Vestibular-evoked Myogenic Potential Tests Research Articles

Management Strategies of Vestibular Neuritis:- A Review

ABSTRACT A common peripheral vestibular disorder called vestibular neuritis (VN) results in abrupt development of vertigo symptoms without any accompanying auditory symptoms, such as tinnitus, aural fullness, or hearing impairment. The precise cause of VN is yet unknown. The clinical history and test results serve as the foundation for the VN diagnostic criteria. Despite an unclear cause of VN, a thorough understanding of its clinical course and management has been established. Clinically, VN is characterized by a spinning sensation that lasts longer than 24 hours, the absence of cochlear symptoms, and other neurological symptoms. The diagnosis of VN is done by different tests which include a head impulse test, bithermal caloric test, and vestibular-evoked myogenic potential tests. The treatment of VN is based on different stages of this disease such as acute, subacute, and chronic. Antiemetics, vestibular suppressants, and intravenous hydration are some of the symptomatic treatments available. For those with chronic VN, vestibular rehabilitation is a highly useful tool in lowering feelings of lightheadedness and floating. The usefulness of antivertigo medications for VN is not well shown. The purpose of this review article was to explore the current management strategies of VN.

Electrode Montage for Bilateral Cervical Vestibular-Evoked Myogenic Potential Testing.

Cervical vestibular-evoked myogenic potentials (cVEMPs) are predominantly ipsilateral, myogenic responses originating from saccular activation. Some individuals have contralateral-crossed cVEMP responses with monaural air-conducted stimulation (ACS) which can contaminate cVEMP responses with bilateral stimulation. While the origin of the contralateral-crossed response is under debate, its presence has implications for cVEMP testing with midline bone conduction vibration (BCV). The purpose of this study was to determine the origin of the contralateral-crossed cVEMP response. It was hypothesized that the crossed response is due to electrode contamination and would disappear with a modified electrode montage. This is a cross-sectional research study. Fifteen healthy participants (30 ears; mean age: 27.4 19-39; 10 females). Participants completed cVEMP testing using three stimulation methods (monoaural ACS, binaural ACS, and midline BCV) and two electrode montages (sternum reference and Fp reference). In the monoaural ACS with sternum reference condition, 53.3% ears had contralateral-crossed cVEMP responses that were in-phase with the ipsilateral response for all but three ears. Whereas in the monoaural ACS with Fp reference condition, 3% had a contralateral-crossed cVEMP response. ACS and BCV cVEMP corrected amplitudes were significantly larger in the sternum reference conditions, which is attributed to artificial enhancement from the in-phase contralateral-crossed responses. The significant reduction of contralateral-crossed responses in the Fp reference condition suggests that the contralateral-crossed cVEMP response is due to reference electrode contamination and may be a more appropriate reference placement when completing cVEMPs with midline BCV.

Is the Otolithic Function Affected in Patients with Obstructive Sleep Apnea Syndrome?

While cardiovascular and neurological diseases induced by obstructive sleep apnea syndrome (OSAS) hypoxia are well established, the association between neuro-otological diseases and OSAS is not entirely understood. Vestibular and audiological tests have been used to evaluate the degeneration of neurons in the brainstem caused by recurrent hypoxia. Evaluation of the vestibular-evoked myogenic potential (VEMP) test findings applied to detect the possible influence on the vestibular reflex arc due to hypoxia in patients diagnosed with OSAS using Activity-Specific Balance Confidence (ABC) and Berg Balance Scale (BBS) scales determination of scores. This was a cross-sectional study. Participants aged 18 to 60 who underwent polysomnography due to snoring/sleep apnea were divided into an OSAS, and a control group of subjects were also included. Each group consisted of 20 participants. All participants were evaluated with cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests. The groups were compared regarding variables such as the rate of oVEMP and cVEMP waves obtained, the interval between the waves, and the latency and amplitude. Also, BBS and ABC scales were applied to all participants. The cVEMP (50%) and oVEMP (45%) response rates and amplitudes were significantly lower in the OSAS group. No significant difference was found between the groups when comparing other VEMP parameters. However, a statistically significant decrease was observed in the ABC and BBS scores in the OSAS group. The identification of VEMP alterations in the OSAS group is a clear indication that the vestibular reflex pathways may be adversely affected by hypoxia. Personal rehabilitation programs can be created by evaluating activities of daily living with the ABC and static and dynamic balances with BBS in patients with OSAS.

Changes of Otolith and Balance Function Related to Cochlear Implant in Hearing Loss With Inner Ear Malformations Children.

The increase of bilateral cochlear implantation (CI) in recent years has made it essential to comprehend the effects of CI on otolith function. This study aimed to investigate the development of gross motor and otolith function in patients with inner ear malformations (IEMs) using vestibular-evoked myogenic potentials (VEMPs). Overall, 78 patients with sensorineural hearing loss (SNHL) (age 5.7 ± 4.1 years) were divided into two groups based on the presence (IEM group, n = 39) or absence (control group, n = 39) of IEMs. VEMP testing was performed both before and 1-3 months after CI, and the evaluation of gross motor development was carried out. The mean ages for achieving head control and independent walking were delayed in the IEM group compared with the control group (p = 0.02). The preoperative cervical VEMP (cVEMP) and ocular VEMP (oVEMP) response rates were higher in the control group (60% and 86.95%) than in the IEM group (57.69% and 74.35%) (p < 0.05). Additionally, abnormal cVEMP was associated with delayed acquisition of independent walking (p = 0.017). Saccular and utricular functions after CI were lost by 40% and 31.75%, respectively, in patients who elicited preoperative VEMPs waveform (n = 25). Among SNHL patients, balance development is more delayed in patients of IEMs than in patients without IEMs. The cVEMP and oVEMP waveforms differed greatly between the two groups. The otolith-vestibular nerve conduction pathway can be affected by CI, potentially leading to otolith function impairment. Therefore, it is essential to assess otolith and balance functions before CI, and this evaluation should be considered an integral part of clinical practice.

Detecting endolymphatic hydrops in patients with cranial nerve VIII schwannoma using hydrops MR examination.

This study utilized Hydrops MRI in patients with cranial nerve (CN) VIII schwannoma to assess the concomitance with endolymphatic hydrops (EH), aiming to elucidate the mechanism of hydrops formation in these patients. Twenty-six patients diagnosed as CN VIII schwannoma including vestibular schwannoma (VS) in 24 and intracochlear schwannoma (ICS) in 2 were enrolled. Fifteen patients received radiosurgery and 11 patients opted for a wait-and-scan approach. All patients underwent an inner ear test battery, followed by Hydrops MRI. Based on Hydrops MRI, 6 patients (23%) with positive EH were assigned to Group A, while the other 20 patients showing negative EH were assigned to Group B. The abnormality rates of inner ear test battery in Group A ran from the audiometry (100%), cervical vestibular-evoked myogenic potential (cVEMP) test (83%), ocular VEMP (oVEMP) test (67%) to the caloric test (33%), exhibiting a significantly declining sequence. This declining sequence is consistent with the decreasing order in the prevalence of EH from the cochlea (83%), saccule (50%) to utricle (50%). However, Group B did not show such decreasing trend, indicating that Groups A and B did not share the common mechanism. The mean tumor size prior to radiosurgery was 1.91 ± 0.89cm, which significantly reduced to 1.53 ± 0.60cm at a mean interval of 6years following radiosurgery. In contrast, tumor size remained unchanged in those opted for a wait-and-scan approach. It is recommended to utilize Hydrops MRI for patients with CN VIII schwannoma during annual follow-up, particularly those experienced episodic vertigo and/or deteriorated hearing. The Hydrops MRI can not only monitor tumor size, but also detect the presence of EH, so as to guide treatment decision.

Hearing and balance functions in patients with systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disease, characterized by multiple organ involvement, which is seen more often in young females. Objectives To evaluate the hearing and balance functions in SLE patients. Materials and methods Twenty-four SLE patients, 24 healthy controls underwent pure tone audiometry (0.125–16 kHz), VNG, vestibular evoked myogenic potential (VEMP), and video head impulse test (vHIT). Results A statistically significant difference was determined between the control group and the SLE group at 0.125, 0.25, 0.5, 1.0, 6.0, 8.0, 10, 12, 14, and 16 kHz frequencies. Sensorineural hearing loss was observed in 37.5% of the SLE group. The pursuit test was pathological at the rate of 25% in the SLE group. No response was obtained in six SLE patients in the oVEMP test and four SLE patients in the cVEMP test. The mean posterior SCC VOR gain values were 0.64 ± 0.2 in the SLE group. A significant difference was determined between the groups with respect to posterior SCC VOR gains. Conclusions and significance Our findings show that SLE disease may negatively affect the hearing system and the vestibular system as well. The current study is the first study to comprehensively evaluate SLE patients with VNG, VEMP, and vHIT tests.

Ocular Vestibular-Evoked Myogenic Potential Assists in the Differentiation of Multiple System Atrophy From Parkinson's Disease.

Vestibular-evoked myogenic potentials (VEMPs) can help in assessing otolithic neural pathway in the brainstem, which may also contribute to the cardiovascular autonomic function. Parkinson's disease (PD) is associated with altered VEMP responses; however, the associations between VEMP abnormalities and multiple system atrophy (MSA) remain unknown. Therefore, we compared the extent of otolith dysfunction using ocular (oVEMP) and cervical VEMPs between patients with MSA and PD. We analyzed the clinical features, VEMP, and head-up tilt table test (HUT) findings using the Finometer in 24 patients with MSA and 52 with de novo PD who had undergone neurotologic evaluation at a referral-based university hospital in South Korea from January 2021 to March 2023. MSA was associated with bilateral oVEMP abnormalities (odds ratio [95% confidence interval] = 9.19 [1.77-47.76], p = 0.008). The n1-p1 amplitude was negatively correlated with the Unified Multiple System Atrophy Rating Scale I-II score in patients with MSA (r = -0.571, p = 0.033), whereas it did not correlate with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-III score in patients with PD (r = -0.051, p = 0.687). The n1 latency was negatively correlated with maximum changes in systolic blood pressure within 15 s during HUT in patients with PD (r = -0.335, p = 0.040) but not in those with MSA (r = 0.277, p = 0.299). Bilaterally abnormal oVEMP responses may indicate the extent of brainstem dysfunction in MSA. oVEMP reflects the integrity of otolith-autonomic interplay, reliably assists in differentiating between MSA and PD, and helps infer clinical decline.

Relationship between vestibular schwannoma and endolymphatic hydrops

BackgroundBoth vestibular schwannoma (VS) and Meniere's disease (MD) patients underwent hydrops MRI to clarify the relationship between VS and endolymphatic hydrops (EH). MethodsEighty patients with VS or MD underwent an inner ear test battery followed by hydrops MRI, and were then divided into 3 groups. Group A comprised 58 MD patients (62 ears) with positive EH but negative VS. Group B included 18 VS patients (18 ears) with negative EH, while Group C consisted of 4 patients (4 ears) who had VS concomitant with EH. Another 14 MD patients who tested negative for EH on hydrops MRI were initially excluded from this cohort, but were later included for comparison. ResultsThe decreasing prevalence of EH at the cochlea, saccule and utricle in Group A was identified in 59 (95%), 42 (68%) and 40 (65%) ears, respectively, mimicking a declining sequence of abnormality rates running from audiometry (86%), cervical vestibular-evoked myogenic potential (cVEMP) test (55%) to the ocular (oVEMP) test (53%). However, such decreasing trend was not identified in Groups B and C. In Groups C and A combined, 4 (6%) of 62 EH patients had concomitant VS. Conversely, 4 (18%) of 22 VS patients in Groups C and B combined had concurrent EH. ConclusionA very low (6%) rate of VS in EH patients indicates that VS in EH patients may be coincidental. In contrast, EH was identified in 18% prevalence of VS patients, mirroring the 22% prevalence of cochlear EH demonstrated in VS donors through histopathological studies.

Cervical and ocular vestibular-evoked myogenic potentials test results and its relation to vestibular signs and symptoms in individuals with vestibular migraine

ObjectiveThe objective of the present study was to characterize the response rate, latency, and amplitude parameters of the cervical and ocular vestibular evoked myogenic potentials in individuals with vestibular migraine. The objective was also to describe the signs and symptoms exhibited by individuals with vestibular migraine and find out an association with VEMP results.MethodThirty individuals with a diagnosis of vestibular migraine and thirty healthy individuals participated in the study. The diagnosis of the vestibular migraine was made based on the diagnosis criteria given by the Barany Society and the International Headache Society. Cervical and ocular vestibular evoked myogenic potentials were recorded using 500 Hz tone burst stimulus for all the participants in both groups.ResultsThe latency was prolonged, and the amplitude was reduced for both the cervical and ocular vestibular evoked myogenic potentials in individuals with vestibular migraine compared with healthy individuals. There was no association between signs and symptoms exhibited by vestibular migraine individuals and VEMP results.ConclusionsBoth the sacullocollic and otolith ocular pathways are affected in vestibular migraine. Hence, there is a necessity for vestibular evaluation in all patients with vestibular migraine to understand the spectrum of the pathology.

Comparison of vestibular evoked myogenic potentials between low and high tone idiopathic sudden sensorineural hearing loss

Objectives: Vestibular evoked myogenic potentials (VEMP) have been reported to be useful in evaluating not only vestibular function but also the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL) patients. Even though low frequency, high frequency, and all frequency-involved ISSNHL groups tend to show varied clinical characteristics, there is a lack of data using VEMP results to analyze these subgroups. We investigated if the VEMP test is a valuable tool to predict recovery from hearing loss in association with different frequencies. Methods: A total of 26 ISSNHL patients were divided into three different groups impaired with low tone (ascending type), high tone (descending type), and all tones (flat type) based on the initial audiograms. Each group included five, 10, and 11 patents, respectively, and their VEMP results were compared between the three subgroups. Results: Abnormal VEMP results were found in five of the total 26 ISSNHL patients (19.2%). Two (40.0%), one (10.0%), and two (18.1%) patients of low tone, high tone, and all tone hearing loss groups, respectively, showed abnormal VEMP results. However, there was no statistically significant difference between the three groups. Conclusions: Even though VEMP is known as a valuable tool for predicting the prognosis of ISSNHL patients, it does not seem to reflect frequency-sensitive aspects of ISSNHL.

Masseter Vestibular-Evoked Myogenic Potential Result of Possible Meniere's Patients.

The masseter vestibular-evoked myogenic potential (mVEMP) test evaluates the vestibulomasseteric reflex neural pathway between the sound-stimulated saccule hair cells and the motor neurons of the trigeminal nerve. This study aims to investigate the contribution of mVEMP to the conclusive diagnosis of recurrent vestibulopathy patients that were diagnosed with Possible Meniere's disease. The study includes 20 healthy individuals aged 18 to 40 years and 20 patients that were diagnosed with Possible Meniere's disease according to the American Academy of Otorhinolaryngology and Head and Neck Surgery (AAO-HNS, 1995) Guidelines for the Definition of Meniere's Disease. In addition to the AAO-HNS, 1995 criteria, the presence of aural signs on the affected side was questioned according to the Meniere's criteria updated in 2015. mVEMP records were obtained by using surface electrodes placed on masseter muscles. Latency and amplitude values and asymmetry ratios of mVEMP waves were used for statistical analysis. Asymmetry ratios were 15.9 ± 9.7% for the control group and 60.61 ± 45.52 for the experimental group; this difference was statistically significant (p < 0.05). The absolute latency and amplitude results were not statistically different between groups (p > 0.05). As Murofushi et al. (2001) stated in the literature, cervical vestibular-evoked myogenic potential (VEMP)/ocular VEMP latencies were not affected in peripheral pathologies, and in our study, no difference was observed between the groups in mVEMP latencies. The findings of our study showed that asymmetry ratio and absence of waves should be used in the clinical evaluation of Possible Meniere's disease. We conclude that mVEMP can be used to determine the lateralization of vestibular disorders and to support the presence of a vestibular pathology. mVEMP can contribute to the vestibular test battery.

Multi-frequency VEMPs improve detection of present otolith responses in bilateral vestibulopathy.

To investigate whether multi-frequency Vestibular Evoked Myogenic Potential (VEMP) testing at 500, 750, 1,000, and 2,000 Hz, would improve the detection of present dynamic otolith responses in patients with bilateral vestibulopathy (BV). Prospective study in a tertiary referral center. BV patients underwent multi-frequency VEMP testing. Cervical VEMPs and ocular VEMPs were recorded with the Neuro-Audio system (v2010, Neurosoft, Ivanovo, Russia). The stimuli included air-conducted tone bursts of 500, 750, 1,000, and 2,000 Hz, at a stimulation rate of 13 Hz. Outcome measures included the percentage of present and absent VEMP responses, and VEMP thresholds. Outcomes were compared between frequencies and type of VEMPs (cVEMPs, oVEMPs). VEMP outcomes obtained with the 500 Hz stimulus, were also compared to normative values obtained in healthy subjects. Forty-nine BV patients completed VEMP testing: 47 patients completed cVEMP testing and 48 patients completed oVEMP testing. Six to 15 % more present VEMP responses were obtained with multifrequency testing, compared to only testing at 500 Hz. The 2,000 Hz stimulus elicited significantly fewer present cVEMP responses (right and left ears) and oVEMP responses (right ears) compared to the other frequencies (p ≤ 0.044). Using multi-frequency testing, 78% of BV patients demonstrated at least one present VEMP response in at least one ear. In 46% a present VEMP response was found bilaterally. BV patients demonstrated a significantly higher percentage of absent VEMP responses and significantly higher VEMP thresholds than healthy subjects, when corrected for age (p ≤ 0.002). Based on these results, a pragmatic VEMP testing paradigm is proposed, taking into account multi-frequency VEMP testing. Multi-frequency VEMP testing improves the detection rate of present otolith responses in BV patients. Therefore, multi-frequency VEMPs should be considered when evaluation of (residual) otolith function is indicated.

The Caloric Test Is More Consistent With the Presence of Endolymphatic Hydrops Than the Vestibular-Evoked Myogenic Potential Test in Meniere's Disease.

Objective This study aimed to investigate the correlation between enhanced inner ear magnetic resonance imaging (MRI) findings and vestibular and cochlear function test results in patients with definite Meniere's disease and confirmed endolymphatic hydrops. Methods Among 70 consecutive patients diagnosed with definite Meniere's disease, 49 underwent contrast-enhanced 3-T inner ear MRI. The patients also underwent pure-tone audiometry, glycerol, caloric, and vestibular-evoked myogenic potential (VEMP) tests. Correlations between the pure-tone audiometry, glycerol test, caloric test, VEMP test, and MRI findings were evaluated using the chi-square test or Fisher's exact test, Student's t-test, one-way ANOVA, and Bonferroni's post-hoc test. Results Contrast-enhanced inner ear MRI revealed that 33 of 49 patients (67.3%) had endolymphatic hydrops. Among them, 19 patients had bilateral endolymphatic hydrops, and 14 had unilateral hydrops. The mean hearing threshold was higher in patients with endolymphatic hydrops than those without (p< 0.001). The proportion of patients with positive glycerol test results was higher among those with endolymphatic hydrops than in those without (p= 0.01). The rate of abnormal caloric response in patients with and without endolymphatic hydrops was not significantly different (p= 0.09). Furthermore, the rate of abnormal VEMP response in patients with and without endolymphatic hydrops was not significantly different (p= 0.70). On the affected side, in the caloric test, the ratio of the presence of vestibular and cochlear hydrops was similar (p= 1.00). On the affected side, in the VEMP test, the ratio of the presence of vestibular and cochlear hydrops was also similar (p= 0.80). The consistency of the caloric test in detecting cochlear hydrops was higher than that of the VEMP test (p= 0.04). The consistency of the caloric test in detecting vestibular hydrops tended to be higher (but not significantly) than that of the VEMP test (p= 0.11). Conclusion The cochlea and vestibule on the clinically affected side were more likely to have endolymphatic hydropsrevealed by contrast-enhanced 3-T inner ear MRI than on the unaffected side. The sum of the three low frequencies (125, 250, and 500 Hz) of the pure-tone audiometry was higher in patients with endolymphatic hydrops than in those without endolymphatic hydrops. The caloric test was more consistent in detecting endolymphatic hydrops, especially cochlear hydrops, than the VEMP test in patients with definite Meniere's disease. The results of this study may contribute to the future diagnosis of Meniere's disease and improve the understanding of endolymphatic hydrops.

Vestibular-evoked myogenic potentials and video head impulse test in cochlear otosclerosis

BackgroundOtosclerosis is one of the most common causes of hearing loss in adults with clinical onset between 20 and 40 years of age. Vestibular symptoms may be the most agonizing and primary symptom in cases with otosclerosis, so the assessment of patients is important. The vestibular-evoked myogenic potentials test (VEMP) is used to assess the saccular and the utricular functions using cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), respectively. The video head impulse test (vHIT) which measure vestibulo-ocular reflex (VOR) to rapid impulsive head acceleration in the plane of each semicircular canal (SCC) has allowed quantitative monitoring of each canal function.MethodsTwenty subjects with bilateral otosclerosis were studied, ranging in age from 30 to 55 years, divided into two groups. One group consisted of 10 adult patients with bilateral conductive otosclerosis. The second group consisted of 10 adult patients with bilateral mixed otosclerosis. All the patients underwent cVEMP and oVEMP, using a BC 500Hz tone burst stimulus and vHIT in three planes, left anterior right posterior (LARP), right anterior left posterior (RALP), and lateral SCCs.ResultsThe findings indicate statistically significant differences in the peak-to-peak amplitudes of cVEMP and oVEMP in the two studied groups, and the mixed cases had lower amplitudes than conductive cases and a significant increase in p13 latencies. Also, there is a statistically significant difference in the lateral SCC gain between the two groups, as mixed cases had lower gain than conductive cases, but not for anterior or posterior SCCs, with no gain less than 0.8 in all three canals.ConclusionThe findings suggested that the saccule is more liable to be affected by cochlear otosclerosis followed by the utricle. The three SCCs are mostly spared.

Characteristics of vestibular-evoked myogenic potentials in children with vestibular malformation and severe sensorineural hearing loss

BackgroundWith the increasing clinical focus on the safety of bilateral cochlear implantation (CI) and the potential risk of bilateral vestibular dysfunction, evaluating vestibular end-organ function in patients with vestibular malformations with accompanying abnormalities has been strongly recommended. ObjectivesTo identify the vestibular-evoked myogenic potential (VEMP) values among children with sensorineural hearing loss (SNHL) with vestibular malformation and assess the effectiveness of VEMP testing for inner ear malformations (IEM) diagnosis. MethodsThis study included 96 children (192 ears), including those with vestibular malformations (48 ears), large vestibular aqueduct syndrome (LVAS) (50 ears), and SNHL without IEM (94 ears; control group). All groups underwent ocular and cervical VEMP (oVEMP and cVEMP, respectively) testing. The response rates, VEMP parameters, and wave characteristics were compared. ResultsThe cVEMP response rates were 37.5 %, 64 %, and 58.51 % and the oVEMP response rates were 42.86 %, 78.95 %, and 77.27 % in the vestibular malformation, LVAS, and control groups, respectively, and significantly differed between groups (cVEMP: X2 = 18.228, P<0.001) (oVEMP: X2 = 7.528, P = 0.023). Significant inter-group differences were observed for the cVEMP and oVEMP latency and amplitude (P < 0.05). The LVAS group's waveform exhibited a prolonged latency and increased amplitude compared with that of the other groups. ConclusionPatients with SNHL were highly susceptible to otolith dysfunction, regardless of comorbid vestibular malformation presence. Measuring VEMPs is an effective and rapid evaluation technique for vestibular function and could provide a basis for vestibular rehabilitation training.

Post Cochlear Implantation Vertigo: Ictal Nystagmus and Audiovestibular Test Characteristics.

To investigate ictal nystagmus and audiovestibular characteristics in episodic spontaneous vertigo after cochlear implantation (CI). Retrospective and prospective case series. Twenty-one CI patients with episodic spontaneous vertigo after implantation were recruited. Patient-initiated home video-oculography recordings were performed during one or more attacks of vertigo, using miniature portable home video-glasses. To assess canal and otolith function, video head-impulse tests (vHITs) and vestibular-evoked myogenic potential tests were conducted. Nystagmus slow-phase velocities (SPVs), the presence of horizontal direction-changing nystagmus, and post-CI audiovestibular tests. Main final diagnoses were post-CI secondary endolymphatic hydrops (48%) and exacerbation of existing Ménière's disease (29%). Symptomatic patients demonstrated high-velocity horizontal ictal-nystagmus (SPV, 44.2°/s and 68.2°/s in post-CI secondary endolymphatic hydrop and Ménière's disease). Direction-changing nystagmus was observed in 80 and 75%. Two were diagnosed with presumed autoimmune inner ear disease (SPV, 6.6°/s and 172.9°/s). One patient was diagnosed with probable vestibular migraine (15.1°/s).VHIT gains were 0.80 ± 0.20 (lateral), 0.70 ± 0.17 (anterior), and 0.62 ± 0.27 (posterior) in the implanted ear, with abnormal values in 33, 35, and 35% of each canal. Bone-conducted cervical and ocular vestibular-evoked myogenic potentials were asymmetric in 52 and 29% of patients (all lateralized to the implanted ear) with mean asymmetry ratios of 51.2 and 35.7%. Reversible reduction in vHIT gain was recorded in three acutely symptomatic patients. High-velocity, direction-changing nystagmus time-locked with vertigo attacks may be observed in post-CI implant vertigo and may indicate endolymphatic hydrops. Fluctuating vHIT gain may be an additional marker of a recurrent peripheral vestibulopathy.

Clinical and VEMPS Characteristics of Benign Recurrent Vertigo With Cochlear Symptoms and Migraine.

Objectives: To explore the clinical manifestations and vestibular-evoked myogenic potential (VEMP) characteristics in patients diagnosed with benign recurrent vertigo (BRV) accompanied by cochlear symptoms or migraine history. Methods: A total of 34 patients were diagnosed with BRV (57 ears) and 30 healthy volunteers (60 ears) were recruited. They were divided into 4 groups: Group A consisted of 17 patients diagnosed as BRV with cochlear symptoms (21 ears), Group B consisted of 11 patients diagnosed as BRV with migraine history (22 ears), and Group C consisted of 7 patients with BRV without cochlear symptoms and migraine history (14 ears). Group D, as a Normal control (NC) group, consisted of 30 healthy volunteers without a history of migraine and cochlear symptoms. Detailed consultations and VEMP testing were performed separately. The VEMPs elicitation rate, amplitude ratio at different frequencies and amplitude statistics were compared and analyzed among the 4 groups. Results: The amplitudes of cervical vestibular evoked myogenic potential (cVEMP) have significant differences between Groups D and A, and Group C, under 500 Hz (PAD = .017, PBD = .052, PCD = .044), but the amplitudes of cVEMP have significant differences between Groups D and A, and Group B under 1000 Hz, respectively (PAD = .008, PBD = .020, PCD = .119). The amplitudes of ocular vestibular evoked myogenic potential (oVEMP) have significant differences between Groups D and A, and Group B, under 500 Hz, respectively (PAD = .029, PBD = .005, PCD = .198). oVEMP amplitudes significantly differ between Groups D and A under 1000 Hz (PAD = .049, PBD = .079, PCD = .103). The statistical difference was absent in elicit rates of cVEMP and oVEMP between the NC and experimental groups (cVEMP: PAD = .525, PBD = .917, PCD = .374; oVEMP: PAD = .678, PBD = .523, PCD = .427). Moreover, there is no significant difference between the NC group and experimental groups among VEMPs and VEMP frequency amplitude ratio (P > .05). Conclusion: VEMPs could be a diagnostic indicator for BRV patients with cochlear symptoms. The pathogenesis of BRV may be related to damage to the otolithic apparatus.

Prognosis of vestibular dysfunction in idiopathic sudden sensorineural hearing loss with vertigo: a prospective cohort study.

Approximately 28%-57% of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) have an acute vertigo attack and probable vestibular dysfunction; however, the prognosis of vestibular function in these patients remains unclear. A prospective cohort study of patients with ISSNHL and vertigo was conducted to evaluate the prognosis of vestibular function, especially the roles of peripheral vestibular restoration and central compensation, in patients with ISSNHL and vertigo. Clinical data were recorded at baseline and at 60days from onset in participants with unilateral ISSNHL with vertigo. Enrolment occurred from May 1, 2019 to May 1, 2022 in the outpatient clinics and inpatient departments of the Eye and ENT Hospital of Fudan University in Shanghai. The primary outcome measure was the recovery rate of vestibular function 60days after onset as assessed by vestibular function tests, including caloric tests, cervical and ocular vestibular-evoked myogenic potential tests (cVEMP, oVEMP), video head impulse tests (vHIT), and sensory organization tests (SOT). The secondary outcome measure was the recovery of subjective evaluations in vestibular dysfunction (the dizziness handicap inventory [DHI], and the visual analogue scale for vertigo [VAS-V]) and hearing assessments (pure-tone audiometry [PTA]). Overall, 86 patients were recruited, with an average duration of disease of 11.7days and follow-up time of 60.7days. Vestibular function was significantly improved (p < 0.05) after 60days. The recovery rates were 100% for anterior semicircular canal (ASC), 56% for posterior semicircular canal (PSC), 41% for horizontal semicircular canal (HSC), 28% for saccule, and 23% for utricle. The recovery of vestibular function was not significantly related to changes in DHI (p = 0.245), VAS-V score (p = 0.509), or hearing outcome (p = 0.390). Restoration of peripheral vestibular sensory input and central vestibular compensation can occur during the course of ISSNHL with vertigo. The otolith organs are at a higher risk of being affected and have worse recovery than the semicircular canals. Incomplete and in-process restoration of vestibular dysfunction may perturb and delay the establishment of central compensation for balance. Neither hearing outcomes nor subjective vestibular symptoms are related to recovery from vestibular dysfunction. ClinicalTrials.gov (identifier NCT03951584).

An Exploratory Study of Cervical Vestibular-Evoked Myogenic Potential in Users of Personal Listening Devices.

The use of personal listening devices (PLDs) is becoming increasingly popular, particularly among young people. Numerous studies have demonstrated that being exposed to PLDs can have adverse effects on the auditory system. Owing to the similarities between the auditory and vestibular systems, it is possible that the negative effects of PLD use may extend to the vestibular system, an area that has not been extensively studied. The study aimed to investigate the impact of exposure to PLDs on the vestibular system, specifically the sacculo-collic reflex assessed by the cervical vestibular-evoked myogenic potential. The current study used a cross-sectional study design. A total of 80 participants were divided into four groups based on the history of PLD exposure. Each group consisted of 20 participants who underwent cervical vestibular-evoked myogenic potential (cVEMP) testing using alternating polarity 500 Hz tone bursts. Analysis of variance (ANOVA) and Bonferroni post hoc test were used to obtain the statistically significant difference among the group. The results showed that the amplitude of p1-n1 of cVEMP was significantly reduced in individuals with longer PLD exposure duration. The study suggests that listening to music through a PLD at high levels of volume controls could be deleterious to the vestibular well-being of an individual. The study highlights the importance of being aware of the adverse effects of using PLDs to prevent potential damage to the vestibular systems.

Audio-vestibular signs in rheumatoid arthritis

Aims: The purpose of this study is to show audiovestibular signs in patients affected by the connective tissue diseases which include RA (rheumatoid arthritis) . Methods: In our study, the study group included 30 RA patients and 30 patients included as control group which had no ear disorder. All patients had audiovestibular evaluations that include pure tone audiometry, tympanometry, acoustic reflexes, otoacoustic emissions (OAE) and vestibular evoked myogenic potential (VEMP). Results: In RA group pure tone audiometry; air conduction at 500, 1000, 4000 Hz frequencies, bone conduction at 500, 4000 Hz frequencies were having more hearing loss than the control group. Tympanometry testing results showed that pressure and the gradient were increased in RA group compared with control group. In acoustic reflex test; the amplitude values were less than the control group at 500, 1000, 4000 Hz frequencies in RA group’s contralateral ear. When the RA group compared with control group in OAE testing, amplitüde values of TEOAE testing was decreased in RA group at 1000, 2000 Hz frequencies, and at 1000 Hz frequency, the amplitüde value was decreased in DPOAE testing. In VEMP testing; N1 latency amplitude was longer than the control group and P1N1 amplitude was shorter than the control group. Conclusion: When the systemic effects and etiopathogenesis of RA was thought; it was concluded that and audiovestibular system may be affected by this way