oVEMP Test Results Research Articles

Evaluation of utricular and saccular function in BPPV patients: The role of VEMP in diagnosis

Aim: The pathological cause of Benign Paroxysmal Positional Vertigo (BPPV) is the degeneration of the otolith organs (utricle and sacculus). Vestibular Evoked Myogenic Potentials (VEMP) assess the functions of the otolith organs. The objective of this research was to evaluate the otolith organ functions of patients with unilateral idiopathic BPPV (canalolithiasis of the posterior and lateral semicircular canals) by cVEMP and oVEMP tests. Material and Methods: The study prospectively included 35 patients with BPPV (canalolithiasis of the posterior and lateral semicircular canals) and 30 healthy individuals. Bilateral cVEMP and oVEMP tests were administered to all participants. Participants were divided into three groups: control, BPPV-affected ear, and unaffected ear.Results: In our study, cVEMP and oVEMP abnormalities were statistically significantly different both between the affected and unaffected ear groups and between the affected ear and control groups. There were statistically significant differences in the cVEMP and oVEMP amplitude values both between the affected and unaffected ear groups and between the affected ear and control groups. Also, the asymmetry ratios of the cVEMP and oVEMP tests were statistically significantly different between the case group and the control group. The cVEMP and oVEMP wave latencies (p1, n1, p1-n1) were not statistically significantly different among the BPPV-affected ear, unaffected ear, and control groups. The results of measurements were not statistically significantly different between the posterior and lateral canal involvement subgroups of BPPV patients.Conclusion: Abnormal cVEMP and oVEMP test results, which are observed more frequently in patients with BPPV compared to the control group, indicate utricular and saccular degeneration. Higher oVEMP abnormality ratios compared to those of cVEMP in BPPV patients suggest that utricular dysfunction may be more common than saccular dysfunction.

Role of ocular VEMP test in assessing the occurrence of vertigo in otosclerosis patients

ObjectiveThis study adopted an inner ear test battery comprising audiometry, caloric test, ocular vestibular-evoked myogenic potential (oVEMP) test and cervical VEMP (cVEMP) test to find the factors related to the occurrence of vertigo in patients with otosclerosis. MethodsFifty otosclerosis patients comprising 27 patients with vertigo (Group A) and 23 patients without vertigo/dizziness (Group B) were enrolled. Each patient underwent otoscopy, image study, audiometry, caloric test, and oVEMP and cVEMP tests via bone vibration stimuli. ResultsThe sequence of inner ear deficits in Group A was in the order from oVEMP test (84%), cVEMP test (51%), caloric test (38%) and mean bone-conducted (BC) hearing threshold (14%), exhibiting a significantly declining trend (p<0.001). The rate of inner ear dysfunction in Group B also declined significantly but in a different order – cVEMP test (55%), oVEMP test (52%), mean BC hearing threshold (33%), and caloric test (18%). Comparison between the two groups revealed a significant difference in the oVEMP test results (p<0.01), but not in the results of the BC hearing threshold, caloric test or cVEMP test (p>0.05). Further, no significant differences existed between the BC hearing threshold and vestibular function test results. ConclusionOtosclerosis patients with vertigo have more frequent abnormalities of oVEMPs to impulsive stimulation than do those without, consistent with more frequent abnormalities of the utricle. Abnormalities of oVEMPs and cVEMPs are more frequent than for caloric testing and BC hearing thresholds. SignificanceThe relative frequency of abnormalities may reflect the degree of pathological involvement of the utricle, saccule, semicircular canals and cochlea in otosclerosis patients with vertigo.

Registering grades of sudden deafness to predict the hearing outcome via an inner-ear test battery

Objectives: An inner ear test battery comprising audiometry and ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests was applied to patients with sudden deafness to map their lesions and predict hearing outcome. Design: Retrospective study. Study sample: Seventy-five patients with unilateral sudden deafness underwent an inner-ear test battery. Registering the grades of sudden deafness was based on the number of abnormal test results in the inner ear test battery. Results: After treatment for three consecutive months, mean hearing gain declined significantly from Grade I (one abnormal test) to Grade IV (four abnormal tests). Significant relations existed between hearing outcome and oVEMP test results (p < 0.05), caloric test results (p < 0.05), but not cVEMP test results and pre-treatment mean hearing level. Combined caloric and oVEMP test results demonstrated a stronger predictor with a c statistic of 0.722 than either test alone, indicating that this regression model fits the whole set of observations well and is effective in predicting the hearing outcome. Conclusion: Abnormal caloric and oVEMP test results in sudden deafness patients may indicate poor prognosis for hearing improvement, whereas hearing recovery can be anticipated when both tests reveal normal responses.

Inner ear deficits after chronic otitis media

Investigation of the causes of vestibular symptoms in patients with chronic otitis media (COM) faces frustration, mainly because the bithermal caloric test using tap water is generally contraindicated in perforated ears. This study utilized audiometry, ocular vestibular-evoked myogenic potential (oVEMP) test, and cervical VEMP (cVEMP) test to evaluate inner ear deficits after COM. A total of 85 COM patients (117 ears) underwent otoscopy, image study, audiometry, oVEMP test, and cVEMP test. Mean bone-conducted (BC) hearing threshold ≤25 dB was observed in 74 ears, 26-40 dB in 30 ears, and >40 dB in 13 ears. Restated, abnormal BC hearing threshold was identified in 43 ears (37 %). Percentages of abnormal cVEMP test, oVEMP test, and BC hearing threshold in 117 COM ears were 65, 62, and 37 %, respectively, exhibiting a significantly declining sequence in inner ear function. Furthermore, cVEMP/oVEMP test results were significantly correlated with BC hearing threshold, whereas no correlation existed between the cVEMP and oVEMP test results. In conclusion, the sequence of inner ear deficits after COM runs from the saccule/utricle to the cochlea and semicircular canals. Restated, in addition to BC hearing test, the cVEMP/oVEMP test may serve as a supplementary tool for early detection of inner ear involvement in COM patients.

Differentiating cerebellopontine angle meningioma from schwannoma using caloric testing and vestibular-evoked myogenic potentials

ObjectiveThis study utilized audiometry, and caloric, ocular vestibular-evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) tests to differentiate between cerebellopontine angle (CPA) meningioma and schwannoma. Patients and methodsEleven CPA meningioma patients with mean tumor size 2.8±1.4cm and another 11 CPA schwannoma patients with mean tumor size 2.7±1.0cm were enrolled in this study. All patients underwent a battery of audiovestibular function tests. ResultsThe two groups did not differ significantly in terms of clinical manifestation. The abnormal percentage of caloric test in the meningioma group was 36%, compared to 91% in the schwannoma group, and thus both groups differed significantly. However, such difference was not observed between the two groups regardless of mean hearing level, oVEMP test and cVEMP test. ConclusionCombined caloric with oVEMP test results may help differentiate a CPA tumor. Correlation between the caloric and oVEMP test results in a CPA tumor indicates a schwannoma nature, while dissociation between the caloric and oVEMP test results depicts a meningioma character.

Influence of facial paresis on ocular vestibular-evoked myogenic potentials

Conclusion: The ocular vestibular-evoked myogenic potential (oVEMP) test with eyes up condition may help differentiate facial paresis with and without vestibular nerve deficit, while the oVEMP test with the eyes closed condition is not reliable for testing patients with facial paresis. Objective: This study investigated the influence of facial paresis on oVEMPs via the eyes up versus eyes closed conditions. Methods: Twenty patients with unilateral facial paresis underwent a battery of audiovestibular function tests. The oVEMP test was performed via bone-conducted vibration stimuli with the eyes up and eyes closed conditions used in a randomized order. Results: Under the eyes up condition, the rate of abnormal oVEMP tests in the lesion ear was 30%, significantly higher than the 0% in the opposite healthy ear, indicating that the lesion ear not the recorded eye is responsible for abnormal oVEMPs. However, abnormal oVEMP test results of lesion ears under the eyes closed condition did not significantly differ from those of opposite healthy ears. Analysis of caloric and oVEMP test results indicated that both tests obtained normal responses from 10 ears, and abnormal responses from 5 ears. The caloric and oVEMP test results were significantly correlated.

Correlation between caloric and ocular vestibular evoked myogenic potential test results

Conclusion: The ocular vestibular evoked myogenic potential (o-VEMP) test results correlate significantly with caloric test results for patients with acoustic neuroma (AN), but not for patients with Meniere's disease (MD), indicating that the o-VEMP test may replace the caloric test for evaluating the vestibular nerve from which the AN arises. Conversely, the caloric, o-VEMP, and cervical VEMP (c-VEMP) tests should be performed to map lesion sites in the vestibular labyrinth. Objective: This study performed caloric, o-VEMP, and c-VEMP tests on patients with central and peripheral vestibular disorders to investigate their relationships. Methods: In all, 66 patients comprising 16 with unilateral AN and 50 with unilateral definite MD were enrolled. All patients underwent caloric, o-VEMP, and c-VEMP tests. Results: In the AN group, the caloric test identified canal paresis and caloric areflexia in 10 ears, while the o-VEMP and c-VEMP tests identified abnormal (absent or delayed) responses in 12 and 11 ears, respectively. A significant correlation existed between caloric and o-VEMP test results, but not between caloric and c-VEMP test results, or between o-VEMP and c-VEMP test results. For the MD group, abnormal caloric, o-VEMP, and c-VEMP test results were obtained for 24%, 44%, and 38% of hydropic ears, respectively. No correlation existed between any two test results.