Avaliação da vertical visual subjetiva em adultos jovens / Evaluation of subjective visual vertical in young adults

RESUMO Objetivo Avaliar a vertical visual subjetiva em indivíduos adultos jovens sem queixas vestibulares e/ou alterações do equilíbrio corporal. Método Estudo do tipo observacional, descritivo, analítico, de delineamento transversal, no qual foram avaliados 50 adultos jovens, com idade entre 18 e 30 anos. Foram excluídos do estudo indivíduos com alteração neurológica, alteração cognitiva evidente, deficiência física que influenciasse no equilíbrio corporal, alteração visual sem uso de lentes corretivas, uso de medicamentos com ação sobre o sistema nervoso central e/ou vestibular, relato de ingestão alcoólica 24 horas antes da avaliação e indivíduos com alterações e/ou queixas vestibulares. Os participantes foram submetidos à anamnese e à avaliação da vertical visual subjetiva, por meio do teste do balde. O teste foi realizado em três condições sensoriais diferentes: 1- Indivíduo sentado, com os dois pés sobre superfície estável (piso de paviflex); 2- Indivíduo sentado, com os pés em cima de uma espuma; 3- Indivíduo em pé sobre uma espuma. Resultados A vertical visual subjetiva não apresentou diferença significativa (p= 0,93) entre as condições sensoriais estudadas. Conclusão Em adultos jovens hígidos, o sistema proprioceptivo não influenciou significativamente a avaliação da vertical visual subjetiva, realizada por meio do teste do balde.

ABSTRACT Objective To evaluate subjective visual vertical in young adults without vestibular complaints and/or body balance problems. Methods This was a descriptive cross-sectional, observational and analytical study that assessed 50 young adults aged 18 to 30 years. Adult were excluded from the study if they had neurological and cognitive disorders, physical disability that affected their balance, visual impairment with no use of corrective lenses, use of drugs with effects on the central nervous system and/or the vestibular system and self-report of alcoholic use 24 hours before the assessment, and adults with vestibular problems and/or complaints The participants answered questions in a medical history interview and underwent subjective visual vertical assessment with the bucket method. The test was performed under three different sensory conditions: 1 - Subjects sitting with both feet on a stable surface (Paviflex® flooring); 2- Subjects sitting with their feet on top of foam; 3- Subjects on top of foam. Results The subjective visual vertical did not show a significant difference (p = 0.93) among the study sensory conditions. Conclusion The proprioceptive system did not significantly influence the measurement of the subjective visual vertical in young healthy adults.

cVEMP correlated with imbalance in a mouse model of vestibular disorder

BACKGROUND@#Cervical vestibular evoked myogenic potential (cVEMP) testing is a strong tool that enables objective determination of balance functions in humans. However, it remains unknown whether cVEMP correctly expresses vestibular disorder in mice.@*OBJECTIVE@#In this study, correlations of cVEMP with scores for balance-related behavior tests including rotarod, beam, and air-righting reflex tests were determined in ICR mice with vestibular disorder induced by 3,3'-iminodipropiontrile (IDPN) as a mouse model of vestibular disorder.@*METHODS@#Male ICR mice at 4 weeks of age were orally administered IDPN in saline (28 mmol/kg body weight) once. Rotarod, beam crossing, and air-righting reflex tests were performed before and 3-4 days after oral exposure one time to IDPN to determine balance functions. The saccule and utricles were labeled with fluorescein phalloidin. cVEMP measurements were performed for mice in the control and IDPN groups. Finally, the correlations between the scores of behavior tests and the amplitude or latency of cVEMP were determined with Spearman's rank correlation coefficient. Two-tailed Student's t test and Welch's t test were used to determine a significant difference between the two groups. A difference with p < 0.05 was considered to indicate statistical significance.@*RESULTS@#After oral administration of IDPN at 28 mmol/kg, scores of the rotarod, beam, and air-righting reflex tests in the IDPN group were significantly lower than those in the control group. The numbers of hair cells in the saccule, utricle, and cupula were decreased in the IDPN group. cVEMP in the IDPN group was significantly decreased in amplitude and increased in latency compared to those in the control group. cVEMP amplitude had significant correlations with the numbers of hair cells as well as scores for all of the behavior tests in mice.@*CONCLUSIONS@#This study demonstrated impaired cVEMP and correlations of cVEMP with imbalance determined by behavior tests in a mouse model of vestibular disorder.

Evaluation of Saccule Function in Patients with Vitamin D Deficiency

BACKGROUND AND OBJECTIVES: Considering important role of vitamin D in many physiological processes including vestibular system in the ear, aim of present study is to evaluate saccule function via cervical vestibular evoked myogenic potential (cVEMP), in patients with vitamin D deficiency. SUBJECTS AND METHODS: After routine audiological tests, cVEMP were recorded in 15 patients with vitamin D deficiency and 16 normal subjects. The short tone burst (95 dB nHL, 500 Hz) was presented to ears. cVEMP was recorded with surface electromyography over the contracted ipsilateral sternocleidomastoid muscle. RESULTS: Mean of p13, n13, interpeak latencies and amplitude ratios were measured in both groups. Statistical analysis did not show differences between two groups. CONCLUSIONS: Maybe serum 25-hydroxyvitamin D concentration was not low enough to have effect on saccule in the patients in present study or saccule have had low susceptibility to effects of vitamin D deficiency. For better judgment about effect of vitamin D deficiency on saccular function planning studies with high sample size is recommended.

Clinical Characteristics and Management of Saccular Cysts: A Single Institute Experience

OBJECTIVES: A saccular cyst is defined as a dilated saccule of the larynx, filled with mucus, and is located between the false vocal cords and the thyroid cartilage. Although this uncommon laryngeal condition is benign in nature, it could lead to dyspnea, stridor, and airway obstruction, depending on its size and location. Furthermore, some saccular cysts have been associated with laryngeal carcinoma. This study aimed to characterize this rather uncommon laryngeal condition to aid in determining the proper management of this pathology. METHODS: Medical records were retrospectively reviewed of all patients with saccular cysts diagnosed and treated between 2006 and 2017 at a tertiary otolaryngologic care center. RESULTS: Seven patients with saccular cysts were identified (male:female=2:5; mean age, 34.1 years); two were pediatric patients. Surgical intervention was performed in all patients by laryngo-microsurgery using CO2 laser. There was no recurrence after the initial surgical treatment. CONCLUSION: Saccular cysts can be managed endoscopically using CO2 laser, without requiring an external approach. Therefore, an endoscopic approach should be actively considered for an optimal treatment outcome.

Cervical Vestibular-Evoked Myogenic Potentials in Sedated Toddlers

Abstract Introduction Cervical vestibular-evoked myogenic potentials (cVEMPs) are difficult to test in toddlers who cannot follow instructions or stay calm. Objective Due to the growing need for vestibular testing in very young children as a part of a delayed walking assessment battery, this study aimed to provide a solution to this problem by recording the cVEMPs in toddlers during sedation. Method The cVEMPs measures were assessed in 30 toddlers aged 12 to 36 months with normal motormilestones. They were sedated with chloral hydrate. Then, the head was retracted ~ 30° backward with a pillow under the shoulders, and turned 45° contralateral to the side of stimulation to put the sternocleidomastoid (SCM)muscle in a state of tension. Results The P13 and N23 waves of the cVEMPs were recordable in all sedated toddlers. The cVEMPs measures resulted in the following: P13 latency of 17.5 ± 1.41 milliseconds, N23 latency of 25.58 ± 2.02 milliseconds, and peak-topeak amplitude of 15.39 ± 3.45 μV. One-sample t-test revealed statistically significant longer latencies and smaller amplitude of the toddlers' cVEMPs relative to the normative data for adults. Conclusions The difficulty of cVEMPs testing in toddlers can be overcome by sedating them and attaining a position that contracts the SCM muscle. However, the toddlers' recordings revealed delayed latencies and smaller amplitudes than those of adults.

Potenciales evocados vestibulares miogénicos / Myogenic vestibular evoked potentials

El equilibrio es el estado de un cuerpo requerido por fuerzas opuestas e iguales, es el mantenimiento de la posición corporal adecuada a cada circunstancia, tanto en condición estática como dinámica. Los laberintos posteriores regulan en gran proporción esas fuerzas y la normalidad está basada en la igualdad de sus tonos, están conformados por el vestíbulo membranoso (constituido por el utrículo y el sáculo) y los conductos semicirculares. Los conductos semicirculares pueden ser examinados a través de las pruebas vestibulares rotatorias o bicalóricas, los órganos otolíticos (utrículo y sáculo) por su ubicación anatómica quedan limitados en el estudio de sus funciones; sin embargo, existe una prueba neurofisiológica (potencial evocado vestibular miogénico) capaz de explorar la función del sáculo y del nervio vestibular inferior, que aprovecha la posibilidad que tiene el sáculo de ser estimulado con altas intensidad de sonido en diferentes frecuencias(AU)

Equilibrium is the required state of a body by opposing and equal forces, it is the maintenance of the body position appropriate to each circumstance, both in static and dynamic condition. The posterior labyrinths regulate these forces to a great extent, and normality is based on the equality of their tones. They are made up of the semicircular ducts and the membranous vestibule (constituted by the utricle and the saccule). Semicircular ducts can be examined through rotational or bicalorical vestibular tests, otolithic organs (utricle and saccule) because of their anatomical location are limited in the study of their functions, however, there is a neurophysiological test (evoked vestibular myogenic potential) capable of exploring the function of the saccule and inferior vestibular nerve, which takes advantage of the ability of the saccule to be stimulated with high sound intensity at different frequencies(AU)

Potencial evocado miogênico vestibular ocular e cervical simultâneo em indivíduos normais / Ocular and cervical vestibular evoked myogenic potential simultaneous in normal individuals

RESUMO Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos sem queixas auditivas e vestibulares. Métodos: Participaram da pesquisa 30 indivíduos sem queixa auditiva e com audição dentro dos padrões de normalidade. A coleta de dados foi realizada por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13 e N23 do potencial evocado miogênico vestibular cervical e para a latência da onda N10 do potencial evocado miogênico vestibular ocular. No gênero feminino não houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13, N23, N10, P15, interamplitude no potencial evocado miogênico vestibular cervical e interamplitude no potencial evocado miogênico vestibular ocular e para a latência das ondas P13, N23, N10 e P15. No gênero masculino houve diferença entre as orelhas direita e esquerda para a amplitude da onda P13. Conclusão: Os resultados do potencial evocado miogênico vestibular cervical e ocular combinado foram consistentes, uma vez que as respostas geradas pelos potenciais evocados miogênicos vestibulares apresentaram morfologia, latência e amplitude adequadas, o que permite a avaliação da via vestibular ipsilateral descendente e da via vestibular contralateral ascendente.

ABSTRACT Purpose: To characterize the recording and analyze the results of the combined cervical and ocular vestibular evoked myogenic potential in individuals without hearing and vestibular complaints. Methods: In this study, 30 individuals without hearing complaints and hearing within normal limits were evaluated. Data were collected through the simultaneous recording of cervical and ocular vestibular evoked myogenic potential. Results: Differences were observed between the right and left ears for the amplitude of waves P13 and N23 of the cervical vestibular evoked myogenic potential and the latency of wave N10 of the ocular vestibular evoked myogenic potential. For female subjects, there was no difference between the right and left ears for the amplitude of waves P13, N23, N10, and P15; interamplitude in cervical vestibular evoked myogenic potential and interamplitude in ocular vestibular evoked myogenic potential; and latency in waves P13, N23, N10, and P15. For male subjects, there was a difference between the right and left ears for the amplitude of wave P13. Conclusion: The results of the combined cervical and ocular vestibular evoked myogenic potentials were consistent, because the responses generated by the vestibular evoked myogenic potentials presented an adequate morphology, latency, and amplitude, allowing for the evaluation of the ipsilateral descending vestibular pathways and the contralateral ascending vestibular pathways.

Comparison of Video Head Impulse Test with Posterior Semicircular Canal Plane and Cervical Vestibular Evoked Myogenic Potential / 대한평형의학회지

OBJECTIVE: Cervical vestibular evoked myogenic potential (cVEMP) is thought to be assessing the function of the saccule and inferior vestibular nerve. Therefore, cVEMP indirectly reflects the function of the posterior semicircular canal. Recently, the video head impulse test (vHIT) is considered as useful clinical tool to detect each semicircular canal dysfunction. Goal of this study was to evaluate and compare the results of cVEMP with posterior canal plane of vHIT (p-vHIT). METHODS: Retrospectively, we compared the results of cVEMP with p-vHIT in 43 patients who visited with dizziness. We analyzed the inter-test agreement of cVEMP with p-vHIT. RESULTS: Positive asymmetry of cVEMP was present in 37.2% (16/43), and no responses of both ears were identified in 16.3% (7/43). In p-vHIT analysis, unilateral positive was 27.9% (12/43), bilateral positive was 11.6% (5/43) and negative in both sides was 60.5% (26/43). The inter-test agreement between cVEMP and p-vHIT was 75.8% (25/33) as we considered even in lesion side. And, Fleiss's kappa value showed a fair to good agreement (kappa value=0.559). In bilateral no response group (7 patients) in cVEMP, variable additional information could be obtained using p-vHIT. CONCLUSION: cVEMP and p-vHIT showed relatively lower inter-test agreement than expected. But, p-vHIT could be easily performed, and give additional information for differential diagnosis.

Potencial evocado miogênico vestibular ocular: revisão de literatura / Ocular vestibular evoked myogenic potential: literature review

RESUMO Objetivo Identificar e sistematizar os principais estudos sobre o potencial evocado miogênico vestibular ocular e suas aplicações no diagnóstico das diversas doenças vestibulares. Estratégia de pesquisa Foram localizados artigos que descrevem a utilização do potencial evocado miogênico vestibular ocular na avaliação de doenças vestibulares nas bases PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. Critérios de seleção Foram incluídos estudos originais, com resumo disponível, publicados no período de janeiro de 2010 a março de 2016. Análise dos dados Foi realizada a descrição do delineamento do estudo e elencados os achados para a avaliação de potencial evocado miogênico vestibular ocular. Resultados Foram encontrados 265 estudos, dos quais 14 contemplaram os critérios de seleção propostos. Em relação à população/amostra de pacientes com alterações vestibulares incluída nos estudos, observou-se que as doenças mais investigadas foram a neurite vestibular, a vertigem posicional paroxística benigna, o Schwanoma vestibular e a doença de Ménière. Conclusão A maior parte das pesquisas realizadas nos últimos anos e publicadas nas bases de dados PubMed, Web of Science, MEDLINE e Scopus revelou que o potencial evocado miogênico vestibular ocular representa um método eficaz para avaliar a função utricular nas mais diversas doenças vestibulares.

ABSTRACT Purpose To identify and systematize the main studies on the ocular vestibular evoked myogenic potentials and their applications in the diagnosis of various vestibular diseases. Research strategy Articles that describe the use of ocular vestibular evoked myogenic potentials the evaluation of vestibular diseases were located in PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. Selection criteria Original studies, with available abstract, published in the period 2010 to March 2016 were included. Data analysis The study design was described, and the characteristics for the evaluation of ocular vestibular evoked myogenic potentials were listed. Results 265 studies were found, but just 14 contemplated the proposed selection criteria. In relation to the population / sample of patients with vestibular disorders included in the study, it was observed that the most researched diseases were the vestibular neuritis, benign paroxysmal positional vertigo, vestibular Schwanoma and Meniere's disease. Conclusion The most of the research realized in recent years and published in the databases PubMed, Web of Science, MEDLINE and Scopus revealed that the ocular vestibular evoked myogenic potentials is an effective method to evaluate the utricular function in various vestibular disorders.

Hemospermia due to Multiple Stones in the Enlarged Prostatic Utricle

Cystic enlargement of prostatic utricle, a vestigial remnant of mullerian duct, is a rare condition in males. The prostatic utricle distends with urine during voiding and then passively drains. Poor emptying leads to urine retention and stasis. Stone formation may result from obstruction. Patients present clinically with chronic urinary tract infection, hematuria, urethral discharge, epididymitis, and voiding dysfunction. We present a case of multiple stones in the enlarged prostatic utricle associated with hemospermia.

Internacionalização, ciência e saúde: a medicina regenerativa global e os mercados paralelos / Internationalization, science and health: global regenerative medicine and the parallel markets

A medicina regenerativa implica em uma mudança de paradigma, a regeneração do organismo ao nível celular ou tecidual – um assunto contemporâneo controverso e de difícil estandardização. O artigo apresenta um resumo das tendências científicas, econômicas, sociais e de regulamentação global nessa área, analisadas em relação a dilemas teóricos relevantes em antropologia médica e sociologia da ciência e da saúde. Em especial, aqueles que tratam da construção de um ‘aparato coletivo de sentido’ para as novas entidades biológicas e ontológicas, a formação da cidadania biológica e a governança pela incerteza. Apresentam-se, também, evidências empíricas sobre um fenômeno chave para a governança e a regulamentação, qual seja a instalação de uma nova demanda transnacional em pesquisa e saúde através de mercados paralelos de óvulos e de terapias celulares em experimentação. Utilizam-se dados qualitativos coletados para uma pesquisa mais abrangente, resenhas jornalísticas e entrevistas com lideranças internacionais. Conclui-se com uma reflexão sobre a importância da governança internacional em ensaios clínicos e dos caminhos a serem explorados, visando uma harmonização da diversidade de práticas normativas.

Regenerative medicine involves a paradigm change due to organism regeneration at cellular and tissue level – a controversial contemporary issue and difficult to regulate. This article presents a summary of the main scientific, economic, social and regulatory global trends, analyzed according to relevant theoretical dilemmas in medical anthropology and in the sociology of science and health. This is especially true of the construction of a ‘collective frame of reference’ on the new biological and ontological entities, the shaping of biological citizenship, and governance through uncertainty. Empirical evidence is also presented on a key aspect in regulation and governance, namely the emergence of a new transnational demand in health research through the establishment of parallel markets for ova and experimental cellular therapies. Qualitative data collected for a broader research paper is analyzed, as well as journal reviews and information gathered during interviews with international leaders. The paper concludes with a discussion on the importance on international governance of clinical trials and on further exploration, towards a multilevel harmonization of a diversity of normative practices.

Conditions of Cervical Vestibular Evoked Myogenic Potentials Test to Minimize Interaural Variation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical vestibular evoked myogenic potentials (cVEMP) test has been widely used to assess the function of the saccule and inferior vestibular nerve. Electrode location and stimulating sound are important factors which might affect the test results. Today those parameters are usually selected to maximize the waveform response. In this study, we tried to find the optimal condition to minimize the range of normal value of cVEMP. SUBJECTS AND METHOD: Thirteen normal subjects (26 ears) were included. We placed electrodes at five different locations over the sternocleidomastoid muscle (SCM) and used four different stimulation sounds. Variances of parameters, including interpeak amplitude, interaural difference (IAD) and normal value were analyzed and compared. RESULTS: When using the classical condition (mid point of SCM and 500 Hz) without rectification, IAD ratio was 20.8+/-14.2% and the range of normal value was 39%. When we used 2000 Hz tone burst sound at the classical electrodes site, IAD ratio and normal value were minimized, resulting in 18.7+/-14.3% and 31% respectively. After the rectification, when using the classical condition, IAD ratio was 26.4+/-22.3% and the range of normal value was 49%. The minimum IAD ratio was measured as 17.4+/-13.7% when we used click sound at SCM at the level of mandibular angle. And the minimum normal value of 32% was measured when we used 1000 Hz tone burst sound at SCM at the level of mandibular angle. CONCLUSION: Although the condition was not optimal for maximizing the interpeak amplitude, we could alternatively use the condition to minimize the normal value.

Air-conducted ocular vestibular-evoked myogenic potential in patients with sudden sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the characteristics of air-conducted ocular vestibular-evoked myogenic potential(oVEMP) in patients with sudden sensorineural hearing loss (SSHL). So as to understanding the range and the degree of the vestibular system damage in patients with SSHL.@*METHOD@#Thirty-five cases of unilateral SSHL were enrolled as the observing group from December in 2013 to December in 2014. 500 Hz air-conducted tone burst was employed as stimulation. Fifity-five healthy young subjects were recruited as the control group. The results were compared between the affected ears, the contralateral ears and the normal controls.@*RESULT@#Thirty-five patients with SSHL, 31 of them in both ears lead to oVEMP Waveform, 4 sick ears did not elicit oVEMP waveform, extraction rate of 88%. 95 dBHL air-conducted get the latencies of P1 and N1, P1-N1 interval, peak-to-peak P1-N1 amplitude in healthy ear were (11.92 ± 0.85)ms; (17.07 ± 1.04)ms, (5.15 ± 0.69)ms, (5.44 ± 2.53) µv. 95 dBHL air-conducted get the latencies of P1 and N1, P1-N1 interval, peak-to-peak P1-N1 amplitude in sick ear were (12.16 ± 0.76) ms; (16.94 ± 2.57)ms, (5.16 ± 0.73)ms, (2.89 ± 1.66) v. The 55 cases (110 ears) were elicited P1-N1 complex typical, extraction rate was 100%. The threshold of oVEMP examination was (82.23 ± 2.92) dBHL, 95 dBHL air-conducted get the latencies of P1 and N1, P1-N1 interval, peak-to-peak P1-N1 amplitude in these healthy young people were (11.53 ± 0.80)ms, (16.61 ± 0.87) ms, (5.18 ± 1.04) ms, (5.96 ± 2.59) µv, there were no significant differences between the affected ears, the contralateral ears and the normal controls in the latencies P1 and N1, P1-N1 interval. The wave amplitude in SSHL were lower than the healthy ear and the healthy control group.@*CONCLUSION@#Through the detection of oVEMP in patients with SSHL,we observed that P1-N1 wave amplitude decreased, and it may be related to the damage of the utricle and vestibular nerve.

The diagnosis applying effects of ocular vestibular evoked myogenic potentials in BBPV disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the diagnosis applying effects of ocular vestibular evoked myogenic potentials(oVEMP) in peripheral BPPV disease.@*METHOD@#During September 2012 to January 2015, we selected 80 healthy people in our hospital medical center as the control group, choose the same period of primary benign paroxysmal positional vertigo as the observation group of 80 patients. Two groups were carried out fully functional auditory evoked potential analysis, determination of oVEMP and cervical vestibular evoked myogenic potentials (cVEMP) anomaly amplitude threshold, P1 latencies, N1 incubation period.@*RESULT@#The cVEMP abnormal rate in the observation group was 28.8%, the oVEMP abnormal rate was 38.8%, while cVEMP and oVEMP abnormal rates in the control group was 1.3% and 2.5% respectively that compared to significant differences between the two groups (P < 0.05). The oVEMP test amplitude in the observation group was (5.98 ± 2.15) µv, the N1 incubation period was (10.03 ± 0.76)ms, while the control group were (4.09 ± 2.11)µv and (11.67 ± 0.78) ms that compared difference were statistically significant (P < 0.05). The cVEMP test amplitude in the observation group was (154.8 ± 43.9)2 µv, while the control group was (180.49 ± 45.34)µv, compared the difference was statistically significant (P < 0.05).@*CONCLUSION@#Paroxysmal positional vertigo patients ocular vestibular evoked myogenic potentials abnormal rate is relatively high, the utricle dysfunction for more severe than the balloon can be the subject of an objective function of the ear stone judgment, judgment in favor of the disease.

The roles of otolith organs in the recurrence primary benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the roles of otolith organs in the occurrence and recurrence of primary benign paroxysmal positional vertigo (BPPV) by vestibular evoked myogenic potential (VEMP) test.@*METHOD@#We enrolled 17 recurrent primary BPPV patients and 42 non-recurrent primary BPPV patients between September 2014 and November 2014. All patients underwent VEMP tests, including cervical vestibular evoked myogenic potential (cVEMP and ocular vestibular evoked myogenic potential (oVEMP) tests. The abnormal case was defined as non-elicitation or asymmetry rate between bilateral sides is larger than 29%.@*RESULT@#Significant difference was found in abnormal rate between cVEMP and oVEMP (P 0.05). No significant difference was found in sex and age between recurrent and non-recurrent groups (P > 0.05).@*CONCLUSION@#The impairment of otolith organs, especially the utricle, is related to primary BPPV. Dysfunction of utricle may play a role in recurrence of BPPV. Recurrence of BPPV is not correlated with sex and age.

Clinical Applications of Vestibular Evoked Myogenic Potentials in Vestibular Disorders / 대한평형의학회지

Cervical and ocular vestibular evoked myogenic potential (VEMP) may be one of the important clinical tools for evaluation of vestibular function. Cervical VEMP evaluates saccule and reflects the functional status of inferior vestibular nerve combining with vertical head impulse test. Ocular VEMP assesses utricle function and provides superior vestibular nerve function in addition to horizontal head impulse test and caloric test. Currently, the clinical implications of VEMP have been expanded to estimate disease severity and location, differentiate diverse vestibular disorders, and predict the prognosis. In present review, we discuss the findings of VEMP according to the lesion location from peripheral vestibular dysfunction to central vestibulopathy and disease characteristics from monophasic transient disorders to chronic progressive disorders.

The Principle and Methodology of Vestibular Evoked Myogenic Potential / 대한평형의학회지

Vestibular evoked myogenic potential (VEMP) has developed as a broadly applied vestibular function test in clinics from its introduction in 1992. In the past, there was only one well known VEMP protocol, which is cervical VEMP, however recently ocular VEMP is also popular. Therefore, clarifying the VEMP recording protocol (cervical VEMP or ocular VEMP) before discussing the VEMP result has become essential. There is considerable difference regarding this VEMP test from other vestibular function tests. VEMP is thought to be assessing the functions of the otolith organs (utricle and saccule) which are evoked by acoustic stimulus. Cervical VEMP is valuable since this is the only available test method which could speculate the function of the saccule and inferior vestibular nerve. Still, there's less clearly understood part regarding the central pathway of VEMP. However, many clinicians and researchers participating in vestibular research speculate that this functional test will have a more dominant role in the near future. Here we describe the basic principles and methodological considerations regarding VEMP recording.

The hearing and vestibular evoked myogenic potentials test in patients with primary benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the result of vestibular evoked myogenic potentials (VEMP) of primary benign paroxysmal positional vertigo(BPPV)and to identify the characteristics in VEMP examination of the primary BPPV and to observe the relevance of patients with primary BPPV and abnormal VEMP with hearing loss.@*METHOD@#Patients with primary BPPV were tested with pure tone audiometry, videonystagmograph and VEMPs test. We analyzed the difference in the two groups with normal hearing and hearing loss, discussed the etiology and pathogenesis.@*RESULT@#Primary BPPV comprised 23.0% with hearing lost, 77.0% hearing normal. The results of oVEMP were abnormal in 79. 7% (59/74) of the cases; and the results of cVEMP were abnormal in 66. 2% (49/74) of the cases; oVEMP and cVEMP differences to the diagnosis of primary BPPV (P<0. 05); oVEMP and cVEMP differences to the diagnosis primary BPPV with hearing lost (P<0. 05).@*CONCLUSION@#oVEMP detection positive rate of primary BPPV is higher than cVEMP,which may be due to otolithic particles falling from the utricle; positive rate of cVEMP in primary BPPV with hearing loss is higher than that of oVEMP, which may related to the cochlear and sacculus occured in the same embryonic tissue structure.

Anatomical Factors Influencing Pneumatization of the Petrous Apex

OBJECTIVES: Aim of the present study was to define the relationship between petrous apex pneumatization and the nearby major anatomical landmarks using temporal bone computed tomography (CT) images. METHODS: This retrospective, Institutional Review Board-approved study analyzed CT images of 84 patients that showed normal findings bilaterally. Pneumatization of the petrous apex was classified using two methods. Eight parameters were as follows: angle between the posterior cranial fossa and internal auditory canal, Morimitsu classification of anterior epitympanic space, distance between the carotid canal and jugular bulb, distance between the cochlear modiolus and carotid canal, distance between the tympanic segment and jugular bulb, high jugular bulb, distance between the vertical segment and jugular bulb, and distance between the lateral semicircular canals and middle cranial fossa. RESULTS: There was a significant difference in Morimitsu classification of the anterior epitympanic space between the two classification methods. Poorly pneumatic upper petrous apices were distributed uniformly in three types of Morimitsu classification, but more pneumatic upper petrous apices were found more often in anterior type. Lower petrous apex was well pneumatized regardless of the types of anterior epitympanic space, but the largest amount of pneumatization was found more frequently in the anterior type of anterior epitympanic space. CONCLUSION: This study showed that there was no reliable anatomic marker to estimate petrous apex pneumatization and suggests that the pneumatization of the petrous apex may be an independent process from other part of the temporal bone, and may not be influenced by the nearby major anatomical structures in the temporal bone. In this study, the anterior type of anterior epitympanic space was found to be closely related to more well-pneumatized petrous apices, which implies that the anterior saccule of the saccus medius may be the main factor influencing pneumatization of the petrous apex.

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.