Ocular Vestibular-evoked Myogenic Potentials Research Articles

The effect of sport training on otolith function in adults with profound sensorineural hearing loss

Objectives It seems that regular physical activity leading to favourable alternations in the bodily system, including improved muscle mass, as well as better postural control. This study aims to assess the effect of strenuous training program on balance function in deaf adults. Methods During a cross-sectional design, 50 deaf patients and 22 healthy adults (with no history of vertigo and hearing loss) were included. Deaf patients were also classified as “non-athletes” and “athletes” groups. The vestibular (Otolith) function testing was carried out using the cervical vestibular-evoked myogenic potential (cVEMP) and ocular vestibular-evoked myogenic potential (oVEMP). Results The mean p13 latency and p13-n23 amplitude of cVEMPs in the control group were significantly shorter, and larger than the deaf groups, respectively. Furthermore, the mean p13-latency in “athletes deaf” group was significantly earlier than the “non-athletes deaf” group. The p1 and n1 oVEMP peak latencies were significantly prolonged in deaf patients than the controls. The comparison of the asymmetry ratio between the control and deaf groups was significant only for the cVEMP response. Conclusion Our results indicated that otolithic dysfunction is a common and hidden problem in the deaf population. Strenuous sport training in adults can be considered as an effective therapeutic intervention to stimulate vestibular function in deaf patients.

Cervical and Ocular Vestibular-Evoked Myogenic Potentials in Patients With Intracochlear Schwannomas.

Objective: To evaluate ocular and cervical vestibular evoked myogenic potentials (oVEMPs and cVEMPs) in patients with solely intracochlear localization of an intralabyrinthine schwannoma (ILS).Study Design: Retrospective analysis of a series of cases.Setting: Monocentric study at a tertiary referral center.Patients: Patients with intracochlear schwannoma (ICS) and VEMP measurements.Outcome Measures: Signed asymmetry ratio (AR) of cVEMPs and oVEMPs to air conducted sound with AR cut-offs considered to be asymmetrical when exceeding ±30% for cVEMPs and ±40% for oVEMPs with respect to the side affected by the tumor (reduced amplitudes on the affected side indicated by negative values, enhanced amplitudes by positive values); VEMP amplitudes and latencies; tumor localization in the cochlear turn and scala.Results: Nineteen patients with a solely intracochlear tumor (ICS patients) [10 males, 9 females, mean age 57.1 (SD: 13.4) years] were included in the study. On the affected side, cVEMPs were absent or reduced in 47% of the patients, normal in 32%, and enhanced in 21%. Ocular VEMPs on the affected side were absent or reduced in 53% of the patients, normal in 32% and enhanced in 15%. Latencies for cVEMPs and oVEMPs were not significantly different between the affected and non-affected side. In all patients with enhanced VEMPs, the tumor was located in the scala tympani and scala vestibuli.Conclusions: As a new and unexpected finding, VEMP amplitudes can be enhanced in patients with intracochlear schwannoma, mimicking the third window syndrome.

Elevated ocular VEMP responses in the absence of a superior semicircular canal dehiscence.

Vestibular evoked myogenic potentials (VEMPs) have an accepted role in the diagnosis of the superior semicircular canal dehiscence (SSCD) syndrome. The current impression is that ocular VEMPs (oVEMPs) are more sensitive than cervical VEMPs (cVEMPs) for detecting a SSCD and that oVEMP testing in response to air conducted sound provides an excellent screening test without risk of radiation exposure from computerized tomography (CT). To report on patients with elevated oVEMP amplitudes but without evidence for a SSCD on multiplanar CT imaging. Retrospective chart review of all patients referred for vestibular function testing to our department. Patients with oVEMP peak-to-peak amplitudes ≥17μν without evidence for a SSCD on imaging were evaluated. 26 patients had oVEMP peak-to-peak amplitudes ≥17μν with no evidence of a SSCD on imaging. The most common diagnosis was Meniere's disease in those identified. oVEMPs can provide false positive results for diagnosis of a SSCD and an elevated oVEMP amplitude in itself is insufficient for diagnosis of a SSCD.

Normative Data of Ocular Vestibular Evoked Myogenic Potentials in Response to Chirp Stimulus.

This study aims at comparing the tone-burst (TB) and narrow-band (NB) CE-chirp stimuli in terms of amplitude, latency, and interaural asymmetry ratio (IAR) in ocular vestibular evoked myogenic potentials (oVEMP). In this prospective study, we enrolled 60 healthy subjects (27 men, 33 women) with a mean age of 25.83 (range, 18-48) years. Otological examination was normal in all the subjects. The subjects did not have any otological disease. All the subjects underwent oVEMP testing. We used 500 Hz TB stimulus and 500 Hz NB CE-chirp stimulus in random order. oVEMP test was performed at 100 dB normalized hearing level. P1 latency, N1 latency, and P1N1 amplitude were measured for each ear and stimulus, and IAR was calculated. Ocular VEMPs were obtained from all the subjects for both the stimuli. P1 and N1 latencies were significantly shorter in chirp stimulus than in TB stimulus for both the sides (p<0.0001). P1 and N1 amplitudes were significantly higher for chirp stimulus than for TB stimulus for both the sides (p<0.0001). There was no significant difference between the ears in IAR between the 2 types of stimuli. Narrow-band CE-chirp stimulus is an effective stimulus to evoke oVEMP with higher amplitudes and shortened latencies.

Vestibular mapping in patients with unilateral peripheral-vestibular deficits.

To test the hypothesis that patterns of semicircular canal (SCC) and otolith impairment in unilateral vestibular loss depend on the underlying disorders, we analyzed peripheral-vestibular function of all 5 vestibular sensors. For this retrospective case series, we screened the hospital video-head-impulse test database (n = 4,983) for patients with unilaterally impaired SCC function who also received ocular vestibular-evoked myogenic potentials and cervical vestibular-evoked myogenic potentials (n = 302). Frequency of impairment of vestibular end organs (horizontal/anterior/posterior SCC, utriculus/sacculus) was analyzed with hierarchical cluster analysis and correlated with the underlying etiology. Acute vestibular neuropathy (AVN) (37.4%, 113 of 302), vestibular schwannoma (18.2%, 55 of 302), and acute cochleovestibular neuropathy (6.6%, 20 of 302) were most frequent. Horizontal SCC impairment (87.4%, 264 of 302) was more frequent (p < 0.001) than posterior (47.4%, 143 of 302) and anterior (37.8%, 114 of 302) SCC impairment. Utricular damage (58%, 175 of 302) was noted more often (p = 0.003) than saccular impairment (32%, 98 of 302). On average, 2.6 (95% confidence interval 2.48-2.78) vestibular sensors were deficient, with higher numbers (p ≤ 0.017) for acute cochleovestibular neuropathy and vestibular schwannoma than for AVN, Menière disease, and episodic vestibular syndrome. In hierarchical cluster analysis, early mergers (posterior SCC/sacculus; anterior SCC/utriculus) pointed to closer pathophysiologic association of these sensors, whereas the late merger of the horizontal canal indicated a more distinct state. While the extent and pattern of vestibular impairment critically depended on the underlying disorder, more limited damage in AVN and Menière disease was noted, emphasizing the individual range of loss of function and the value of vestibular mapping. Likely, both the anatomic properties of the different vestibular end organs and their vulnerability to external factors contribute to the relative sparing of the vertical canals and the sacculus.

Assessment of cervical and ocular vestibular evoked myogenic potentials in migraine patients

BackgroundPatients suffering from vestibular migraine (VM) are known to have various vestibular test abnormalities interictally and ictally. Recently, vestibular evoked myogenic potentials (VEMPs) have become accepted as a valid method for otolith function assessment. Many studies have identified various vestibular symptoms and laboratory abnormalities in migraineurs. Since migraineurs with no accompanying vestibular symptoms might exhibit subclinical vestibular dysfunction, we investigated vestibular function using ocular and cervical VEMPs in migraine patients. The aim was to study cervical VEMP and occular VEMP in migraineurs with and without vestibular symptoms interictally.ResultsMigraine and VM patients showed significantly longer P13 latency of cVEMP compared to controls. A statistically significant cVEMP interaural P13 latency difference was found in VM compared to healthy controls. Cervical VEMP N23 latency, peak-to-peak amplitude, interaural N23 latency, and amplitude asymmetric ratio did not show any significant difference in migraine and VM patients compared to healthy controls as well as no significant difference across the three groups regarding oVEMP parameters.ConclusionsAbnormal interictal cVEMP results in migraineurs might indicate subclinical vestibulo-collic pathway dysfunction.

Effect of Cochlear Implantation on Vestibular Evoked Myogenic Potentials and Wideband Acoustic Immittance.

The objective of this study was to determine if absent air conduction stimuli vestibular evoked myogenic potential (VEMP) responses found in ears after cochlear implantation can be the result of alterations in peripheral auditory mechanics rather than vestibular loss. Peripheral mechanical changes were investigated by comparing the response rates of air and bone conduction VEMPs as well as by measuring and evaluating wideband acoustic immittance (WAI) responses in ears with cochlear implants and normal-hearing control ears. The hypothesis was that the presence of a cochlear implant can lead to an air-bone gap, causing absent air conduction stimuli VEMP responses, but present bone conduction vibration VEMP responses (indicating normal vestibular function), with changes in WAI as compared with ears with normal hearing. Further hypotheses were that subsets of ears with cochlear implants would (a) have present VEMP responses to both stimuli, indicating normal vestibular function and either normal or near-normal WAI, or (b) have absent VEMP responses to both stimuli, regardless of WAI, due to true vestibular loss. Twenty-seven ears with cochlear implants (age range 7 to 31) and 10 ears with normal hearing (age range 7 to 31) were included in the study. All ears completed otoscopy, audiometric testing, 226 Hz tympanometry, WAI measures (absorbance), air conduction stimuli cervical and ocular VEMP testing through insert earphones, and bone conduction vibration cervical and ocular VEMP testing with a mini-shaker. Comparisons of VEMP responses to air and bone conduction stimuli, as well as absorbance responses between ears with normal hearing and ears with cochlear implants, were completed. All ears with normal hearing demonstrated 100% present VEMP response rates for both stimuli. Ears with cochlear implants had higher response rates to bone conduction vibration compared with air conduction stimuli for both cervical and ocular VEMPs; however, this was only significant for ocular VEMPs. Ears with cochlear implants demonstrated reduced low-frequency absorbance (500 to 1200 Hz) as compared with ears with normal hearing. To further analyze absorbance, ears with cochlear implants were placed into subgroups based on their cervical and ocular VEMP response patterns. These groups were (1) present air conduction stimuli response, present bone conduction vibration response, (2) absent air conduction stimuli response, present bone conduction vibration response, and (3) absent air conduction stimuli response, absent bone conduction vibration response. For both cervical and ocular VEMPs, the group with absent air conduction stimuli responses and present bone conduction vibration responses demonstrated the largest decrease in low-frequency absorbance as compared with the ears with normal hearing. Bone conduction VEMP response rates were increased compared with air-conduction VEMP response rates in ears with cochlear implants. Ears with cochlear implants also demonstrate changes in low-frequency absorbance consistent with a stiffer system. This effect was largest for ears that had absent air conduction but present bone conduction VEMPs. These findings suggest that this group, in particular, has a mechanical change that could lead to an air-bone gap, thus, abolishing the air conduction VEMP response due to an alteration in mechanics and not a true vestibular loss. Clinical considerations include using bone conduction vibration VEMPs and WAI for preoperative and postoperative testing in patients undergoing cochlear implantation.

Ocular Vestibular-Evoked Myogenic Potential Amplitudes Elicited at 4 kHz Optimize Detection of Superior Semicircular Canal Dehiscence.

Introduction: High-resolution temporal bone computed tomography (CT) is considered the gold standard for diagnosing superior semicircular canal dehiscence (SCD). However, CT has been shown over-detect SCD and provide results that may not align with patient-reported symptoms. Ocular vestibular-evoked myogenic potentials (oVEMPs)—most commonly conducted at 500 Hz stimulation—are increasingly used to support the diagnosis and management of SCD. Previous research reported that stimulation at higher frequencies such as 4 kHz can have near-perfect sensitivity and specificity in detecting radiographic SCD. With a larger cohort, we seek to understand the sensitivity and specificity of 4 kHz oVEMPs for detecting clinically significant SCD, as well as subgroups of radiographic, symptomatic, and surgical SCD. We also investigate whether assessing the 4 kHz oVEMP n10-p15 amplitude rather than the binary n10 response alone would optimize the detection of SCD.Methods: We conducted a cross-sectional study of patients who have undergone oVEMP testing at 4 kHz. Using the diagnostic criteria proposed by Ward et al., patients were determined to have SCD if dehiscence was confirmed on temporal bone CT by two reviewers, patient-reported characteristic symptoms, and if they had at least one positive vestibular or audiometric test suggestive of SCD. Receiver operating characteristic (ROC) analysis was conducted to identify the optimal 4 kHz oVEMP amplitude cut-off. Comparison of 4 kHz oVEMP amplitude across radiographic, symptomatic, and surgical SCD subgroups was conducted using the Mann-Whitney U test.Results: Nine hundred two patients (n, ears = 1,804) underwent 4 kHz oVEMP testing. After evaluating 150 temporal bone CTs, we identified 49 patients (n, ears = 61) who had radiographic SCD. Of those, 33 patients (n, ears = 37) were determined to have clinically significant SCD. For this study cohort, 4 kHz oVEMP responses had a sensitivity of 86.5% and a specificity of 87.8%. ROC analysis demonstrated that accounting for the inter-amplitude of 4 kHz oVEMP was more accurate in detecting SCD than the presence of n10 response alone (AUC 91 vs. 87%). Additionally, using an amplitude cut-off of 15uV reduces false positive results and improves specificity to 96.8%. Assessing 4 kHz oVEMP response across SCD subgroups demonstrated that surgical and symptomatic SCD cases had significantly higher amplitudes, while radiographic SCD cases without characteristic symptoms had similar amplitudes compared to cases without evidence of SCD.Conclusion: Our results suggest that accounting for 4 kHz oVEMP amplitude can improve detection of SCD compared to the binary presence of n10 response. The 4 kHz oVEMP amplitude cut-off that maximizes sensitivity and specificity for our cohort is 15 uV. Our results also suggest that 4 kHz oVEMP amplitudes align better with symptomatic SCD cases compared to cases in which there is radiographic SCD but no characteristic symptoms.

Evaluation of ocular and cervical vestibular evoked myogenic potentials in patients with conductive and sensorineural hearing loss

Background Vestibular evoked myogenic potential (VEMP) test is an electrophysiological testing that can assess dysfunction of otolithic organs and the integrity of their pathways precisely. Aim Compare amplitude and latency of ocular and cervical vestibular evoked myogenic potentials evoked by air- and bone-conducted stimuli in three different groups. Materials and methods The control group (group 1) included ten healthy volunteers adults (20 ears) with normal hearing thresholds. Group 2 consisted of ten patients (20 ears) with conductive hearing loss (CHL) and group 3 comprised 10 patients (20 ears) with sensorineural hearing loss (SNHL). All participants underwent pure tone audiometry, immittancemetry ocular vestibular evoked myogenic potential (oVEMPs) and cervical vestibular evoked myogenic potential (cVEMPs) by air and bone conduction stimuli. Results The response rate of cVEMPs and oVEMPs elicited by both types of stimuli was 100% in control group and SNHL group. In the group of conductive hearing loss, air conduction(AC) (c VEMPs and o VEMPs) response rate was 60%. There was a statistically significant positive correlation between latencies of oVEMPs and cVEMPs evoked by AC and BC methods and degrees of hearing loss in SNHL group. Conclusion Ocular and cervical VEMPs elicited by bone conduction (BC) stimuli aren’t vulnerable to conductive hearing loss. Bc VEMPs provides assessment of vestibular system in patients with conductive hearing loss. Significant correlation was found between cVEMPs and oVEMPs abnormalities and severity of sensorineural hearing loss.

Assessing the cervico-ocular reflex system via modifying the ocular vestibular-evoked myogenic potential test

Purpose The aim of this study was to devise a novel test for assessing the cervico-ocular reflex (COR) system via head vibration (termed h-COR) or neck vibration (termed n-COR) method. Materials and methods Thirteen patients with complete loss of bilateral vestibulo-ocular reflex (VOR) showing oscillopsia were assigned to Group A, while 13 patients with bilateral VOR loss but no oscillopsia were Group B. Another 13 healthy elderly served as a control. The COR test was performed via modifying the ocular vestibular-evoked myogenic potential (oVEMP) test by tapping at the forehead with head rotation (h-COR) or at mid-dorsal neck with head straight (n-COR). Results Both h-COR and n-COR tests displayed similar cI–cII waveforms. None of the Group A or healthy elderly showed present h-COR, while 8% of Group A and 31% of the healthy elderly revealed present n-COR. In contrast, present h-COR and n-COR were elicited in 85 and 77% of Group B, respectively. Restated, significantly higher response rate of COR in Group B (without oscillopsia) than Group A (with oscillopsia) indicates that present COR is related to the alleviation of oscillopsia. Conclusions Head vibration method (h-COR test) is superior to neck vibration method (n-COR test) for assessing the COR system.

Effective diagnostics for vertigo, dizziness and equilibrium disorders

Vertigo, dizziness and equilibrium disorders are symptoms with avariety of causes. First, four cardinal questions (type and duration of the vertigo, triggering factors, accompanying symptoms) must be answered. After that, the search for aspontaneous nystagmus (differentiation of peripheral and central disorder using the HINTS[head impulse, nystagmus, test of skew]-test ) and, as part of apositioning examination, the search for abenign paroxysmal positional vertigo (BPPV) are necessary. If the result is negative an instrument-based receptor-specific examination is carried out. The caloric examination (low-frequency stimulus) tests the horizontal semicircular canal and the superior vestibular nerve, whereas the 3‑D video head impulse test (vHIT, high-frequency stimulus) is used to analyze all three semicircular canals as well as the superior and inferior vestibular nerves. Analysis of the cervical vestibular evoked myogenic potential (cVEMP) checks the function of the sacculus and that of the ocular VEMP (oVEMP) checks the function of the utriculus. The final overall analysis usually gives adefinitive diagnosis or at least provides asuspected diagnosis, which then determines the further diagnostic procedure (e.g. targeted radiological diagnostics if vestibular paroxysmia, superior canal dehiscence or a vestibular schwannoma are suspected).

The effect of superior canal dehiscence size and location on audiometric measurements, vestibular-evoked myogenic potentials and video-head impulse testing.

To correlate objective measures of audio-vestibular function with superiorcanaldehiscence (SCD) size and location in ears with SCD and compare results with literature. We retrospectively evaluated 242 patients exhibiting SCD and/or extremely thinned bone overlying superior canals (SC) on CT scans and selected 73 SCD patients (95 ears with SCD). Data concerning audiometry, impedance audiometry, video-head impulse test (vHIT), cervical vestibular-evoked myogenic potentials (cVEMPs) and ocular VEMPs (oVEMPs) to air- (AC) and bone-conducted (BC) stimuli were collected for each pathologic ear and correlated with dehiscence size and location. AC pure-tone average (PTA) (p = 0.013), low-frequency air-bone gap (ABG) (p < 0.001), AC cVEMPs amplitude (p = 0.002), BC cVEMPs amplitude (p < 0.001) and both AC and BC oVEMPs amplitude (p < 0.001) positively correlated with increasing SCD size. An inverse relationship between dehiscence length and both AC cVEMPs and oVEMPs thresholds (p < 0.001) and SC vestibulo-ocular reflex (VOR) gain (p < 0.001) was observed. Dehiscences at the arcuate eminence (AE) exhibited lower SC VOR gains compared to SCD along the ampullary arm (p = 0.008) and less impaired BC thresholds than dehiscences at the superior petrosal sinus (p = 0.04). We confirmed that SCD size affects AC PTA, ABG and both amplitudes and thresholds of cVEMPs and oVEMPs. We also described a tendency for SC function to impair with increasing SCD size and when dehiscence is located at the AE. The latter data may be explained either by a spontaneous canal plugging exerted by middle fossa dura or by a dissipation through the dehiscence of mechanical energy conveyed to the endolymph during high-frequency impulses.

An exploration of vestibular function pre and post unilateral cochlear implantation

Objectives: To examine the effects of unilateral cochlear implantation on the balance system for adult patients with bilateral severe to profound sensory neural hearing loss. Methods: 7 CI candidates. The function of the sacculus, utricle, and three semi-circular canals (SCCs) was assessed separately using air conduction cervical vestibular evoked myogenic potentials (VEMP), vibration ocular VEMP and the video head impulse test (vHIT) respectively on each side, pre- and post-operatively. Results: The Otoliths appear more affected by implantation than SCCs. In 3 of 7 cases VEMP was affected by implantation. In 2 cases this was associated with short-term dizziness. Discussion: Differential assessment of vestibular end organ function may elucidate how cochlear implantation affects the vestibular system. As many CI candidates have some vestibular function, pre-implant vestibular assessment may help to inform which side of implantation may best preserve that function if other audiology and surgical considerations are equal. Post-implant assessment with VEMP may help to predict short-term dizziness. More work with a larger sample will be needed to make the case for routine clinical assessment. Conclusions: There is potential benefit of conducting multimodal vestibularassessment pre and post cochlear implantation. The otoliths appear more affected by implantation than the SCC.

Vestibular Evoked Myogenic Potential (VEMP) Test-retest Reliability in Children.

Vestibular evoked myogenic potentials (VEMPs) are short-latency muscle potentials measured from the neck (cervical VEMP; cVEMP) or under the eyes (ocular VEMP; oVEMP), which provide information regarding function of the saccule and utricle, respectively. VEMPs are reliable when performed in adults; however, reliability of VEMPs in children is unknown. Therefore, the purpose of the study was to determine the test-retest reliability of c- and oVEMP testing in normal control children. Prospective. Hospital. Ten adults, 14 adolescent children and 13 young children with normal hearing. c- and oVEMP testing were completed across two test sessions in response to air-conduction 500 Hz tone-burst and impulse hammer stimuli. Additionally, oVEMP was completed using eyes-open and eyes-closed conditions. Intraclass correlation coefficients were calculated to determine the reliability of c- and oVEMP outcomes. When using air-conduction stimuli, c- and oVEMP amplitudes are reliable across test sessions in normal control children and adults. With impulse hammer stimuli, cVEMP amplitudes showed high reliability; however, oVEMP amplitudes showed low reliability in both eyes-open and eyes-closed conditions. Comparison between eyes-open and eyes-closed oVEMP conditions revealed shorter latencies and higher peak-to-peak amplitudes in the eyes-open condition. In this small cohort of normal control children, cVEMPs are reliable using air-conduction and impulse hammer stimuli and oVEMPs are reliable using air-conduction stimuli in the eyes-open condition. oVEMP in eyes-closed conditions were less reliable compared with eyes-open conditions and resulted in a large number of absent responses.

Evidence-based diagnostic use ofVEMPs : From neurophysiological principles to clinical application.

BackgroundVestibular evoked myogenic potentials (VEMPs) are increasingly being used for testing otolith organ function.ObjectiveThis article provides an overview of the anatomical, biomechanical and neurophysiological principles underlying the evidence-based clinical application of ocular and cervical VEMPs (oVEMPs and cVEMPs).Material and methodsSystematic literature search in PubMed until April 2019.ResultsSound and vibration at a frequency of 500 Hz represent selective vestibular stimuli for the otolith organs. The predominant specificity of oVEMPs for contralateral utricular function and of cVEMPs for ipsilateral saccular function is defined by the different central projections of utricular and saccular afferents. VEMPs are particularly useful in the diagnosis of superior canal dehiscence and otolith organ specific vestibular dysfunction and as an alternative diagnostic approach in situations when video oculography is not possible or useful.ConclusionThe use of VEMPs is a simple, safe, reliable and selective test of dynamic function of otolith organs.Electronic supplementary materialThe online version of this article (10.1007/s00106-019-00767-2) contains supplementary material with further information on the following topics: S1: The striola: an ideal “jerk” detector. S2: Sound and vibration as otolithic stimuli. S3: Vestibular microphonics. S4: Superior canal dehiscence. Contribution and additional material are available at www.springermedizin.de. Please enter the title of the article in the Search, the supplementary material can be found at the end of the article under “Additional content”.

Vestibular evoked myogenic potentials in vestibular migraine and Meni\xe8re\u2019s disease: cVEMPs make the difference

ObjectiveVestibular evoked myogenic potentials (VEMPs) have been suggested as biomarkers in the differential diagnosis of Menière’s disease (MD) and vestibular migraine (VM). The aim of this study was to compare the degree of asymmetry for ocular (o) and cervical (c) VEMPs in large cohorts of patients with MD and VM and to follow up the responses.Study designRetrospective study in an interdisciplinary tertiary center for vertigo and balance disorders.MethodscVEMPs to air-conducted sound and oVEMPs to bone-conducted vibration were recorded in 100 patients with VM and unilateral MD, respectively. Outcome parameters were asymmetry ratios (ARs) of oVEMP n10p15 and cVEMP p13n23 amplitudes, and of the respective latencies (mean ± SD).ResultsThe AR of cVEMP p13n23 amplitudes was significantly higher for MD (0.43 ± 0.34) than for VM (0.26 ± 0.24; adjusted p = 0.0002). MD—but not VM—patients displayed a higher AR for cVEMP than for oVEMP amplitudes (MD 0.43 ± 0.34 versus 0.23 ± 0.22, p < 0.0001; VM 0.26 ± 0.14 versus 0.19 ± 0.15, p = 0.11). Monitoring of VEMPs in single patients indicated stable or fluctuating amplitude ARs in VM, while ARs in MD appeared to increase or remain stable over time. No differences were observed for latency ARs between MD and VM.ConclusionsThese results are in line with (1) a more common saccular than utricular dysfunction in MD and (2) a more permanent loss of otolith function in MD versus VM. The different patterns of o- and cVEMP responses, in particular their longitudinal assessment, might add to the differential diagnosis between MD and VM.

A Basis for Standardizing Superior Semicircular Canal Dehiscence Management.

(1) To determine how otologic/neurotologic surgeons counsel patients with superior semicircular canal dehiscence (SSCD). (2) To understand the plethora of presenting symptoms associated with SSCD and appropriate management. (3) To suggest appropriate management; oftentimes avoiding surgery. This was a survey study of both community and academic physicians. A 23-question survey was distributed to all members of the American Neurotological (ANS) and American Otologic Societies (AOS) via email in the Fall of 2018. A total of 54 responses were received from a possible pool of 279 for a response rate of 19.4%. Inferences were made about the population through sample proportions and confidence intervals. All respondents use computed tomography (CT) in diagnosing SSCD and 11.1% use CT exclusively. Cervical vestibular evoked myogenic potential (VEMP; 77.8%) are used more often than ocular VEMPs (38.9%). Magnetic resonance imaging (7.4%) is used infrequently; 96.3% of surgeons surveyed have seen patients with SSCD on imaging that are asymptomatic. Following surgical treatment, respondents reported balance issues and mild-to-moderate high-frequency sensorineural hearing loss (88.4%); 32.6% reported that the majority (>50%) of their patients needed further intervention after surgery, typically aggressive vestibular rehabilitation. There is a discrepancy in the systematic approach to SSCD between both the surgeons and the published literature. Patients with SSCD on ultra-high-resolution CT may have myriad symptoms while others are asymptomatic, and surgery may lead to additional complications. We will present a methodical recommendation to assist in the management of patients with SSCD depending upon their symptoms. This may improve patient selection, counseling, and outcomes.

Comparisons among vestibular examinations and symptoms of vertigo in sudden sensorineural hearing loss patients.

Vertigo in sudden sensorineural hearing loss (SSNHL) is hypothesized as an extension of the disease caused by the anatomical proximity of the cochlea and vestibule. The present study aimed to demonstrate the association of vestibular function test (VFT) results with SSNHL disease severity and prognosis. This study assessed clinical records of 263 SSNHL patients admitted to our hospital, between January 2010 and October 2017. Steroid treatment comprised high-dose intravenous dexamethasone (16mg/d) or oral methylprednisolone (64mg/d) for 4days and tapered oral methylprednisolone for 8days after discharge. Caloric tests were performed in all patients, and cervical vestibular-evoked myogenic potential (c-VEMP) and ocular VEMP (o-VEMP) tests were performed in 209 and 144 patients, respectively. Ninety six patients had vertigo, and caloric abnormalities were observed in 119 patients. Initial PTA in patients with vertigo were worse than in those without vertigo (63.0dB vs 72.7dB, P=.002). Initial PTA in patients with abnormal o-VEMP was worse than in those with normal o-VEMP (61.4dB vs 73.0dB, P=.004). PTA improvement after steroid treatment in patients with vertigo was lower than in those without vertigo (25.0dB vs 20.9dB, P=.028). PTA improvement after treatment in patients with abnormal caloric results was lower than in those with normal caloric results (26.0dB vs 18.4dB, P=.013). The functions of vestibular organs, particularly the utricle and lateral semicircular canal, are associated with disease severity and hearing outcome in SSNHL patients.

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.

Predictive Value of Vestibular Evoked Myogenic Potentials in the Diagnosis of Menière's Disease and Vestibular Migraine.

To explore the usefulness of vestibular evoked myogenic potentials (VEMPs) in the diagnosis of Menière's disease (MD) and vestibular migraine (VM). Retrospective cohort. Multidisciplinary neurotology clinic. Definite MD and definite VM patients between January, 2015 and May, 2017, as well as healthy volunteers. Cervical and ocular VEMP (cVEMP and oVEMP) testing. VEMP response, amplitude, and latency. Twenty five definite MD, 34 definite VM, and 13 control subjects were analyzed. MD affected ears had significantly lower cVEMP (p = 0.007) and oVEMP (p < 0.001) amplitudes than control ears. VM ears had significantly lower oVEMP (p = 0.001), but not cVEMP (p = 0.198) amplitudes than control ears. MD affected ears, but not VM ears, had significantly more absent cVEMP (25.9% versus 0%, p = 0.005) and oVEMP responses (40.7% versus 0%, p < 0.001) than control ears. oVEMP latency was significantly shorter for both MD affected (p < 0.001) and VM ears (p < 0.001) than control ears. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated using a neurotology clinic MD prevalence of 7.9% in dizzy patients. A present cVEMP or oVEMP both have more than 93% chance of ruling MD out in the tested ear, while a cVEMP amplitude more than 54.9 μV or oVEMP amplitude more than 5.1 μV both have more than 94% of ruling out MD in the tested ear. Despite some overlap in VEMP results between MD and VM, when the diagnosis is uncertain between the two disorders due to symptomatic overlap and nonspecific audiometric data, VEMPs can be helpful in guiding treatment toward one disease entity or the other until more evidence points to a definitive diagnosis.