Vestibular Evoked Myogenic Potential Parameters Research Articles

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.

Exploring the Relationship between Masseter and Cervical Vestibular-Evoked Myogenic Potentials in Young Adults with Hearing Thresholds Less Than or Equal to 15 dB HL.

Cervical vestibular-evoked myogenic potentials (cVEMPs) and masseter vestibular-evoked myogenic potentials (mVEMPs) are considered to have a common saccular origin. While a few studies have examined both vestibular-evoked myogenic potentials (VEMPs) in individuals with brainstem disorders as part of a test battery, the relation between these two potentials has rarely been the subject of discussion. The present study explored the relation between mVEMPs and cVEMPs using electromyography (EMG)-scaled parameters in normal-hearing young adults. Within-subject study design. Twenty young adults between 18 and 39 years of age (11 males, 9 females) participated in the study. cVEMP and mVEMP were performed on all the participants at 95 dBnHL with 500 Hz tone burst stimuli. Various VEMP parameters were evaluated including P13 and N23 peak latencies, the amplitude of the P13-N23 complex, and the Interaural Amplitude Asymmetry Ratio in EMG-scaled and unscaled conditions. All participants exhibited a 100% response rate for cVEMP and mVEMP responses. There were no significant ears and gender effect for both cVEMP and mVEMP. No correlation was found between cVEMP and mVEMP. There was no significant difference found between P1 and N1 latency values of cVEMP and mVEMP; however, a significant variation was observed for peak-to-peak amplitude both in EMG-scaled and unscaled conditions between cVEMP and mVEMP. Minimal to no association between any parameters of cVEMPs and mVEMPs suggests no significant relationship between these two VEMPs.

Vestibular-Evoked Myogenic Potential in Otosclerosis: A Systematic Review

Background: Vestibular symptoms are noted in about 40% of the individuals with otosclerosis. Vestibular-evoked myogenic potential (VEMP) is a short latency potential that assesses the functioning of otolithic organs in the vestibular system. Aim/Objectives: This systematic review explored the VEMP findings in individuals with otosclerosis. Material and Methods: Three databases, PubMed, Scopus, and Cochrane were used to perform a systematic literature review regarding VEMP findings among individuals with otosclerosis. Results: A total of 14 studies that encompasses various VEMP parameters in otosclerosis patients were included. The air-conducted vestibular-evoked myogenic potential (AC-VEMP) often had poor response rates in otosclerosis due to conductive hearing loss. Presence of bone-conducted vestibular-evoked myogenic potential (BC-VEMP) before surgery indicated intact otolithic organs in otosclerosis. Postoperatively, presence of VEMP indicated intact vestibular structures postsurgery, while its absence could indicate vestibular trauma, though other factors like stimulus intensity or efficacy of the fitted piston could influence the results. AC-VEMP responses postsurgery suggested resolution of conductive pathology or absence of lasting effects of otosclerosis. Studies show cVEMP is more affected, indicating saccular dysfunction. Conclusion: Otosclerosis affects VEMP responses, with variations observed between AC- and BC-VEMPs. While AC-VEMP responses may be affected by conductive hearing loss, BC-VEMPs offer insights into inner ear function.

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.

Cervical and ocular vestibular evoked myogenic potentials in patients with Diabetic Peripheral Neuropathy

BackgroundDiabetes causes impaired microarterial blood flow, demyelination and neuronal damage, which may lead to cochlear damage and vestibular malfunction. Vestibular evoked myogenic potentials (VEMP) is a simple, reproducible test. Cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) can be explored in the saccadic-spinal and utriculo-ocular pathways in regular clinical practice.ObjectiveTo evaluate possible vestibular evoked myogenic potential (VEMP) abnormalities in patients with diabetic peripheral neuropathy.Materials and methods89 patients with Type 2 Diabetes in the present study consisted of three groups: 29 patients with no peripheral neuropathy (NDPN group), 26 patients with asymptomatic neuropathy (SDPN group), 34 patients with symptomatic neuropathy (DPN group). Meanwhile, 42 healthy subjects were recruited as controls. The clinical characteristics (including gender, age, body mass index (BMI), and illness duration), as well as lipids (including triglyceride (TG), cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL)), uric acid, fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) were compared among the four groups. Four groups were assessed using two vestibular tests including oVEMP and cVEMP. Latency and amplitude parameters were analyzed from VEMP plots.ResultsThe latency of n10, p15 (oVEMP), p13, n23 (cVEMP) were significantly prolonged in the SDPN and DPN groups compared with the control and NDPN groups (p < 0.01), whereas latencies were similar in NDPN and the control groups. The amplitudes were not significantly different (p > 0.05). oVEMP latency p15 and cVEMP latency (p13, n23) were positively correlated with HbA1c, FBG, and illness duration, and oVEMP latency n10 was positively correlated with HbA1c and FBG. A nomogram, including FBG, HbA1C, HDL, TG, TC, LDL and group, was constructed to predict VEMP parameters and p13 was found to be independently associated with diabetic subgroups. Receiver operating characteristic curve (ROC) analysis showed good accuracy in predicting p13 in this nomogram. A user-friendly website has been created to facilitate the application of this prediction model ( https://fyey.shinyapps.io/VEMP_Model/ ).ConclusionPatients with diabetic peripheral neuropathy may have vestibular dysfunction. VEMP may be useful in assessing vestibular impairment in diabetic patients.

Effectiveness of galvanic vestibular evoked myogenic potential for evaluation of Meniere’s disease

ObjectivesAlthough the cause of Meniere’s disease (MD) is not fully understood, endolymphatic hydrops is widely believed to be responsible for MD. Previous studies have used Air-Conducted Sound (ACS)-induced Vestibular Evoked Myogenic Potentials (VEMPs) to evaluate otolithic function in patients with MD. However, the use of Galvanic Vestibular Stimulation-VEMPs (GVS-VEMPs) with other vestibular tests in MD has been rare. This study aimed to explore the application of galvanic VEMPs in assessing MD. MethodsNormal individuals and patients with unilateral definite MD were included in this retrospective study. All participants underwent pure tone audiometry. Ocular and cervical VEMPs induced by GVS, and ACS were recorded. The characteristic parameters of VEMPs (n1 latency, p1 latency, amplitude, and AR) were analyzed. ResultsThe provocation rates of GVS-VEMPs did not differ between MD patients and control individuals. Compared with ACS, GVS could evoke potentials with longer latencies. MD patients presented GVS-VEMPs with lower amplitudes and ACS-cVEMP with shorter latencies and had a higher response rate in GVS-oVEMP. However, no differences or correlations were found in the characteristic parameters of GVS-VEMPs among the different stages of MD. ConclusionsGVS is as effective as ACS for inducing VEMP, and GVS-VEMP recording can detect retrolabyrinthine degeneration in MD. Further research is needed to assess the utility of GVS-VEMP in the evaluation of MD severity. Level of evidenceLevel 4.

REM sleep without atonia and vestibular-evoked myogenic potentials: clinical brainstem dysfunction in early-stage Parkinson's disease and isolated REM sleep behavior disorder

ObjectiveTo determine whether the onset of rapid eye movement (REM) sleep behavior disorder (RBD) is associated with changes in brainstem neuronal pathway dysfunction as reflected by vestibular-evoked myogenic potentials (VEMPs) and to evaluate associations between VEMPs and REM sleep without atonia (RSWA) in patients with early-stage Parkinson's disease (PD) and isolated RBD (iRBD). MethodsEighty-two early-stage PD patients, 40 iRBD patients, and 41 healthy control individuals underwent one-night video-polysomnography (vPSG) and VEMPs examination. We compared cervical (cVEMP), ocular (oVEMP), and masseter (mVEMP) VEMP parameters among PD with RBD (PD + RBD), PD without RBD (PD-RBD), iRBD, and control groups and analyzed correlations between VEMPs and RSWA in PD and iRBD groups. ResultsThe PD + RBD group showed delays in bilateral cVEMP (Lp13, Ln23, Rn23: all p < 0.05) and oVEMP (Ln10, Rn10, Rp15: all p < 0.05) peak latencies compared with the PD-RBD group. Total cVEMP scores were higher in the PD + RBD group than in the iRBD group (p = 0.033). In PD patients, phasic RSWA was correlated with total cVEMP scores (p = 0.003), and tonic RSWA was correlated with left oVEMP scores (p = 0.013). ConclusionsBrainstem neurophysiology as evidenced by altered VEMPs in patients with PD and iRBD could reflect disease evolvement. Moreover, VEMPs alterations may vary depending on the presence of RBD in PD patients. The associations between altered RSWA and VEMP parameters highlight the meaningfulness of detecting brainstem dysfunction in early-stage PD.

Retro-labyrinthine Lesion Site Detected by Galvanic Vestibular Stimulation Elicited Vestibular-evoked Myogenic Potentials in Patients with Auditory Neuropathy.

Auditory neuropathy (AN) is a unique pattern of hearing loss with preservation of hair cell function. The condition is characterized by the presence of otoacoustic emissions (OAE) or cochlear microphonic (CM) responses with severe abnormalities of the auditory brainstem response (ABR). The vestibular branches of the VIII cranial nerve and the structures innervated by it can also be affected. However, the precise lesion sites in the vestibular system are not well characterized in patients with AN. The air-conducted sound (ACS) vestibular-evoked myogenic potentials (VEMPs) and galvanic vestibular stimuli (GVS)-VEMPs were examined in 14 patients with AN. On examination of VEMPs (n=14, 28 ears), the absent rates of ACS-cervical VEMP (cVEMP), ACS-ocular VEMP (oVEMP), GVS-cVEMP, GVS-oVEMP and caloric test were 92.9% (26/28), 85.7% (24/28), 67.9% (19/28), 53.6% (15/28), and 61.5% (8/13), respectively. Impaired functions of the saccule, inferior vestibular nerve, utricle, superior vestibular nerve, and horizontal semicircular canal were found in 25.0% (7/28), 67.9% (19/28), 32.1% (9/28), 53.6% (15/28) and 61.5% (8/13) patients, respectively. On comparing the elicited VEMPs parameters of AN patients with those of normal controls, both ACS-VEMPs and GVS-VEMPs showed abnormal results in AN patients (such as, lower presence rates, elevated thresholds, prolonged latencies, and decreased amplitudes). The study suggested that patients with AN often have concomitant vestibular disorders. Retro-labyrinthine lesions were more frequently observed in this study. GVS-VEMPs combined with ACS-VEMPs may help identify the lesion sites and facilitate detection of areas of vestibular dysfunction in these patients.

Tap-hammer elicited vestibular-evoked myogenic potentials system: its design and preliminary application

Objective: The aim of this study was to design and perform "Tap-hammer"system that can be used to elicit vestibular evoked myogenic potentials (VEMP) in normal adults and to report the preliminary results of this system. Methods: A triggered Tap-hammer was designed, made and connected with an electric recording system, to form as a system for Tap-VEMP recording. Twenty healthy adult volunteers (7 males and 13 females, aged 20 to 37 years, 40 ears in total) were recruited for air-conducted sound VEMP (ACS-VEMP) and Tap-VEMP examinations. Waveforms and parameters of both VEMPs were recorded and analyzed. SPSS 22.0 software was used for statistical analysis. Results: The response rates of ACS-, Tap-ocular VEMP (oVEMP) and ACS-, Tap-cervical VEMP (cVEMP) were both 100% (40/40). The mean±SD n1 latency, p1 latency, n1-p1 interval, amplitude, and asymmetry ratio (AR%) of Tap-oVEMP were (9.80±2.51)ms, (13.90±3.26)ms, (4.09±1.43)ms, (16.43±9.61)μV, (22.68±17.35)% respectively. The mean±SD p1 latency, n1 latency, p1-n1 interval, amplitude, and asymmetry ratio (AR%) of Tap-cVEMP were (13.26±2.07)ms, (21.84±2.89)ms, (8.58±2.10)ms, (457.65±274.94)μV, (20.42±13.46)% respectively. Both n1 latency and p1 latency of Tap-VEMPs were shorter than those in ACS-VEMPs (P<0.05). No statistical difference could be found between the two stimulation methods in the parameters of n1-p1 interval, amplitude, and asymmetry ratio(P>0.05). Conclusion: The Tap-hammer system can elicit VEMP responses in healthy young people. This system can be used as an alternative stimulation method for bone conduction VEMP.

Auditory and vestibular dysfunction in patients with Parkinson\u2019s disease

BackgroundMotor dysfunction in patients with Parkinson disease (PD) is just the tip of the iceberg. Auditory and vestibular dysfunction in patients with PD gained much attention owing to them being one of the nonmotor symptoms.AimTo explore abnormalities of pure tone audiometry (PTA), brainstem auditory evoked potentials (BAEPs), vestibular evoked myogenic potential (VEMP), and videonystagmography (VNG) in patients with PD and their correlation with motor and cognitive dysfunction.Patients and methodsThe study was conducted on 20 patients with PD and 15 controls. Selected patients were subjected to evaluation of motor symptoms using Unified Parkinson’s Disease Rating Scale (UPDRS) and cognitive function using Parkinson disease-Cognitive Rating Scale (PD-CRS). PTA, BAEPs, cervical VEMPs, and VNG were carried out for all patients and controls.ResultsPatients with PD show higher mean hearing thresholds at all PTA frequencies in both ears than controls. Analysis of BAEP demonstrated that patients with PD have significantly prolonged absolute latencies of wave III and wave V and interpeak latencies of I–III and I–V in both ears than controls. VEMP findings revealed that patients have significantly delayed P13 and N23 latencies and smaller P13–N23 amplitude in both ears than controls. VNG findings showed canal paresis in 60% of patients with PD and nystagmus in 60% of patients with PD. Correlative results revealed statistically significant correlations between VEMP parameters and UPDRS as well as PD-CRS, but there were no statistically significant correlations between PTA frequencies or BAEP latencies and UPDRS or PD-CRS.ConclusionAuditory and vestibular dysfunction is common in PD but cannot be totally correlated with the motor and cognitive symptoms.

P250 Simultaneous recording of cervical and ocular vestibular-evoked myogenic potentials

Objective To increase clinical application by reducing the testing time for recording vestibular-evoked myogenic potentials (VEMPs), we evaluated whether a simultaneous recording of ocular and cervical VEMPs after monaural and binaural stimulation can be achieved without a loss in diagnostic sensitivity and specificity. Methods Using randomized cross-over trials, 40 healthy subjects (HS) and 20 patients with acute vestibular neuritis underwent simultaneous recording of ocular and cervical VEMPs on each side during monaural stimulation, bilateral simultaneous recording of ocular VEMPs and cervical VEMPs during binaural stimulation, and conventional sequential recording of ocular and cervical VEMPs on each side using air-conducted sound (500 Hz, 5 ms tone-burst). We compared the time required to test and VEMP parameters among the study conditions. Clinical trial registration: NCT03049683. Results Either simultaneous recording during monaural and binaural stimulation effectively reduced the recording time by about 55% of that for conventional sequential recordings in both HS and patients groups. The simultaneous recording with monaural stimulation resulted in the latencies and thresholds of both VEMPs and amplitude of cervical VEMPs similar to those found during the conventional recordings in both groups, but larger oVEMP amplitude (156%) in HS. In contrast, compared to the conventional recording, simultaneous recording of each VEMP during binaural stimulation showed reduced amplitudes (31%) and increased thresholds for cervical VEMPs in both groups. Conclusion The results of simultaneous recording of cervical and ocular VEMPs during monaural stimulation were comparable to those obtained from the conventional recording while reducing the time to record both VEMPs on each side.

Ageing Effect on Air-Conducted Ocular Vestibular Evoked Myogenic Potential.

One of the recent diagnostic tests to assess the function of otolithic organs is through vestibular evoked myogenic potential (VEMP) testing. There are equivocal findings on effect of aging on ocular VEMP (oVEMP) parameters with reference to latencies. Hence this study was taken up to investigate the age related changes in oVEMP parameters. This present study considered 30 participants in each age group i.e., young adults, middle-aged adults and older adults. oVEMP were recorded using insert earphone at 100dBnHL at 500hZ short duration tone burst. The results showed in older adult significant difference in response rate, latencies and amplitude as compared to young and middle adult. Hence age should be taken into consideration when interpreting oVEMP results.

Epidemiology of vestibular evoked myogenic potentials: Data from the Baltimore Longitudinal Study of Aging

ObjectiveTo evaluate whether age-related changes in vestibular evoked myogenic potentials (VEMPs) differ by demographic and cardiovascular risk groups. MethodsParticipants in the Baltimore Longitudinal Study of Aging underwent cervical and ocular VEMP testing. VEMP latency, amplitude, asymmetry ratios, and prevalence of absent responses were compared across demographic and cardiovascular risk groups. ResultsIn 257 participants (mean age 72.9, 57% female), ocular VEMP (oVEMP) n10 latency increased by 0.12ms/decade while amplitude decreased by 2.9μV/decade. Black participants had better oVEMP function (shorter latency, increased amplitude, and decreased odds of absent responses) relative to white participants. In 250 participants (mean age 72.6, 54% female), EMG-corrected cervical VEMP (cVEMP) amplitude decreased by 0.14μV/decade and p13 latency was 0.38ms longer in males. The odds of absent responses were significantly higher in individuals age ⩾80 for oVEMPs, and age ⩾70 for cVEMPs. Cardiovascular risk factors had no association with VEMP parameters. ConclusionsWe confirmed age-related declines in otolith function, and observed a protective effect of black race on oVEMP latency and amplitude. SignificanceThese results illustrate how measures of otolith function change with age in community-dwelling adults. Further investigations are needed to ascertain whether better otolith function in blacks might contribute to a lower risk of mobility disability and falls.

Vestibular evoked myogenic potential according to middle ear condition in chronic otitis media with tympanic membrane perforation

Conclusion: Vestibular evoked myogenic potential (VEMP) function results can vary between individuals with different middle ear conditions. Therefore, by analyzing VEMP results after paper patching, we can predict the condition of the middle ear in chronic otitis media (COM) patients. Objectives: VEMP responses decrease with impairment of sound transmission, such as in conductive hearing loss (CHL). COM with tympanic membrane (TM) perforation is a common disorder that causes various degrees of CHL. The aim of this study was to evaluate and clarify the VEMP responses in patients with COM with different middle ear pathology. Methods: This study included 50 patients with unilateral COM with TM perforation. Initial pure-tone audiometry (PTA) and VEMP responses were recorded. After paper patching, PTA and VEMP were re-performed. Each VEMP response was compared with those of the healthy controls. Moreover, VEMP responses between pre- and post-paper patching were compared. Results: There was a positive correlation between normalizing of VEMP parameters, such as p13 and VEMP asymmetry ratio (VAR), and reduction of air–bone gap in patients with COM after paper patching. The VEMP response in patients with COM with intact ossicle and clean mucosa was more normalized compared with those in patients with COM with different middle ear conditions.

Vestibular-evoked myogenic potentials, clinical evaluation, and imaging findings in multiple sclerosis

Vestibular-evoked myogenic potentials (VEMP), short-latency electromyographic responses elicited by acoustic stimuli, evaluate the function of vestibulocollic reflex and may give information about brainstem function. The aim of the present study is to evaluate the potential contribution of VEMP to the diagnosis of multiple sclerosis (MS). Fifty patients with MS and 30 healthy control subjects were included in this study. The frequency of VEMP p1-n1 and n2-p2 waves; mean p1, n1, n2, and p2 latency; and mean p1-n1 and n2-p2 amplitude were determined. The relation between clinical and imaging findings and VEMP parameters was evaluated. The p1-n1 and n2-p2 waves were more frequently absent in MS than in control subjects [p1-n1 wave absent: MS, 25 (25 %) ears; control, 6 (10 %) ears; P ≤ 0.02] [n2-p2 wave absent: MS, 44 (44 %) ears; control, 7 (12 %) ears; P ≤ 0.001]. The mean p1-n1 amplitude was lower in MS than in control subjects (MS, 19.1 ± 7.2 μV; control, 23.3 ± 7.4 μV; P ≤ 0.002). A total of 24/50 (48 %) MS patients had VEMP abnormalities (absent responses and/or prolonged latencies). VEMP abnormalities were more frequent in patients with than without vestibular symptoms (P ≤ 0.02) and with brainstem functional system score (FSS) ≥ 1 than FSS = 0 (P ≤ 0.02). In patients with MS, absence of p1-n1 wave was more frequent in patients with than without vestibular symptoms [absence of p1-n1 wave: vestibular symptoms, 9 (45 %) ears; no vestibular symptoms, 16 (20 %) ears; P ≤ 0.03] and patients with Expanded Disability Status Scale (EDSS) score ≥ 5.5 [absence of p1-n1 wave: EDSS ≥ 5.5, 7 (70 %) ears; EDSS <5.5, 18 (20 %) ears; P ≤ 0.001]. Abnormal VEMP may be noted in MS patients, especially those with vestibular symptoms and greater disability. The VEMP test may complement other studies for diagnosis and follow-up of patients with MS.

Clinical Value of Vestibular Evoked Myogenic Potential in Assessing the Stage and Predicting the Hearing Results in Ménière's Disease

ObjectivesOur goal was to find the clinical value of cervical vestibular evoked myogenic potential (VEMP) in Ménière's disease (MD) and to evaluate whether the VEMP results can be useful in assessing the stage of MD. Furthermore, we tried to evaluate the clinical effectiveness of VEMP in predicting hearing outcomes.MethodsThe amplitude, peak latency and interaural amplitude difference (IAD) ratio were obtained using cervical VEMP. The VEMP results of MD were compared with those of normal subjects, and the MD stages were compared with the IAD ratio. Finally, the hearing changes were analyzed according to their VEMP results.ResultsIn clinically definite unilateral MD (n=41), the prevalence of cervical VEMP abnormality in the IAD ratio was 34.1%. When compared with normal subjects (n=33), the VEMP profile of MD patients showed a low amplitude and a similar latency. The mean IAD ratio in MD was 23%, which was significantly different from that of normal subjects (P=0.01). As the stage increased, the IAD ratio significantly increased (P=0.09). After stratification by initial hearing level, stage I and II subjects (hearing threshold, 0-40 dB) with an abnormal IAD ratio showed a decrease in hearing over time compared to those with a normal IAD ratio (P=0.08).ConclusionVEMP parameters have an important clinical role in MD. Especially, the IAD ratio can be used to assess the stage of MD. An abnormal IAD ratio may be used as a predictor of poor hearing outcomes in subjects with early stage MD.

Clinical Value of VEMP in Ménière’s Disease

Objective: 1) To find clinical value of cervical vestibular evoked myogenic potential (VEMP) in Ménière’s disease (MD). 2) To evaluate whether the VEMP results can be useful in assessing the stage of MD. 3) To evaluate the clinical effectiveness of VEMP in predicting hearing outcome. Method: The amplitude, peak latency and interaural amplitude difference ratio (IAD ratio) was obtained using cervical VEMP. The VEMP results of MD were compared with normal subjects and MD stages were compared with IAD ratio. Finally, the hearing changes were analyzed according to their VEMP results. Results: In clinically definite unilateral MD (n = 41), the prevalence of cervical VEMP abnormality in IAD ratio was 34.1%. Compared with healthy subjects (n = 33), the VEMP profile showed low amplitude and similar latency. The mean IAD ratio in MD was 23%, and was significantly different from healthy subjects ( P = .01). As the stage increased, IAD ratio was significantly increased ( P = .078). After stratification by initial hearing level, stage I and II subjects (hearing threshold, 0-40 dB) with abnormal IAD ratio showed a decrease in hearing over time compared to those with normal IAD ratio ( P = .065). Conclusion: VEMP parameters have an important clinical role in MD. Especially, IAD ratio can be used to assess the stage of MD. An abnormal IAD ratio may be used as a predictor of poor hearing outcomes in subjects with early stage MD.

Comparison of tone burst versus logon stimulation for vestibular evoked myogenic potentials

The following study has been carried out to compare the effectiveness of logon and tone burst acoustic stimulation to elicit vestibular evoked myogenic potential (VEMP) responses. The methods and the subjects include 31 healthy adult volunteers (62 ears) who were enrolled in this study. Two different acoustic stimuli, logon (L-VEMP) and tone burst (T-VEMP), were used to elicit VEMP responses in each subject. Bilateral recordings with simultaneous binaural acoustic stimulations were used during VEMP recordings. During the recording period, the subjects were in supine position with their head elevated. The results observed were that the response rate of p1n1 wave was 91.9% for L-VEMP and 88.7% for T-VEMP. The response rate of n2p2 wave was 80.6% for L-VEMP, and 75.8% for T-VEMP. There were no significant differences between the two groups with respect to the latencies of p1, n1, n2 and p2, p1n1 and n2p2 interval, and p1n1 and n2p2 amplitude. The conclusion was that there was no difference between logon and tone burst stimulation with respect to VEMP response rates and VEMP parameters. Therefore, they are not superior to each other.

No Effects of Anti-Motion Sickness Drugs on Vestibular Evoked Myogenic Potentials Outcome Parameters

To investigate the effects of meclizine (50 mg), baclofen (10 mg), cinnarizine (20 mg) + dimenhydrinate (40 mg), and promethazine (25 mg) + dextro-amphetamine (5 mg) on the parameters of the vestibular evoked myogenic potential (VEMP) test. Double-blind placebo-controlled prospective randomized trial. University hospital. Twenty-four (first block: baclofen versus placebo) and 20 healthy male subjects (second block: meclizine, cinnarizine + dimenhydrinate and promethazine + dextro-amphetamine versus placebo). VEMP test. Threshold, p13 and n23 latencies, p13-n23 latency difference, p13-n23 peak-to-peak amplitude, mean rectified voltage of the sternocleidomastoid muscle contraction and the corrected amplitude. There were no clinically significant pharmacologic effects on the VEMP outcome parameters. However, there was a statistically significant left-right asymmetry after intake of the combination promethazine + d-amphetamine for the parameters p13 and latency difference. The absence of clinically significant effects can be explained by the predominant presence of the target receptors for the applied drugs in the medial vestibular nucleus, which receives the lowest grade of saccular projections. It also can be hypothesized that the VEMP methodology and techniques in general do not allow determining pharmacologic effects in a healthy group of subjects because of a too small discriminative power. The left-right asymmetry can be explained by a depressive action of the drugs on the central compensation mechanisms. Because there were no significant differences between the VEMP parameters obtained after intake of the placebos of both blocks, we concluded that there were no training effects.

Saccular sensitivity function measured by vestibular evoked myogenic potential

Conclusions: Vestibular myogenic potential responses were present when evoked by tone burst stimuli of 250, 500, 1000, and 2000 Hz; however, they were more effective for low-frequency stimuli. Objectives: Few studies refer to specific frequency sensitivities of the saccular afferents. Accordingly, the aim of the present study was to analyze p13 and n23 latency and amplitude parameters of vestibular evoked myogenic potential (VEMP) captured with tone bursts at frequencies of 250, 500, 1000, and 2000 Hz. Methods: VEMP was captured in 156 ears (78 subjects), recorded in the sternocleidomastoid muscle, averaging 200 stimuli, stimulus rate of 5 Hz, duration 10 ms (rise, 4 ms; plateau, 2 ms; fall, 4 ms), at intensity of 95 dB nHL. The recordings were performed in 50 ms windows. Results: We found lower p13 latencies in women compared with men, except for the frequency of 250 Hz. We found higher mean absolute latency values for p13 and n13 and lower p13-n13 amplitude and p13-n13 inter-peak values for a frequency of 2000 Hz. Higher amplitudes were observed at frequencies of 250 and 500 Hz. When frequencies of 250, 500, 1000, and 2000 Hz were compared using ANOVA, we found statistically significant differences for all the VEMP parameters (p ≤ 0.005).