A comparative study of detection methods for assessing superior and inferior vestibular nerve damages in patients with vestibular neuritis / 临床耳鼻咽喉头颈外科杂志

Objective:This study aims to compare the examination results of the vestibular evoked myogenic potential（VEMP） and video head impulse testing（vHIT） in patients with vestibular neuritis（VN）, thus exploring the methods to distinguish superior and inferior vestibular nerve damages in VN patients, and their feasibility. Methods:A total of 25 patients with unilateral VN treated in the Otology Department of the First Hospital of Qinhuangdao from May 2018 to July 2021 were recruited. They were respectively tested for ocular VEMP（oVEMP）, cervical VEMP（cVEMP） and vHIT, and the examination results were analyzed. Results:Examination results of oVEMP showed that 96%（24/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patient had no waveform introduced of both ears. The overall abnormal rate examined by oVEMP was 100%（26/26）. Examination results of cVEMP showed that 36%（9/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patients had no waveform introduced of both ears. The overall abnormal rate examined by cVEMP was 40%（10/25）, and 60%（15/25） patients had normal waveforms of both ears. Examination results of vHIT showed that 100%（25/25） patients had semicircular canal gain decline of one side, 92%（23/25） had anterior Semicircular canal decline of one side, and 36%（9/25） had posterior semicircular canal decline of one side. VEMP and vHIT results were compared. Examination results of VEMP showed that 60%（15/25） VN patients had superior vestibular nerve damage, and 40%（10/25） had both superior and inferior vestibular nerve damages. Examination results of vHIT showed that 64%（16/25） VN patients had superior vestibular nerve damage, and 36%（9/25） had both superior and inferior vestibular nerve damages. There was no significant difference in the ratio of VN patients with superior and inferior vestibular nerve damages examined by VEMP or vHIT（χ²=0.085, P>0.05）. The matching ratio of VEMP and vHIT results was 80%（20/25）, and the non-matching ratio was 20%（5/25）. Conclusion:Consistent results obtained from both VEMP and vHIT can preliminarily identify the type of vestibular nerve damage. If their results are not consistent, it is recommended not to identify the scope of the vestibular nerve damage.

Potencial miogênico evocado vestibular cervical em crianças e adolescentes com aqueduto vestibular alargado: revisão sistemática / Cervical vestibular evoked myogenic potential in children and adolescents with enlarged vestibular aqueduct: systematic review

RESUMO Objetivo Reunir os parâmetros encontrados no potencial miogênico evocado vestibular cervical (cVEMP) em crianças e adolescentes com síndrome do aqueduto vestibular alargado (SAVA) e identificar as possíveis alterações, quando comparados aos valores encontrados em normo-ouvintes da mesma faixa etária. Estratégia de pesquisa Revisão sistemática cadastrada na base PROSPERO, elaborada por meio de busca nos bancos de dados virtuais, a partir dos unitermos selecionados. Critérios de seleção Incluídos artigos científicos disponíveis na íntegra que relataram a avaliação com o uso do cVEMP na faixa etária entre 0 e 18 anos, com diagnóstico de SAVA, sem restrição de idioma e ano de publicação; excluídos estudos em paciente com algum distúrbio, outras patologias otoneurológicas e população fora da faixa etária estimada. Resultados Foram identificados 984 registros, a partir da pesquisa nas bases de dados consultadas e selecionados 5 artigos. Em um total de 133 pacientes que realizaram o cVEMP, foi observada presença de resposta na maioria dos casos, sem diferença significativa nas latências, mas com aumento na amplitude e diminuição nos limiares do cVEMP. Conclusão O teste cVEMP é recomendado na avaliação de crianças e adolescentes com SAVA e as características de aumento na amplitude e diminuição nos limiares podem ser utilizadas como parâmetros clínicos na identificação da referida síndrome, juntamente com a história clínica do paciente e os exames de imagem. No entanto, é imprescindível a realização de mais estudos com o exame cVEMP, ainda, em crianças e adolescentes com SAVA, para a melhor padronização dos valores encontrados, a fim de efetivar o diagnóstico correto.

ABSTRACT Purpose To gather the parameters found in the cervical vestibular evoked myogenic potential (cVEMP) in children and adolescents with enlarged vestibular aqueduct syndrome (SAVA) and identify the possible changes, when compared to the values found in normal hearing people of the same age group. Research strategy Systematic review registered in the PROSPERO database, prepared through a search in virtual databases, based on the selected keywords. Selection criteria Included scientific articles available in full that reported the evaluation using cVEMP in the 0 and 18 years old group , with a diagnosis of SAVA, without restrictions of language and year of publication; Studies on patients with any disorder other than otoneurological ones and populations outside the proposed age range were excluded. Results 984 records were identified from the search in the databases consulted and 5 articles were selected. In a total of 133 patients who underwent cVEMP, the presence of a response was observed in most cases, with no significant difference in latencies, but with an increase in amplitude and a decrease in cVEMP thresholds. Conclusion The cVEMP test is recommended in the evaluation of children and adolescents with SAVA and the characteristics of increase in amplitude and decrease in thresholds can be used as clinical parameters in the identification of this syndrome, together with the patient's clinical history and imaging exams. However, it is essential to carry out more studies with the cVEMP test, also in children and adolescents with SAVA, to better standardize the values found, in order to make the correct diagnosis.

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

Abstract Objectives: Although 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. Methods: Normal 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. Results: The 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. Conclusions: GVS 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 evidence: Level 4.

Galvanic vestibular evoked myogenic potentials: normative data and the effect of age / Potenciais evocados miogênicos vestibulares galvânicos: dados normativos e o efeito da idade

Abstract Introduction: Galvanic vestibular evoked myogenic potentials evaluate vestibular nerve responses using electric stimulation by records collected from the sternocleidomastoid muscle. A normal vestibular evoked myogenic potential response consists of the first positive, P1, and negative, N1, peaks. The response can be affected by factors such as age and gender and is also consequential in the diagnosis of pathologies. Objectives: The present study was performed to obtain normative data on healthy adults, to help in diagnosis by establishing clinical norms as well as to investigate changing test parameters with age in galvanic vestibular evoked myogenic potentials. Methods: A total of 100 healthy participants were included in the study. Galvanic vestibular evoked myogenic potential (current 3 mA, duration 1ms) was performed randomly on both ears of each participant. The participants between the ages of 18-65 (mean age 39.7 ± 13.9) were divided into 5 groups according to their ages. Normative data of galvanic vestibular evoked myogenic potentials parameters were calculated in groups and in total, and age-related changes were examined. Results: The galvanic vestibular evoked myogenic potential waveform was elicited from all participants (200 ears). The latency of P1 and N1 was 7.82 ± 3.29ms and 22.06 ± 3.95 ms, respectively. The P1-N1 amplitude value was 66.64 ± 24.5 μV. The percentage of vestibular asymmetry was 16.29 ±11.99%. The latencies of P1 and N1 and P1-N1 amplitude values demonstrated significant differences among different age groups (p < 0.01). Conclusions: The results of this study show that as age increased, latencies were prolonged, and amplitudes gradually decreased. The normative data aids in the diagnosis of retrolabyrinthine lesions and the increase in the clinical use of galvanic vestibular evoked myogenic potentials.

Resumo Introdução: Os potenciais evocados miogênicos vestibulares galvânicos avaliam as respostas do nervo vestibular com estimulação elétrica por meio de registros coletados do músculo esternocleidomastóideo. Uma resposta normal de potenciais evocados miogênicos vestibulares consiste nos primeiros picos positivo, P1, e negativo, N1. A resposta pode ser afetada por fatores como idade e sexo e também tem importância no diagnóstico de doenças. Objetivos: Obter dados normativos em adultos saudáveis, para ajudar no diagnóstico através do estabelecimento de normas clínicas, e investigar a alteração dos parâmetros de teste com a idade em potenciais evocados miogênicos vestibulares galvânicos. Método: Foram incluídos no estudo 100 participantes saudáveis. O potencial evocado miogênico vestibular galvânico (corrente 3mA, duração 1ms) foi realizado de forma aleatória nas duas orelhas de cada participante. Os participantes entre 18 e 65 anos (média de 39,7 ±13,9) foram divididos em 5 grupos de acordo com a idade. Os dados normativos dos parâmetros dos potenciais evocados miogênicos vestibulares galvânicos foram calculados nos grupos e no total e as alterações relacionadas à idade foram examinadas. Resultados: A forma de onda do potencial evocado miogênico vestibular galvânico foi obtida de todos os participantes (200 orelhas). A latência de P1 e N1 foi de 7,82±3,29ms e 22,06 ±3,95 ms, respectivamente. O valor da amplitude P1-N1 foi de 66,64 ±24,5 μV. O percentual de assimetria vestibular foi de 16,29± 11,99%. Os valores das latências de P1 e N1 e da amplitude P1-N1 mostraram diferenças significantes entre os diferentes grupos etários (p < 0,01). Conclusão: Os resultados deste estudo mostram que à medida que a idade aumentou as latências foram prolongadas e as amplitudes diminuíram gradualmente. Os dados normativos auxiliam no diagnóstico de lesões retrolabirínticas e na disseminação do uso clínico dos potenciais evocados miogênicos vestibulares galvânicos.

Vestibular status in partial deafness / Condição vestibular na surdez parcial

Abstract Introduction The hair cells of the cochlea and the vestibulum are closely connected and may be susceptible to the same noxious factors. The relationship between their function has been a continuing field of investigation. The indications for cochlear implantation have been broadened and now include the patients with partial deafness. This raises the question of their vestibular status. Objective The aim of the study was to investigate whether there is any difference between the vestibular function of patients with low frequency residual hearing and those with totally deaf ears. Methods A total of 360 ears with profound sensorineural hearing loss were analysed before cochlear implantation. The patients were divided into four groups, according to their low frequency residual hearing (Group 1 ‒ normal or slightly elevated low frequency residual hearing; Group 2 ‒ elevated threshold but still usable hearing at low frequencies; Group 3 - non-functional residual hearing; Group 4 ‒ no detectable hearing threshold within the limits of the audiometer). The patients underwent vestibular tests: cervical vestibular evoked myogenic potential, ocular vestibular evoked myogenic potential, caloric test and video-head impulse test. Results The rates of elicited responses in cervical vestibular evoked myogenic potential were as follows: in Group 1 (59.3 %); Group 2 (57.5 %); Group 3 (35.2 %); Group 4 (7.7 %). For ocular vestibular evoked myogenic potential the percentage of correct outcomes was: Group 1 (70.8 %); Group 2 (56.0 %); Group 3 (40.0 %); Group 4 (14.3 %). For the caloric test we counted normal responses in 88.9 % of Group 1; 81.6 % of Group 2; 57.9 % of Group 3; 53.3 % of Group 4. For video-head impulse test we also found markedly better results in Group1, followed by Group 2, and much worse in Group 3 and 4. Conclusion Patients with partial deafness not only have a better cochlea but also better vestibular function, which needs to be protected. In summary, the better the low frequency residual hearing, the better the vestibular status.

Resumo Introdução As células ciliadas da cóclea e do vestíbulo estão intimamente ligadas e podem ser suscetíveis aos mesmos fatores nocivos. A relação entre suas funções tem sido um campo de investigação há muito tempo. As indicações para implante coclear foram ampliadas e agora incluem os pacientes com surdez parcial. Isso levanta a questão de sua condição vestibular. Objetivo Investigar se existe alguma diferença entre a função vestibular de pacientes com audição residual de baixa frequência e aqueles com surdez total. Método Foram analisadas antes do implante coclear 360 orelhas com perda auditiva neurossensorial profunda. Os pacientes foram divididos em quatro grupos, de acordo com a audição residual de baixa frequência (Grupo 1 - audição residual de baixa frequência normal ou levemente elevada; Grupo 2 - limiar auditivo elevado, mas ainda usável em baixas frequências; Grupo 3 - audição residual não funcional; Grupo 4 - sem limiar auditivo detectável dentro dos limites do audiômetro). Os pacientes foram submetidos a testes vestibulares: potencial evocado miogênico vestibular cervical, potencial evocado miogênico vestibular ocular, prova calórica e teste do impulso cefálico com vídeo. Resultados As taxas de respostas obtidas no potencial evocado miogênico vestibular cervical foram as seguintes: no Grupo 1 (59,3%); Grupo 2 (57,5%); Grupo 3 (35,2%); Grupo 4 (7,7%). Para o potencial evocado miogênico vestibular ocular, o percentual de resultados corretos foi: Grupo 1 (70,8%); Grupo 2 (56,0%); Grupo 3 (40,0%); Grupo 4 (14,3%). Para a prova calórica, contamos respostas normais em 88,9% do Grupo 1; 81,6% do grupo 2; 57,9% do Grupo 3; 53,3% do Grupo 4. Para o teste do impulso cefálico com vídeo, também encontramos resultados significativamente melhores no Grupo 1, seguidos pelo Grupo 2, e muito piores nos Grupos 3 e 4. Conclusão Pacientes com surdez parcial não só apresentam uma função coclear melhor, mas também melhor função vestibular, que precisa ser protegida. Em resumo, quanto melhor for a audição residual de baixa frequência, melhor a condição vestibular.

Characteristic of Sudden Sensorineural Hearing Loss with Objective Vestibular Involvement / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To analyze the difference in audiologic-vestibular and clinical characteristics between acute cochlea-vestibulopathy (ACV) and idiopathic sudden sensorineural hearing loss (ISSNHL). SUBJECTS AND METHOD: We retrospectively analyzed the clinical characteristics of 91 patients diagnosed as sudden hearing loss (ACV; n=20, ISSNHL; n=71). Patients with vestibular hypofunction were categorized as ACV and all others as ISSNHL. Demographics and clinical findings were compared. Audiologic features such as degree of hearing loss, type of audiometric configuration and hearing improvements were analyzed. In addition, vestibular function test results and hearing recovery were further analyzed among ACV group. RESULTS: Demographics and other clinical findings were not much different between groups. There was a significant difference with respect to audiologic features between the ACV group and ISSNHL group: the initial hearing threshold of the ACV group was higher than that of the ISSNHL group, and their treatment onset was also shorter. There was also a significant difference in the hearing outcome showing very low rate of complete recovery in ACV group. The final hearing threshold of the ACV group was higher than that of the ISSNHL group. Dizziness was the only significant variable in the multiple regression analysis. In the ACV group, the cervical vestibular evoked myogenic potential inter-aural amplitude difference (cVEMP IAD) ratio showed a correlation to the hearing recovery in some frequencies; patients with no cVEMP response showed poor outcome compared to those with cVEMP waveform. CONCLUSION: The ACV group shows a poor prognosis just as in the case of sudden hearing loss defined in the traditional sense of vertigo. The IAD value of the vestibular evoked myogenic potentials test will be helpful in assessing hearing improvement, especially when a high IAD value at the middle frequency is associated with a poor prognosis.

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.

Aplicações dos potenciais evocados miogênicos vestibulares: revisão sistemática de literatura / Applications of vestibular-evoked myogenic potentials: a systematic literature review

RESUMO Objetivos Revisar a literatura científica sobre as principais técnicas usadas para gerar o potencial evocado miogênico vestibular (VEMP) e suas aplicações clínicas. Estratégia de pesquisa Os artigos que descrevem os métodos de registro e as aplicações do VEMP foram localizados nas bases de dados PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. O levantamento realizado limitou-se aos artigos publicados nos idiomas Inglês, Português e Espanhol, entre janeiro de 2012 e maio de 2018. Critérios de seleção Artigos sobre os aspectos técnicos para a realização do VEMP ocular, cervical ou do músculo sóleo, com estimulação auditiva ou galvânica e artigos sobre as aplicações clínicas do VEMP foram incluídos; artigos repetidos nas bases de dados, artigos de revisão de literatura, relato de casos, cartas e editoriais foram excluídos. Resultados A estratégia de busca resultou na seleção de 28 artigos. Os estudos evidenciaram três métodos de registro do VEMP: cervical, ocular e no músculo sóleo. As aplicações clínicas do VEMP incluíram doença de Ménière, neurite vestibular, síndrome da deiscência do canal semicircular superior, doença de Parkinson, lesões centrais isquêmicas e mielopatias motoras. Conclusão Independentemente da técnica de registro, o VEMP mostrou-se útil como ferramenta complementar para o diagnóstico de doenças vestibulares periféricas e centrais.

ABSTRACT Purpose To review the scientific literature on the main techniques used to generate vestibular-evoked myogenic potential (VEMP) and its clinical applications. Research strategy A search for articles describing VEMP recording methods and applications was conducted in the PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The search was limited to articles published in English, Portuguese, and Spanish between January 2012 and May 2018. Selection criteria Articles addressing the technical aspects for performing ocular, cervical or soleus VEMP with auditory or galvanic stimulation and articles on the clinical applications of VEMP were included in this review, whereas articles repeated in the databases, literature reviews, case reports, letters, and editorials were excluded. Results The search strategy resulted in the selection of 28 articles. The studies evidenced three methods of VEMP recording: responses from the cervical, ocular and soleus muscle. Clinical applications of VEMP included Meniere's disease, vestibular neuritis, superior semicircular canal dehiscence syndrome, Parkinson's disease, central ischemic lesions, and motor myelopathies. Conclusion Regardless of the recording technique, VEMP has proved to be useful as a complementary tool for the diagnosis of peripheral and central vestibular diseases.

Potenciales vestibulares miogénicos evocados. Parámetros establecidos para las edades de 18 a 28 años / Vestibular Evoked Myogenic Potentials. Normal parameters for ages form 18 to 28 years old

Introducción: el potencial vestibular miogénico evocado (PVME) es un reflejo muscular-cervical. Se activa mediante estimulación acústica. Es el único estudio que valora el funcionamiento del sáculo y la rama inferior del nervio vestibular, de manera selectiva. Se emplea en el diagnóstico de: a) Patología del oído interno, y b) Enfermedades del sistema nervioso central (SNC). Objetivo: determinar los parámetros de normalidad del PVME la población de 18 a 28 años. Método: se realizó un estudio descriptivo analítico transversal, de 20 sujetos (40 oídos), en edades entre 18 y 28 años, en los que no se constataron antecedentes de patologías vestibulares ni audiológicas, en el Hospital Pediátrico Universitario Octavio de la Concepción de la Pedraja, del municipio Holguín. Resultados: ausencia de diferencias, estadísticamente significativas, entre los valores medios de latencia absoluta del componente, donde p13 para el oído derecho es de 12,87 ms, con una desviación estándar (SD) de 1,78; para el oído izquierdo es de 13,48 ms; SD de 1,69. Conclusiones: la presencia del PVME y el análisis de los valores medios de latencia absoluta del componente n23, aportan integridad a la vía vestibular. Es representativo considerar, la diferencia entre las respuestas de los dos oídos de un mismo sujeto que los valores absolutos. Los resultados de las amplitudes arrojaron amplia variabilidad inter e intra-individual, por lo que la utilidad de estos datos deben ser interpretados con cautela.

Introduction: Vestibular Evoked Myogenic Potential (VEMP) is a cervical muscle reflex. Activated by sound stimulation, it is the only study that values the saccule and the inferior section of vestibular nerve functioning, in a selective way. VEMP is used to diagnose: a) inner ear pathology, b) nervous central system diseases. Objective: to determine VEMP parameters in a the population from 18 to 28 years old. Methods: a descriptive study was made. Twenty normal adults between 18 and 28 years old were studied. No significant differences were observed, between the values of absolute latency of the component, where p13 right ear read 12.87 ms with a standard deviation (SD) of 1.78, and left ear read 13.48 ms, SD of 1.69. Conclusions: the presence of the PVME and the analysis of the values of absolute latency of the n23 component, provide integrity to the vestibular pathway. That´s why, they can be diagnosed by peripheral vestibular pathology. It is better to consider differences among the answer of both ears in the same person, at the same time. A significant variable among the subjects was showed by amplitude results. So data should be analyzed carefully. VEMP is useful for the knowledge of vestibular physiology and pathology.

Hyper-response of Cervical Vestibular Evoked Myogenic Potential in Patients with Meniere Disease: A Preliminary Study / 대한평형의학회지

OBJECTIVES: The purpose of this study is to investigate the hyper-responsiveness of cervical vestibular-evoked myogenic potential (cVEMP) in patients with Meniere disease (MD), and to compare the result of cVEMP between probable and definite MD group. METHODS: A total of 110 patients satisfied with probable MD and definite MD criteria, which is recently formulated by the Classification Committee of the Bárány Society, were included. An interpeak amplitude and interaural amplitude difference (IAD) ratio of both ears was measured. The abnormal response of ipsi-lesional cVEMP was categorized into 2 groups; hyper-response and hypo-response. Chi-square test and Mann-Whitney U-test were used for statistical analysis. RESULTS: In the probable MD and definite MD group, the mean IAD was 25.24%±17.79% and 53.82%±34.98%, respectively (p < 0.01). The abnormal response of cVEMP at the affected ear was more frequent in the definite MD group, compared to the probable MD group (32/40 vs. 13/36, p < 0.01). However, hyper-response was more frequently observed in the patients with probable MD, compared to the patients with definite MD (13/36 vs. 3/40, p < 0.01). CONCLUSION: Hyper-response of cVEMP was more frequently observed in the early probable MD patients. It might be an early sign of MD, related with the saccular hydrops, which can help the early detection and treatment.

Clinical Application and Updates on Vestibular Evoked Myogenic Potential: Proposal for Future Development in Vestibulopathy / 대한평형의학회지

Both cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) are irreplaceable tools in the current vestibular science, but they have many drawbacks. For example, the test-retest reliability of the asymmetry ratio is inadequate for both tests. The American Academy of Neurology noted that there is insufficient evidence to determine whether cVEMP and oVEMP can accurately identify vestibular function specifically related to the saccule/utricle. One of the most important factors underlying the variability of cVEMP seems to be the control of, and compensation for, baseline muscle contraction power. Reasons for variability in oVEMP include a poor signal to noise ratio, the angle of superior gaze, effective and controlled presentation of stimuli, intracranial pressure, and electrode location. Many of these shortcomings could be improved by further development of recording methods and devices. This article examines the reasons for the insufficient reliability of VEMP and proposes avenues for improvement of VEMP recording systems.

Cause analysis and duration of residual dizziness after successful canalith repositioning maneuver in patients with benign paroxysmal positional vertigo / 第二军医大学学报

Objective To explore the duration of residual dizziness after successful canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV) and the possible causes. Methods A total of 60 BPPV patients with successful canalith repositioning maneuver were recruited from Department of Neurology of Changzheng Hospital of Second Military Medical University from Oct. 2016 to Jan. 2017. Visual Analogue Scale (VAS), Hospital Anxeity and Depression Scale (HADS), subjective visual vertical (SVV) and ocular vestibular evoked myogenic potential (oVEMP) were evaluated in the BPPV patients suffering from residual dizziness after successful canalith repositioning maneuvers, and their residual dizziness duration was recorded. According to the residual dizziness duration, the patients were divided into short-term group (≤7 d) and long-term group (7 d), and the difference of clinical characteristics was analyzed. Results There were 36 (60.00%) BPPV patients with residual dizziness after successful canalith repositioning maneuver, and 22 (61.11%) cases recovered within 1 week, and 14 lasted for more than 1 week. Compared with the long-term group, VAS and HADS scores were significantly lower (all P0.05) and reverse deviation incidence of SVV were higher in the short-term group (63.6% [14/22] vs 28.6% [4/14], χ2＝4.21, P＝0.04). There was no significant difference in oVEMP abnormality rate between the two groups. Conclusion The transient otolithic dysfunction and central readaption play a role in the occurrence of residual dizziness of the BPPV patients after successful canalith repositioning maneuver, and the residual dizziness usually has mild symptoms and a shorter duration. The residual dizziness with a duration longer than 7 days is associated with mental and emotional factors.

Cervical vestibular evoked myogenic potential in patients with presbycusis / 实用医学杂志

Objective To explore the association between hearing loss and dysfunction of the vestibular end-organ in older individuals. To evaluate the common risk factors for hearing loss and otolith dysfunction. Meth-ods A total of 120 elderly patients without any vestibular symptoms were recruited in this study. They were divid-ed into two groups:a study group(patients with presbycusis)and a control group(patients without presbycusis). Audiological status was measured with pure tone audiometry and the saccular function was tested with cervical ves-tibular evoked myogenic potential(cVEMP). The results of cVEMP were calculated and compared between the two groups. Results Comparing to the control group,mean P1 and N1 latencies were significantly prolonged(t =4.67,4.59,P < 0.05)and the amplitudes were signi cantly reduced(t = 6.72,P < 0.05)in the study group. A sig-nificant correlation between hearing loss at high frequencies and reduced cVEMP amplitudes(r = -0.41,P < 0.05) were observed in the study group. Noise exposure was significantly associated with cVEMP amplitude(β = -0.52, P < 0.05). Conclusions Presbycusis may be accompanied by the hypofunction of saccular function without any vestibular symptoms,and the high frequency hearing threshold is closely related to the saccular function. Noise ex-posure appears to be related to both cochlear and saccular dysfunction.

Aging and wave-component latency delays in oVEMP and cVEMP: a systematic review with meta-analysis / Envelhecimento e os atrasos nas latências das componentes de onda no oVEMP e no cVEMP: uma revisão sistemática com metanálise

Abstract Introduction: The natural aging process may result in morphological changes in the vestibular system and in the afferent neural pathway, including loss of hair cells, decreased numbers of vestibular nerve cells, and loss of neurons in the vestibular nucleus. Thus, with advancing age, there should be a decrease in amplitudes and an increase in latencies of the vestibular evoked myogenic potentials, especially the prolongation of p13 latency. Moreover, many investigations have found no significant differences in latencies with advancing age. Objective: To determine if there are significant differences in the latencies of cervical and ocular evoked myogenic potentials between elderly and adult patients. Methods: This is a systematic review with meta-analysis of observational studies, comparing the differences of these parameters between elderly and young adults, without language or date restrictions, in the following databases: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature databases: OpenGrey.eu and DissOnline, as well as Research Gate. Results: The n1 oVEMP latencies had a mean delay in the elderly of 2.32 ms with 95% CI of 0.55-4.10 ms. The overall effect test showed p = 0.01, disclosing that such difference was significant. The heterogeneity found was I 2 = 96% (p < 0.001). Evaluation of p1 latency was not possible due to the low number of articles selected for this condition. cVEMP analysis was performed in 13 articles. For the p13 component, the mean latency delay in the elderly was 1.34 ms with 95% CI of 0.56-2.11 ms. The overall effect test showed a p < 0.001, with heterogeneity value I 2 = 92% (p < 0.001). For the n23 component, the mean latency delay for the elderly was 2.82 ms with 95% CI of 0.33-5.30 ms. The overall effect test showed p = 0.03. The heterogeneity found was I 2 = 99% (p < 0.001). Conclusion: The latency of oVEMP n1 wave component and latencies of cVEMP p13 and n23 wave components are longer in the elderly aged >60 years than in young adults.

Resumo Introdução: O processo natural de envelhecimento pode resultar em mudanças morfológicas no sistema vestibular e na via neural aferente, inclusive perda de células ciliadas, diminuição do número de células do nervo vestibular e perda de neurônios no núcleo vestibular. Dessa forma, com o avanço da idade, deveria ocorrer diminuição nas amplitudes e aumento nas latências dos potenciais evocados miogênicos vestibulares (VEMP), principalmente o prolongamento da latência p13. Além disso, muitos artigos não encontraram diferenças significativas nas latências do VEMP com o avanço da idade. Objetivo: Analisar se existem diferenças significativas para as latências do VEMP cervical (cVEMP) e do VEMP ocular (oVEMP) entre idosos e adultos. Método: Revisão sistemática com metanálise de estudos observacionais que comparam diferenças desses parâmetros entre idosos e adultos jovens, sem restrições de idiomas ou datas, nas seguintes bases de dados: Pubmed, ScienceDirect, Scopus, Web of Science, SciELO e Lilacs. Além das bases de literatura cinzenta OpenGrey.eu e DissOnline e ainda no Research Gate. Resultados: As latências n1 do oVEMP tiveram um atraso médio nos idosos de 2,32 ms com IC 95% 0,55-4,10 ms. O teste para o efeito geral obteve p = 0,01 e revelou que tal diferença foi significativa. A heterogeneidade encontrada foi I2 = 96% (p < 0,001). Avaliação da latência de p1 não foi possível devido ao baixo número de artigos selecionados para essa condição. A análise do cVEMP foi feita com 13 artigos. Para o componente p13, o atraso médio para as latências dos idosos foi de 1,34 ms com IC 95% 0,56-2,11 ms. O teste para o efeito geral obteve p < 0,001; com valor da heterogeneidade I2 = 92% (p < 0,001). Para o componente n23, o atraso médio para as latências dos idosos foi de 2,82 ms com IC 95% 0,33-5,30 ms. O teste para o efeito geral obteve p = 0,03. A heterogeneidade encontrada foi I2 = 99% (p < 0,001). Conclusão: A latência do componente de onda n1 do oVEMP e as latências dos componentes de onda p13 e n23 do cVEMP são mais prolongadas em idosos com idade > 60 anos do que em adultos jovens.

Evaluation of vestibular evoked myogenic potentials (VEMP) and electrocochleography for the diagnosis of Ménière's disease / Avaliação dos potenciais evocados miogênicos vestibulares (VEMP) e eletrococleografia no diagnóstico da doença de Ménière

Abstract Introduction: Ménière's disease (MD) is an inner ear disorder characterized by episodic vertigo, tinnitus, ear fullness, and fluctuating hearing. Its diagnosis can be especially difficult in cases where vestibular symptoms are present in isolation (vestibular MD). The definitive diagnosis is made histologically and can only be performed post-mortem, after analysis of the temporal bone. Endolymphatic hydrops is a histopathological finding of the disease and occurs more often in the cochlea and saccule, followed by the utricle and semicircular canals. Vestibular evoked myogenic potentials (VEMP) emerged as the method of assessment of vestibular function in 1994. Until then, there was no unique way of assessing saccular function and the inferior vestibular nerve. Given that the saccule is responsible for most cases of severe hydrops, VEMP appears as a new tool to assist in the diagnosis of MD. Objective: To evaluate the sensitivity and specificity of VEMP and electrocochleography (EcochG) in the diagnosis of definite MD compared with clinical diagnosis. Methods: The study includes 12 patients (24 ears) diagnosed with definite MD defined according to the clinical criteria proposed by the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) in 1995, as well as 12 healthy volunteers allocated to the control group (24 ears). A clinical diagnosis by the AAO-HNS criteria was considered as the gold standard. All patients underwent an otoneurological examination, including pure tone and speech audiometry, VEMP, and extratympanic EcochG. The sensitivity and specificity to detect the presence or absence of disease were calculated, as well as their 95% confidence intervals. The reliability of VEMP and EcochG in both ears was assessed using the kappa index. Results: In both tests and in both ears, the ability to diagnose healthy cases was high, with specificity ranging from 84.6% to 100%. Moreover, the ability of the tests to diagnose the disease varied from low to moderate sensitivity, with values ranging from 37.5% to 63.6%. The agreement of both tests in the right ear, measured by the kappa coefficient, was equal to 0.54 (95% CI: 0.20-0.89), indicating a moderate agreement. In the left ear, that agreement was equal to 0.07 (95% CI: −0.33 to 0.46), indicating a weak correlation between the tests. The sensitivity of the VEMP for the right ear was 63.6% and for the left ear, 62.5%. The sensitivity of EcochG for the right ear was 63.6% and 37.5% for the left ear. Conclusion: The specificity of both tests was high, and the sensitivity of VEMP was higher than that of EcochG.

Resumo Introdução: A doença de Ménière (DM) é uma doença da orelha interna caracterizada por vertigem episódica, zumbido, plenitude aural e audição flutuante. Seu diagnóstico pode ser especialmente difícil nos casos em que os sintomas vestibulares estão presentes isoladamente (DM vestibular). O diagnóstico de certeza é histológico e somente pode ser feito no post mortem, após análise do osso temporal. A hidropisia endolinfática é um achado histopatológico da doença e ocorre mais frequentemente na cóclea e sáculo, seguidos pelo utrículo e canais semicirculares. Os potenciais evocados miogênicos vestibulares (VEMP) surgiram como método de avaliação da função vestibular em 1994. Até então não havia uma maneira exclusiva de avaliação da função sacular e do nervo vestibular inferior e como o sáculo era responsável por grande parte dos casos de hidropisia severa, o VEMP apareceu como uma nova ferramenta para auxiliar no diagnóstico da DM. Objetivo: Avaliar a sensibilidade e especificidade do VEMP e da eletrococleografia (ECochG) no diagnóstico da DM em comparação com o diagnóstico clínico. Método: Foram selecionados 12 pacientes (24 orelhas) com diagnóstico de DM definida de acordo com os critérios clínicos propostos pela American Academy of Otolaryngology-Head and Neck Surgery 1995 (AAO-HNS) e 12 voluntários saudáveis alocados no grupo controle (24 orelhas). Considerou-se o diagnóstico clínico pela AAO-HNS como padrão ouro. Todos os pacientes foram submetidos a exame otoneurológico, incluindo audiometria tonal e vocal, VEMP e eletrococleografia extratimpânica. A sensibilidade e especificidade para detectar a presença ou ausência de doença foram calculadas e os respectivos intervalos de confiança de 95% obtidos. A confiabilidade dos testes de diagnóstico VEMP e eletrococleografia em ambas as orelhas foi avaliada pelo índice kappa. Resultados: Em ambos os testes e em ambas as orelhas, a capacidade para diagnosticar os casos saudáveis é alta, a especificidade varia de 84,6%-100%. Além disso, a capacidade dos testes para o diagnóstico da doença varia de baixa a moderada sensibilidade, com valores de 37,5%-63,6%. A concordância dos dois testes na orelha direita, medida pelo coeficiente de kappa, foi igual a 0,54; 95% IC (0,20-0,89) indicaram uma concordância moderada. Para a orelha esquerda essa concordância foi igual a 0,07 com 95% IC (-0,33-0,46), o que indicou uma concordância fraca entre os testes. A sensibilidade do VEMP para a orelha direita foi de 63,6% e para a orelha esquerda, de 62,5%. A sensibilidade da ECochG para a orelha direita foi de 63,6% e 37,5% para a orelha esquerda. Conclusão: A especificidade de ambos os testes foi alta e a sensibilidade do VEMP foi maior do que a da eletrococleografia.

Assessment of Balance and Vestibular Functions in Patients with Idiopathic Sudden Sensorineural Hearing Loss / 华中科技大学学报（医学）（英德文版）

This study investigated the relationship among the severity of hearing impairment,vestibular function and balance function in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).A total of 35 ISSNHL patients (including 21 patients with vertigo) were enrolled.All of the patients underwent audiometry,sensory organization test (SOT),caloric test,cervical vestibular-evoked myogenic potential (cVEMP) test and ocular vestibular-evoked myogenic potential (oVEMP) test.Significant relationship was found between vertigo and hearing loss grade (P=0.009),and between SOT VEST grade and hearing loss grade (P=0.001).The abnormal rate of oVEMP test was the highest,followed by the abnormal rates of caloric and cVEMP tests,not only in patients with vertigo but also in those without vertigo.The vestibular end organs were more susceptible to damage in patients with vertigo (compared with patients without vertigo).Significant relationship was found between presence of vertigo and SOT VEST grade (P=0.010).We demonstrated that vestibular end organs may be impaired not only in patients with vertigo but also in patients without vertigo.The cochlear and vestibular impairment could be more serious in patients with vertigo than in those without vertigo.Vertigo does not necessarily bear a causal relationship with the impairment of the vestibular end organs.SOT VEST grade could be used to reflect the presence of vertigo state in the ISSNHL patients.Apart from audiometry,the function of peripheral vestibular end organs and balance function should be evaluated to comprehensively understand ISSNHL.Better assessment of the condition will help us in clinical diagnosis,treatment and prognosis evaluation of ISSNHL.

Cervical Vestibular Evoked Myogenic Potential as a Prognostic Indicator of Benign Paroxysmal Positional Vertigo Recurrence / 대한평형의학회지

OBJECTIVES: Recently there was hypothesis that relates the otolith dysfunction to the recurrence of benign paroxysmal positional vertigo (BPPV). Therefore in the present study, we assessed relationship between cervical vestibular evoked myogenic potential (cVEMP) and BPPV recurrence and raise the possibility of cVEMP as a recurrence indicator of BPPV. METHODS: A retrospective review of patient from November 2009 to June 2014 was carried out. Ninety-four patients who suffered from BPPV were enrolled. Medical record review and telephone survey was done to check BPPV recurrence. RESULTS: In medical record review, normal cVEMP group showed 18.9% recurrence rate and abnormal cVEMP group showed 25%. In telephone survey, normal cVEMP group showed 39.19% recurrence rate and abnormal cVEMP group showed 60%. There was no significant statistical difference. CONCLUSIONS: cVEMP abnormality was not a risk factor of BPPV recurrence. Further study with larger number of enrolled subjects is necessary.

Application of Ocular Vestibular Evoked Myogenic Potential and Caloric Test to Different Stages of Meniere Disease / 听力学及言语疾病杂志

Objective To investigate the characteristics and clinical significance of ocular vestibular evoked myogenic potential (oVEMP) and caloric test in Meniere disease (MD) at different hearing stages.Methods Fifty-five patients(52.8±15.8 years old) with MD were divided into stage 1(9 cases,48.8±13.8 years old), stage 2(9 cases,46.0±16.3 years old), stage 3(23 cases,50.3±13.5 years old) and stage 4(cases 14, 53.5±16.2 years) respectively according to the pure tone audiometry.They were evaluated by oVEMP and caloric test.Results The abnormal rates of oVEMP were 55.6%, 66.7%, 78.3%, 78.6%,and caloric tests were 22.2%, 33.3%, 78.3%,and 85.7% respectively in stage 1, 2, 3, and 4 MD patients.The amplitudes of oVEMP in stage of 1, 2, 3, and 4 MD patients were 4.3±4.0 μV,3.5±2.3 μV,2.5±2.4 μV,and 1.3±0.5 μV,respectively.Conclusion The abnormal rates of oVEMP and caloric tests in MD patients increased with the degree of hearing impairment and the amplitudes of oVEMP were decreased, suggesting that utricle and horizontal semicircular canal injuries were aggravated.

Value of vestibular evoked myogenic potential on the diagnosis of inferior vestibular neuritis / 中国耳鼻咽喉头颈外科

OBJECTIVE To invstigate the diagnosis role of VEMP for inferior vestibular neuritis. METHODS 18 patients with inferior vestibular neuritis were studied. Especially, the oVEMP and cVEMP were recorded in all cases. RESULTS All 18 patients with VN (vertigo symptom in 15 cases, and balance disorders in 3 cases) presented normal in PTA, caloric test and Ovemp test. By contrast, the cVEMPs was abnormal in all patients with VN, including flat/no amplitude of cVEMP in 14 cases, and lower amplitude in 4 cases. After three months, 10 patients recovered, with nomal amplitude of cVEMP in 9 cases and lower amplitude in 1 case. And after half-a-year-follow-up, 18 patients went back to normal, with lower amplitude in only 2 cases. CONCLUSION The VEMP examination is valuable in the diagnosis and prognosis of inferior vestibular neuritis.

The Feasibility and Effectiveness of the Simultaneous Recording of Ocular and Cervical Vestibular-evoked Myogenic Potentials / 听力学及言语疾病杂志

Objective To study the feasibility of simultaneously recording ocular vestibular-evoked myogenic potential (oVEMP) and cervical vestibular-evoked myogenic potential (cVEMP) by combined oVEMP and cVEMP tests.Methods Twenty healthy volunteers and twenty-three patients with Meniere's disease were admitted and underwent combined oVEMP and cVEMP tests in a random order,and individual oVEMP and cVEMP tests on another day.The results of combined and individual oVEMP and cVEMP tests were compared.Results For twenty healthy volunteers in oVEMP and cVEMP tests,the 100％ response rate were observed in the both combined and individual test modes.The differences in amplitudes and latencies and interaural amplitude difference were insignifi-cant.For twenty-three patients with Meniere's disease,the results of oVEMP/cVEMP for the affected and unaffected ears failed to sow any significant differneces,regardless of the individual or combined mode.Conclusion The simultaneous recording of oVEMP and cVEMP by the combined mode has similar results to that obtained by individual mode for both healthy or unilateral vestibular hypofunction.Simultaneous oVEMP and cVEMP tests may be a convenient screening test and deserves further clinical applications.