .016). Vestibular evoked myogenic potential is a useful tool to study the otolithic function in patients with BPPV and should be included in the test battery.

Superior Canal Dehiscence Length and Location Influences Clinical Presentation and Audiometric and Cervical Vestibular-Evoked Myogenic Potential Testing

Superior canal dehiscence (SCD) is caused by an absence of bony covering of the arcuate eminence or posteromedial aspect of the superior semicircular canal. However, the clinical presentation of SCD syndrome varies considerably, as some SCD patients are asymptomatic and others have auditory and/or vestibular complaints. In order to determine the basis for these observations, we examined the association between SCD length and location with: (1) auditory and vestibular signs and symptoms; (2) air conduction (AC) loss and air-bone gap (ABG) measured by pure-tone audiometric testing, and (3) cervical vestibular-evoked myogenic potential (cVEMP) thresholds. 104 patients (147 ears) underwent SCD length and location measurements using a novel method of measuring bone density along 0.2-mm radial CT sections. We found that patients with auditory symptoms have a larger dehiscence (median length: 4.5 vs. 2.7 mm) with a beginning closer to the ampulla (median location: 4.8 vs. 6.4 mm from ampulla) than patients with no auditory symptoms (only vestibular symptoms). An increase in AC threshold was found as the SCD length increased at 250 Hz (95% CI: 1.7-4.7), 500 Hz (95% CI: 0.7-3.5) and 1,000 Hz (95% CI: 0.0-2.5), and an increase in ABG as the SCD length increased at 250 Hz (95% CI: 2.0-5.3), 500 Hz (95% CI: 1.6-4.6) and 1,000 Hz (95% CI: 1.3-3.3) was also seen. Finally, a larger dehiscence was associated with lowered cVEMP thresholds at 250 Hz (95% CI: -4.4 to -0.3), 500 Hz (95% CI: -4.1 to -1.0), 750 Hz (95% CI: -4.2 to -0.7) and 1,000 Hz (95% CI: -3.6 to -0.5) and a starting location closer to the ampulla at 250 Hz (95% CI: 1.3-5.1), 750 Hz (95% CI: 0.2-3.3) and 1,000 Hz (95% CI: 0.6-3.5). These findings may help to explain the variation of signs and symptoms seen in patients with SCD syndrome.

Disorders Affecting the Fourth Ventricle

The fourth ventricle encompasses many vital structures including the brainstem as its floor and the cerebellum as its lateral wall and roof. Therefore, lesions affecting the fourth ventricle may present as cerebellar or brainstem manifestations. Herein, we presented our experience in the diagnosis of disorders affecting the fourth ventricle during the past 15 years. Retrospective study. University hospital. From September 1995 to August 2010, 24,838 patients with vertigo/dizziness visited the clinic. Of them, 13 patients (0.5%) had tumor/stroke affecting the fourth ventricle. All patients underwent a battery of audiovestibular function test. All patients had vertigo (100%) and then ataxia (92%) and nausea/vomiting (85%). Eight patients (68%) displayed persistent nystagmus. Most (>75%) patients showed central signs in electronystagmographic recordings and abnormal caloric coupled with visual suppression test. Three patients underwent both ocular and cervical vestibular-evoked myogenic potential tests, and abnormal results were noted in all 3 patients indicating a brainstem involvement. However, magnetic resonance imaging failed to demonstrate brainstem lesion in these 3 patients. Final diagnoses consisted of the following: cavernoma, n = 3; metastatic cancer, n = 3; astrocytoma, n = 2; meningioma, n = 2; epidermoid cyst, n = 1; ependymoma, n = 1; and lymphoma, n = 1. The prognosis was poor as 10 patients (77%) died within 2 years. When a vertiginous patient displayed ataxia, persistent vomiting, and persistent nystagmus, lesion affecting the fourth ventricle should be kept in mind because its prognosis is poor. Abnormal results in electronystagmography and in ocular and cervical vestibular-evoked myogenic potentials may serve as a supplementary to magnetic resonance imaging to delineate the involvement of the lesion.

Brainstem lesion in benign paroxysmal vertigo children: Evaluated by a combined ocular and cervical vestibular-evoked myogenic potential test

Objective This study utilized a combined ocular vestibular-evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) test in children with benign paroxysmal vertigo (BPV) to investigate whether the upper or lower brainstem is more frequently affected in BPV children. Methods Fifteen BPV children aged 4–14 years, and 15 age- and sex-matched healthy children were enrolled. All subjects underwent pure tone audiometry, stabilometry, and a combined oVEMP and cVEMP test using acoustic stimulation. Results All BPV patients displayed normal hearing and clear oVEMPs. However, 11 (73%) of 15 BPV patients had delayed cVEMPs, showing significant difference when compared with 100% normal cVEMPs in healthy children. The sway path and sway area in stabilometry were significantly different between BPV and healthy children, regardless of whether their eyes were open or closed. However, neither the sway path nor sway area correlated significantly with cVEMP results. Conclusion Normal oVEMPs in BPV children indicate an intact vestibulo-ocular reflex pathway, which travels through the upper brainstem. In contrast, delayed cVEMPs in BPV children reflect a retrolabyrinthine lesion along the sacculo-collic reflex pathway, which descends via the lower brainstem. Hence, the lower brainstem is more frequently affected than the upper brainstem in children with BPV.