oVEMP Test Research Articles

Pathological eye movements influence on the recordings of ocular vestibular-evoked myogenic potential

Objective: This study investigated the influence of pathological eye movements on the recordings of ocular vestibulo-evoked myogenic potential (oVEMP).Methods: Ten patients with pathological eye movements of non-vestibular origin (nine congenital nystagmus and one opsoclonus) who had negative MRI result were assigned to Group A. Another 20 vestibular neuritis (VN) patients with spontaneous nystagmus were assigned to Group B. Both groups underwent audiometry, and caloric, oVEMP and cervical VEMP (cVEMP) tests.Results: In Group A, the caloric, oVEMP and cVEMP tests showed 40%, 55% and 50% abnormalities, respectively. In Group B (VN), caloric, oVEMP and cVEMP tests revealed 100%, 80% and 45% abnormalities on the lesion ears, and 0%, 40% and 0% abnormalities on the healthy (opposite) ears, respectively. The 40% oVEMP abnormality on the healthy ears may be due to recording failure from the presence of spontaneous nystagmus, since five of five VN patients showed normal oVEMPs on the healthy ears, one year after presentation.Conclusions: Presence of pathological eye movements may affect the recordings of oVEMP. Thus, the oVEMP test is recommended to perform after acute vertiginous episode to exclude the influence of pathological eye movements on the oVEMP recordings.

Pilot study on the functional evaluation of vestibular otolith-organ pathway in the stage of patients with Meniere disease

Objective: To observe the features of air-conducted sound elicited ocular vestibular-evoked myogenic potential(ACS-oVEMP) and cervical vestibular-evoked myogenic potential(ACS-cVEMP) in patients with Meniere disease (MD). To analyze the relationship between air-conducted sound elicited vestibular-evoked myogenic potentials (ACS-VEMP) responses and clinical stages of disease, as well as its clinical application of cervical and ocular vestibular evoked myogenic potentials in MD. Method: Fifty six patients with MD and 50 normal subjects (100 ears) were recruited for conventional cVEMP and oVEMP examinations. Grades of vestibular function were also collected for patients with MD. The relationship between VEMPs abnormity, grades of vestibular function and clinical stages of MD were analyzed. Results: The abnormal rates of cVEMP and oVEMP in MD patients were 57.1% (32/56) and 64.3% (36/56), which were significantly higher than those in normal subjects respectively (χ2=22.286, P=0.000; χ2=15.217, P=0.000). The abnormal rates of cVEMP and oVEMP in MD patients of stage Ⅰ to stage Ⅳ were 20.0% (1/5) and 40.0% (2/5), 50.0% (9/18) and 50.0% (9/18), 59.3% (16/27) and 70.4% (19/27), and 100.0% (6/6) and 100.0% (6/6) respectively. There was a significant difference in cVEMP abnormity between four stages of MD patients (P=0.046). Significant correlation was found between clinical stages and the grades of vestibular dysfunction (rs=0.417, P=0.001). Conclusions: Dysfunction of vestibular otolithic organs and their input pathways in patients with MD can be detected by cVEMP and oVEMP tests. The abnormal rates of VEMP could show an gradually increasing trend with the development of MD stages. And the extent of vestibular lesions could be detected by cVEMP and oVEMP tests, which may provide a reference for clinical staging of MD.

Simultaneous triple semicircular canal plugging and cochlear implantation in advanced Meniere's disease

Objective: To evaluate the feasibility of combining simultaneous triple semicircular canal plugging (TSCP) and cochlear implantation (CI) to treat vertigo and hearing loss in advanced Meniere's disease(MD) patients, so as to provide an alternative surgical procedure for treating this disorder. Methods: Data from seven patients, who were referred to our hospital and diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006), from Jan. 2015 to Jan. 2016, were retrospectively analyzed in this work. Seven patients, in whom the standardized conservative treatment had been given for at least one year and frequent vertigo still occurred, underwent simultaneous TSCP and CI under general anesthesia via mastoid approach. Postoperative follow-up time was more than six months. Vertigo control and auditory function were measured. Pure tone audiometry, speech perception scores, caloric test, head impulse test (HIT), and vestibular evoked myogenic potential (VEMP) were performed for evaluation of audiological and vestibular functions. Results: All patients had bilateral severe sensorineural hearing loss preoperatively. One side hearing loss was due to MD and another side was due to reasons including sudden sensorineural hearing loss, mumps and other unknown reason. The total control rate of vertigo in seven MD patients was 100.0% in the six-month follow-up, with complete control rate of 85.7% (6/7) and substantial control rate of 14.3% (1/7). Improved hearing threshold and speech perception scores were observed in all study participants. Postoperative average aided hearing threshold was 32.5 dBHL, the average monosyllabic word score was 42.6% and speech perception scores of sentences tested in quiet was 52.3%. Tinnitus improved in five cases, and no significant change in two patients. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3-5 days, while, an average recovery time of balance disorders was 19.7 days. Six months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in cVEMP or oVEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications. Conclusions: A combined approach of TSCP and CI which could control vertigo effectively and improve hearing loss and tinnitus represents an effective and safe therapy for some advanced MD patients.

Role of Vestibular Evoked Myogenic Potentials as an Indicator of Recovery in Patients with Benign Paroxysmal Positional Vertigo.

Ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP) are newer diagnostic methods, which allow an insight into the otolith senses. Our aim was to determine changes in certain parameters of the VEMP wave complex after successfully performed repositioning procedure, as an indicator of the state of recovery in patients with benign paroxysmal positional vertigo (BPPV). This may confirm the theory of otolith returning into the area of otolithic senses. The study included 48 patients with unilateral posterior semicircular canal BPPV. On their first arrival, otoneurological examinations, oVEMP and cVEMP tests were performed. The same were included in follow up check-ups scheduled at seven days and six months after successful implementation of Epley maneuvers. The initial measurement revealed a significantly reduced amplitude of oVEMP on the affected side. On the 7-day measurement, the amplitude increase was observed on the affected side, with significant reduction in the amplitude ratio (p=0.693), which reached statistical significance on the last measurement at 6 months (p=0.006). These findings confirmed the hypothesis of the return of otoconia into the utricular area.

A Comparative Study of Data Collection Methods in the Process of Nursing: Detection of Chemotherapy Side Effects Using a Self-Reporting Questionnaire.

Ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP) are newer diagnostic methods, which allow an insight into the otolith senses. Our aim was to determine changes in certain parameters of the VEMP wave complex after successfully performed repositioning procedure, as an indicator of the state of recovery in patients with benign paroxysmal positional vertigo (BPPV). This may confirm the theory of otolith returning into the area of otolithic senses. The study included 48 patients with unilateral posterior semicircular canal BPPV. On their first arrival, otoneurological examinations, oVEMP and cVEMP tests were performed. The same were included in follow up check-ups scheduled at seven days and six months after successful implementation of Epley maneuvers. The initial measurement revealed a significantly reduced amplitude of oVEMP on the affected side. On the 7-day measurement, the amplitude increase was observed on the affected side, with significant reduction in the amplitude ratio (p=0.693), which reached statistical significance on the last measurement at 6 months (p=0.006). These findings confirmed the hypothesis of the return of otoconia into the utricular area.

N-acetylcysteine as a single therapy for sudden deafness

Conclusion: Like NAC ameliorates hearing loss from acoustic trauma in the inner ear, NAC may also rescue hearing loss from sudden deafness confined to the inner ear.Objective: This study assesses the effect of N-acetyl-L-cysteine (NAC) as a single therapy for sudden deafness.Methods: Thirty-five sudden deafness patients with neither systemic disorders nor central signs in electronystagmography were treated with NAC alone and assigned to Group A. For comparison, another 35 sudden deafness patients treated by corticosteroids and plasma expander were assigned to Group B. There were no significant differences between the two groups in terms of age, sex, laterality, and pre-treatment mean hearing level. All patients underwent an inner ear test battery comprising audiometry, and ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests.Results: Groups A and B did not significantly differ in the pre-treatment mean hearing level, and percentages of abnormal oVEMP, cVEMP, and caloric tests, indicating that the involvement severity of sudden deafness between the two groups was similar. However, Group A (43 ± 27 dB) showed significantly greater mean hearing gain than Group B (21 ± 28 dB), and Group A (91%) revealed better improved rate of hearing than Group B (57%).

Secondary Endolymphatic Hydrops After Acoustic Trauma.

This study applied an inner ear test battery in patients with secondary hydrops after acoustic trauma to assess the inner ear deficits. Retrospective study. University hospital. Twenty patients with secondary hydrops after acoustic trauma were assigned to Group A. The interval between noise exposure and the testing time varied from 1 month to 3 years (median 3 months). Another 20 patients without progressive hearing loss for at least 3 years after acoustic trauma were assigned to Group B. There were no significant differences between the two groups in terms of age, sex, laterality, and noise source. Before treatment, all patients received audiometry, and caloric, ocular vestibular-evoked myogenic potential (VEMP), and cervical VEMP (cVEMP) tests. Percentages of abnormal mean hearing level (MHL), cVEMP test, oVEMP test, and caloric test were 75%, 75%, 61%, and 43% in Group A, and 35%, 57%, 61%, and 39% in Group B, respectively. Both groups exhibited a significantly declining sequence in inner ear function. Comparison of the abnormalities in the inner ear test battery between Groups A and B revealed a significant difference in percentages of abnormal MHL, but not in those of abnormal cVEMP, oVEMP, and caloric tests. Secondary hydrops after acoustic trauma occurs mainly on the cochlear part, but less on the vestibular part probably because previous acoustic trauma, i.e., firearms have severely damaged the vestibular partition.

Ocular vestibular evoked myogenic potentials as a test for myasthenia gravis.

To explore whether ocular vestibular evoked myogenic potentials (oVEMP) can be used to detect a decrement in the extraocular muscle activity of patients with myasthenia gravis (MG). Twenty-seven patients with MG, including 13 with isolated ocular and 14 with generalized MG, and 28 healthy controls participated. We applied repetitive vibration stimuli to the forehead and recorded the activity of the inferior oblique muscle with 2 surface electrodes placed beneath the eyes. To identify the oVEMP parameters with the highest sensitivity and specificity, we evaluated the decrement over 10 stimulus repetitions at 3 different repetition rates (3 Hz, 10 Hz, and 20 Hz). Repetitive stimulation at 20 Hz yielded the best differentiation between patients with MG and controls with a sensitivity of 89% and a specificity of 64% when using a unilateral decrement of ≥15.2% as cutoff. When using a bilateral decrement of ≥20.4% instead, oVEMP allowed differentiation of MG from healthy controls with 100% specificity, but slightly reduced sensitivity of 63%. For both cutoffs, sensitivity was similar in isolated ocular and generalized MG. Our study demonstrates that the presence of an oVEMP decrement is a sensitive and specific marker for MG. This test allows direct and noninvasive examination of extraocular muscle activity, with similarly good diagnostic accuracy in ocular and generalized MG. Thus, oVEMP represents a promising diagnostic tool for MG. This study provides Class III evidence that oVEMP testing accurately identifies patients with MG with ocular symptoms (sensitivity 89%, specificity 64%).

VEMP 所見異常と治療による回復を認めた中枢神経系脱髄疾患の一症例

Multiple sclerosis (MS) is characterized by multiple demyelinations within the central nervous system. It has been reported that patients with MS frequently have abnormal findings of cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP). We report the case of a patient with MS in whom cVEMP and oVEMP testing was useful for assessment of the lesions in the brainstem and their recovery. A 17-year-old woman presented with the feeling of light-headedness and a dull ache in the temple. MRI showed multiple T2-prolonged lesions, suggestive of demyelinated lesions in the left medulla oblongata, left superior cerebellar peduncle and left cerebellar hemisphere. One month after the MRI assessment, the patient's clinical findings worsened. She was diagnosed as having MS. Prior to the start of medical treatment, VEMP testing was performed. Air-conducted cVEMP showed a normal response to right ear stimulation, but decreased p13-n23 amplitudes and prolonged p13 latency in the left ear. Air-conducted oVEMP showed a normal amplitude, but prolonged N1 and P1 latencies in response to right ear stimulation, while there was no response to left ear stimulation. ABRs were normal. The patient was started on steroid pulse treatment, in response to which every T2-prolonged lesion in the MRI improved. Air-conducted cVEMP responses to left ear stimulation were restored to normal. Air-conducted sound oVEMPs showed normal amplitudes, but still slightly prolonged N1 and P1 latencies in response to right ear stimulation. oVEMP responses to left ear stimulation appeared after the treatment. According to the results of the first cVEMP and oVEMP testing, it was considered that lesions existed in the left MLF, vestibular nucleus and intramedullary vestibular nerve, while these structures on the right side were spared. The results of the testing for VEMPs were compatible with the MRI findings and the course of the MS. VEMP testing seems to be useful in the assessment of MS patients.

Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients

BackgroundIt is well-known that ocular vestibular evoked myogenic potentials (oVEMPs) predominantly reflect utricular function whilst cervical vestibular evoked myogenic potentials (cVEMPs) reflect saccular function. To date, there are no published reports on the systemic evaluation of utricular and saccular function in benign paroxysmal positional vertigo (BPPV), nor are there any reports on the differences in VEMPs between patients with recurrent and non-recurrent BPPV. The aim of this study was to evaluate the difference in cervical and ocular (c/o)VEMPs between patients with BPPV and normal controls, as well as between patients with recurrent and non-recurrent BPPV.MethodsThirty patients with posterior canal BPPV and 30 healthy subjects (as normal controls) were prospectively enrolled. cVEMP and oVEMP testing using 500 Hz tone-burst stimuli were performed on all. VEMP tests were repeated 3 times on each subject to ensure reliability and reproducibility of responses. VEMPs were defined as present or absent. Abnormal VEMP was defined by lack of VEMP response.ResultsIn the control group, abnormal cVEMPs responses were detected in 6.67 % and abnormal oVEMPs responses were detected in 3.34 %. In BPPV patients (10 with recurrent BPPV, 20 with non-recurrent BPPV), abnormal cVEMPs responses were detected in 30 % and abnormal oVEMPs responses were detected in 56.7 %. More patients with BPPV showed abnormal responses in c/oVEMPs as compared to the control group (p < 0.05). oVEMPs was more often abnormal as compared to cVEMPs in BPPV patients (p < 0.05). There was no statistical difference between abnormal cVEMP responses in non-recurrent BPPV patients (25 %) and recurrent BPPV patients (40 %) (p > 0.05). Differences in abnormal oVEMP responses (non-recurrent BPPV, 40 %; recurrent BPPV, 90 %) were significant (p < 0.05).ConclusionAn increased occurrence of abnormal c/oVEMP recordings appeared in BPPV patients, possibly as a result of degeneration of the otolith macula. oVEMPs were more often abnormal in BPPV patients as compared to cVEMPs, suggesting that utricular dysfunction may be more common than saccular dysfunction. Furthermore, oVEMP abnormalities in the recurrent BPPV group were significantly higher than those in the non-recurrent BPPV group. Assessment of c/oVEMPs in BPPV patients may therefore be of prognostic value in predicting likelihood of BPPV recurrence.

Ocular vestibular-evoked myogenic potentials using air-conducted sound: test parameters and normative data in healthy children; effect of body position on threshold.

In the present prospective study, we both investigated positioning techniques for the enhancement of oVEMP procedures and the viability of oVEMP testing in a healthy children population. A total of 41 healthy children were enrolled in this study. 21 were boys and 20 were girls, with their ages ranging from 4 to 16years. All children underwent audiometry and tympanometry prior to oVEMP test in upright and supine position. All subjects had normal hearing. The procedure was well tolerated by all children. Typical biphasic oVEMPs presented in 97.56% in upright position and 90.25% in the supine position. No statistically significant difference could be found concerning which position elicits the best or worst responses. However, a trend towards the supine position was noticed. It may be concluded that oVEMP test proved to be a well-tolerated examination of the vestibular system in children aged above 4years old. Our results did not show a statistical difference on the oVEMP thresholds between the two body positions. However, further larger studies are needed to confirm these findings.

Ototoxicity from organic solvents assessed by an inner ear test battery

This study adopted an inner ear test battery comprising audiometry, and ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP) and caloric tests to assess inner ear function in patients with long term exposure to organic solvents. Eighteen patients exposed to organic solvents and another 18 non-exposed controls from the same environment were enrolled in this study. Each subject underwent an inner ear test battery. The percentages of abnormalities identified by the oVEMP test, cVEMP test, audiometry and caloric test for the exposed group were 85%, 54%, 50% and 33%, respectively, which showed significant differences when compared with the respective 8%, 8%, 6% and 0 for the non-exposed group. Additionally, a significantly declining trend of inner ear deficits from the utricle to the saccule, cochlea, and semicircular canals was noted in the exposed group, but not in the non-exposed group. Ototoxicity was identified in those exposed to organic solvents, with the sequence of abnormal inner ear function from the utricle to the saccule, cochlea, and semicircular canals.

CVEMP, oVEMP and Caloric Test Results in Individuals with Meniere’s Disease

Objective : The present study aimed to characterize cVEMP, oVEMP and caloric test findings in individuals with Meniere’s disease. Methods : 29 participants with Meniere’s disease and 29 participants with normal hearing were enrolled for the study. Out of 29 participants in the experimental group, 25 of them had unilateral Meniere’s disease and 4 of them had bilateral Meniere’s disease (Total 33 ears diagnosed with Meniere’s and 25 ears with non-Meniere’s disease). All the participants underwent routine audiological, cVEMP, oVEMP and Caloric testing. Results : Out of 33 ears with Meniere’s disease, 29 ears had absent responses on cVEMP, 23 ears showed absent oVEMP responses, 27 ears had hypo-activity, five ears showed hyper activity and one ear showed normal response to caloric stimulation. In the contralateral ear (25 ears with non-Meniere’s disease) both cVEMP and oVEMP were absent in 5 of the ears, cVEMP was absent and oVEMP was present in 13 ears, cVEMP was present and oVEMP was absent in 1 ear, whereas both cVEMP and oVEMP were present in 6 ears in individuals with Meniere’s disease. However, the caloric responses were present normally in the contralateral ear in individuals with Meniere’s disease. Conclusions : The combination of cVEMP, oVEMP and caloric test provides valuable information regarding localization of hydrops in individuals with Meniere’s disease.

Test Retest Reliability of Ocular Vestibular Evoked Myogenic Potential

Recently oVEMP testing is used to evaluate the function of utricle, with recording from contralateral ocular muscle. Aim of the present study was to see test retest reliability of oVEMP response. A total of 40 normal healthy participants were included for the present study and they underwent oVEMP testing for three recording sessions i.e. test, intra test and inter test sessions. Excellent and near excellent reliability was obtained for both latencies, and n1-p1 peak to peak amplitude. Thus it can be concluded from the current research study that VEMP testing procedures are reliable in normal hearing individuals across, within and between test recordings

Simultaneous Recordings of Cervical and Ocular Vestibular-Evoked Myogenic Potentials

Background: Cervical (cVEMP) and ocular (oVEMP) vestibular-evoked myogenic potentials are short-latency manifestations of vestibulo-ocular and vestibulocollic reflexes that originate from the utricle and saccule. The aim of this study was to determine whether simultaneously recording cVEMP and oVEMP more reliably detects the reflex responses than when making separate recordings. Methods: Both simultaneous recordings and conventional separate recordings of the cVEMP and oVEMP responses to air-conducted tone bursts were obtained in 39 healthy subjects. p13 and n10 latencies, and p13-n23 and n10-p16 amplitudes of cVEMP and oVEMP waveforms were measured, respectively. The asymmetry ratios (ARs) of the amplitudes were calculated. Results: In cVEMP testing, the p13 latencies and p13-n23 amplitudes did not differ significantly between simultaneous and conventional separate recordings. In oVEMP testing, the n10 latencies measured in simultaneous recordings showed a small but statistically significant prolongation compared to the results in separate recordings. Moreover, the n10-p16 amplitudes were significantly larger in the simultaneous recordings. The AR of simultaneous recordings of cVEMP and oVEMP did not differ between the two recording methods. Conclusions: Simultaneously recording cVEMP and oVEMP provides a reliable test and could be a clinically useful and simplified diagnostic tool for evaluating dizzy patients. J Korean Neurol Assoc 33(3):156-161, 2015

Assessment of the Clinical Utility of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing in Elderly Patients.

To assess whether patient age or sex was predictive of a bilaterally absent cervical or ocular vestibular evoked myogenic potential (cVEMP or oVEMP). Retrospective case review. Tertiary center. Patients presenting with normal vestibular tests (i.e. normal caloric and rotational chair) who underwent cVEMP and/or oVEMP testing. Patients with conductive hearing loss were excluded as were those with unilaterally abnormal VEMP results because they presented with evidence of a possible unilateral vestibular impairment. A total of 895 patients met criteria for cVEMPs and 297 for oVEMPs. The presence or absence of cVEMP and oVEMP responses elicited with a 500-Hz 125-dB pSPL air conduction stimulus. A logistic regression was performed including odd ratios and confidence intervals. Compared with adults in their 20s, the odds of bilaterally absent cVEMP responses are 6 times greater for patients in their 50s and 60s and over 22 times greater for patients in their 70s and 80s. A bilaterally absent oVEMP response is 6 times more likely for patients in their 40s, 50s, and 60 and 13 times greater for patients in their 70s. VEMPs in response to air conduction stimuli are bilaterally absent in a large percentage of older patients complaining of dizziness who otherwise have normal vestibular and auditory testing for their age. In combination with other abnormal vestibular findings, an absence of VEMP responses may be of value. However, the functional consequence of an isolated bilaterally absent VEMP is not known and may provide minimal information to an older patient's diagnostic picture. In cases where the response is bilaterally absent, a more intense AC stimulus should be used or bone conducted vibration should be considered.

Assessment of d-methionine protecting cisplatin-induced otolith toxicity by vestibular-evoked myogenic potential tests, ATPase activities and oxidative state in guinea pigs

To date, inadequate study has been devoted to the toxic vestibular effects caused by cisplatin. In addition, no electrophysiological examination has been conducted to assess cisplatin-induced otolith toxicity. The purposes of this study are thus two-fold: 1) to determine whether cervical vestibular-evoked myogenic potentials (VEMPs) and ocular VEMPs are practical electrophysiological methods of testing for cisplatin-induced otolith toxicity and 2) to examine if d-methionine (d-met) pre-injection would protect the otolith organs against cisplatin-induced changes in enzyme activities and/or oxidative status. Guinea pigs were intraperitoneally treated once daily with the following injections for seven consecutive days: sterile 0.9% saline control, cisplatin (5mg/kg) only, d-met (300mg/kg) only, or a combination of d-met (300mg/kg) and cisplatin (5mg/kg), respectively, with a 30minute window in between. Each animal underwent the oVEMP and cVEMP tests before and after treatment. The changes in the biochemistry of the otolith organs, including membranous Na+, K+-ATPase and Ca2+-ATPase, lipid peroxidation (LPO) levels and nitric oxide (NO) levels, were also evaluated. In the cisplatin-only treated guinea pigs, the mean amplitudes of the oVEMP tests were significantly (p<0.05) decreased when compared to the other three groups. In guinea pigs receiving both d-met and cisplatin, the amplitudes of their oVEMP tests were significantly larger (p<0.05) than those of the cisplatin-only group, but smaller (p<0.05) than those of the saline control or d-met-only group. However, no significant difference of the amplitudes of cVEMP tests was noted among the four groups. In comparison with the other three groups, the cisplatin-only group had the lowest (ps<0.05) mean Na+, K+-ATPase and Ca2+-ATPase, and the highest (ps<0.05) LPO and NO levels. The oVEMP tests were feasible for the evaluation of cisplatin-related otolith dysfunction. d-Met attenuated the reduced ATPase activities and increased oxidative stress induced by cisplatin toxicity in the otolith organs.

Diagnostic Value of Frequency-Associated Vestibular-Evoked Myogenic Potential Responses in Ménière's Disease

Thirty subjects with unilateral Ménière's disease (MD) and 18 age-matched controls underwent cervical (cVEMP) and ocular vestibular-evoked myogenic potential (oVEMP) testing using bilateral air-conducted stimulation (ACS) with stimulus frequencies of 500 and 1,000 Hz. The aim of this study is to determine the diagnostic value of frequency-associated responses in MD using oVEMP and cVEMP following 500- and 1,000-Hz ACS. In healthy controls and unaffected ears, responses to 500 Hz were found better than 1,000-Hz ACS in both oVEMP and cVEMP, while ears with MD responded to 1,000-Hz ACS better than to 500-Hz ACS in oVEMP. In cVEMP tests, affected ears responded to 500-Hz and 1,000-Hz ACS equally. Amplitude ratios of 1,000/500 Hz in both oVEMP and cVEMP were successful in differing affected ears from unaffected ears and healthy controls. This study showed frequency alteration of oVEMP and cVEMP can be used as a diagnostic test battery in MD.

Inner ear deficits in irradiated nasopharyngeal carcinoma survivors.

Despite the advancement of concurrent chemoradiotherapy, inner ear symptoms such as hearing loss, tinnitus, or vertigo/dizziness are still experienced in irradiated nasopharyngeal carcinoma (NPC) survivors. This study utilized an inner ear test battery to assess the causes and sequence of inner ear deficits in irradiated NPC survivors with a mean interval of 10 years after radiotherapy. Retrospective study. Thirty-six irradiated NPC survivors were enrolled. Otoscopy and an inner ear test battery comprising audiometry were performed, as well as ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests. Otoscopic examination revealed middle ear complications in 37 ears (51%), including radiation-induced otitis media in 32 ears and otitis media with effusion in five ears. Percentages of abnormal cVEMP test, oVEMP test, bone-conducted mean hearing level, and caloric test were 91%, 75%, 67%, and 39%, respectively, exhibiting a significantly declining sequence in inner ear deficits. Most (67%) NPC survivors had inner ear deficit originated from peripheral vestibular lesion, mainly due to sequela of otitis media. In contrast, 33% of them had inner ear deficit caused by central vestibular disorder. A significant sequential decline in inner ear function of irradiated NPC survivors was observed from the saccule to the utricle, cochlea, and semicircular canals. Most of them were due to sequela of otitis media, followed by central vestibular disorder. 4.

Cervical and ocular vestibular evoked myogenic potentials in Behcet’s disease

ObjectiveTo investigate vestibular evoked myogenic potentials combined with audiologic status in Behcet’s disease (BD) and to compare the results with normal healthy subjects. MethodsCervical vestibular evoked myogenic potential (cVEMP) test, ocular vestibular evoked myogenic potential (oVEMP) test, Dix–Hallpike test, conventional pure tone audiometry (cPTA) and high frequency audiometry (HFA), and 226 and 1000Hz tympanometry were performed to each subject of the study. Cranial magnetic resonance imaging (MRI) with contrast enhancement was also performed to evaluate the central nervous system (CNS) in patients with BD. ResultsVEMP parameters including the mean peak latencies of p13-n23 and n10-p15, AR values and thresholds were not statistically different both in cVEMP and oVEMP between the BD and control groups. Except for 250Hz, mean audiological thresholds were significantly higher in the BD group. Five of the 20 patients had pathological cranial MRI findings that may be compatible with central nervous system involvement. ConclusionTo our knowledge, the present study is the first report investigating oVEMP and cVEMP responses combined with MRI findings in patients with BD. The presence of high frequency hearing loss is a common finding in BD and HFA may help early detection of hearing loss in patients with BD when combined with cPTA.