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Vestibular evoked myogenic potentials (VEMPs) are a tool to assess otolith function and a component of sensor specific vestibular diagnostics. The aim of the present study was to measure VEMP trough bone conducted (BC) stimulation using the B250 prototype and to report amplitudes, latencies and threshold levels for patients before resection of a sporadic unilateral vestibular schwannoma (VS) in order to assess function regarding to the reported nerve of origin. Twenty-seven participants (9 male/18 female) with a mean age of 55.9 years (SD: 10.8) were included for the analysis. In the side contralateral to the tumor, in 24 (89%) of the patients cVEMP could be measured, while oVEMP were recordable in 20 patients (74%). For patients with inferior vestibular nerve of origin (n = 11), cVEMP amplitudes of the affected side were significantly lower as compared to the non-affected side, while the force threshold level was increased. No statistically significant differences were observed for neither, oVEMP amplitudes nor threshold levels in the group with superior vestibular nerve of origin (n = 7). Across groups, p13 latency was significantly increased in the affected ear while all other VEMP latencies were not different between the ears. The B250 transducer was applicable to all participants of the clinical cohort. The sample size, however, was too low for a reliable statistical analysis and only allowed for exploratory analysis. [ABSTRACT FROM AUTHOR]

Abstract Vestibular evoked myogenic potentials (VEMPs) are a tool to assess otolith function and a component of sensor specific vestibular diagnostics. The aim of the present study was to measure VEMP trough bone conducted (BC) stimulation using the B250 prototype and to report amplitudes, latencies and threshold levels for patients before resection of a sporadic unilateral vestibular schwannoma (VS) in order to assess function regarding to the reported nerve of origin. Twenty-seven participants (9 male/18 female) with a mean age of 55.9 years (SD: 10.8) were included for the analysis. In the side contralateral to the tumor, in 24 (89%) of the patients cVEMP could be measured, while oVEMP were recordable in 20 patients (74%). For patients with inferior vestibular nerve of origin (n = 11), cVEMP amplitudes of the affected side were significantly lower as compared to the non-affected side, while the force threshold level was increased. No statistically significant differences were observed for neither, oVEMP amplitudes nor threshold levels in the group with superior vestibular nerve of origin (n = 7). Across groups, p13 latency was significantly increased in the affected ear while all other VEMP latencies were not different between the ears. The B250 transducer was applicable to all participants of the clinical cohort. The sample size, however, was too low for a reliable statistical analysis and only allowed for exploratory analysis.

Introduction: Masseteric VEMPs have been effective in evaluating a diverse spectrum of vestibular conditions associated with various brainstem pathologies, but they have rarely been explored among patients with vestibular neuritis. Case Report: The current investigation included a case series highlighting mVEMP responses in addition to cVEMPs and oVEMPs in three patients diagnosed with vestibular neuritis. In the study, all three patients were found to have absent or diminished responses in cVEMPs, oVEMPs, and mVEMPs. Conclusions: In the present study, the distinctions in cVEMP and oVEMP findings can be attributed to the involvement of inferior and superior vestibular nerve respectively. Furthermore, mVEMP presents a more intricate scenario, both in terms of its genesis and outcomes. This emphasizes the clinical relevance of mVEMP when used in combination with cVEMP and oVEMP, rather than as a substitute for the other VEMPs. [ABSTRACT FROM AUTHOR]

Background: Usher's syndrome type II (USH2) is a rare genetic disorder encompassing hearing loss, vision impairment, and apparent intact vestibular function. Recent research suggests a potential involvement of the otolith vestibular receptors in USH2. Aims/Objectives: Evaluate otolith dynamic function in USH2. Material and Methods: Twenty-two USH2 (median age 53.9 ± 2.99) and age-matched controls underwent a complete battery vestibular testing including air conducted cervical and ocular vestibular evoked myogenic potentials (c-VEMPs and o-VEMPs). Vestibular function tests were correlated with Activities Balance Scale (ABC) and Dizziness Handicap Inventory (DHI) scores. Results: Fourteen USH2 reported previous vertigo (vs none control). Among 88 ears, c-VEMPs were absent in 15 USH2 cases and 4 controls (p = 0.034), while o-VEMPs were absent in 22 USH2 cases and 12 controls (p = 0.129). There were significant differences between USH2 vs controls in right ear o-VEMP N1 latencies (median 11.60/10.40, p < 0.010), N1-P1 amplitudes (median 5.15/10.10, p < 0.003) and in o-VEMP N1-P1 asymmetry ratio (median 24.78/40.50, p < 0.014). USH2 showed a strong correlation between o-VEMP amplitude and DHI score (p = 0.003, ρ = 0.769). No association was found between vertigo and VEMPs subgroups. Conclusions and Significance: Our findings suggest the presence of otolith dysfunction in USH2, which is independent from subjectively reported dizziness. Incorporating vestibular testing into USH2 evaluation and monitoring could enhance characterization of this multisensory disease. [ABSTRACT FROM AUTHOR]

Background: Idiopathic intracranial hypertension (IIH) can affect both hearing and balance due to increased inner ear pressure. Aims/Objectives: This study aimed to evaluate the impact of increased inner ear pressure on hearing and balance in patients with IIH using auditory and vestibular tests. Material and Methods: Twenty-four IIH patients and 28 healthy controls underwent oVEMP, pure tone audiometry, tympanometry, and acoustic reflex tests pre-lumbar punctures. IIH patients received acetazolamide. Pre- and post-treatment results, tinnitus, and vertigo scores were compared. Post-treatment oVEMP and audiometry results were compared between groups. Results: Pre-treatment oVEMP showed a significant left N1 latency difference (p = 0.049). Post-treatment, left ear amplitude (p = 0.035) and both ear amplitude ratios (p = 0.044 and p = 0.047) increased significantly. Audiometry had no significant changes (p < 0.05). Tinnitus and vertigo scores decreased significantly (p ≤ 0.001). Conclusion: Prolonged oVEMP latency suggests IIH may impact the brain stem and vestibular nerve, while increased amplitude values indicate peripheral vestibular involvement. IIH affects hearing across all frequencies, especially at 4000 Hz, impacting both hearing and balance. Significance: Understanding the effects of IIH on auditory and vestibular functions can guide effective treatments, improving quality of life for patients by addressing both hearing and balance issues. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to assess the vestibulo-spinal reflex (VSR) and vestibulo-ocular reflex (VOR) in FMS using the cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) tests, respectively, and to evaluate their relation to disease severity. METHODS: This study included 30 female FMS patients and 30 well-matched healthy controls. They underwent full history taking and assessment of the severity of dizziness/vertigo using the Dizziness Handicap Inventory; assessment of the severity of FMS symptoms using the Revised Fibromyalgia Impact Questionnaire; bedside examination of the dizzy patient; videonystagmography, cVEMP, and oVEMP tests; basic audiologic evaluation; and uncomfortable loudness level (UCL) testing. RESULTS: Dizziness was reported in 46.6% and vertigo in 11.1% of patients. Abnormalities in cVEMP (50%) and oVEMP (63.3%) were mostly unilateral, irrespective of FMS severity. Disease duration affected only the oVEMP amplitude. Fibromyalgia syndrome patients had a statistically significant lower UCL and narrower dynamic range compared to controls. CONCLUSION: The VSR and VOR are commonly affected in FMS patients, and findings suggest central sensitization involving the brain stem. We recommend routine cVEMP and oVEMP testing to assess brainstem function in FMS patients. [ABSTRACT FROM AUTHOR]

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

This study utilized cervical vestibular-evoked myogenic potentials tests (cVEMP) and ocular vestibular-evoked myogenic potentials tests (oVEMP) to investigate the vestibulocollic and vestibuloocular reflex arcs and to evaluate cerebellar and brainstem involvement) in essential tremor (ET). Eighteen cases with ET and 16 age- and gender-matched healthy control subjects (HCS) were included in the present study. Otoscopic and neurologic examinations were performed on all participants, and both cervical and ocular VEMP tests were performed. Pathological cVEMP results were increased in the ET group (64.7%) compared to the HCS (41,2%; p > 0.05). The latencies of P1 and N1 waves were shorter in the ET group than in HCS (p = 0.01 and p = 0.001). Pathological oVEMP responses were significantly higher in the ET group (72.2%) compared to the HCS (37.5%; p = 0.01). There was no statistically significant difference in oVEMP N1-P1 latencies between groups (p > 0.05). Because the ET group had high pathological responses to the oVEMP, but not the cVEMP, the upper brainstem pathways may be more affected by ET. [ABSTRACT FROM AUTHOR]

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

Objective: The video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) are new methods for measuring peripheral vestibular function. The objectives of this study were to compare these tests and the traditionally used caloric test in patients with small and medium‐sized untreated vestibular schwannoma (VS) and to measure the correlation between the tests' results and tumor volume. Study Design: National cross‐sectional study. Setting: Tertiary university clinic. Methods: Prevalence of abnormal cVEMP, oVEMP, caloric test, and 6‐canal vHIT results on the tumor side and the nontumor side were compared and related to tumor volume with regression analyses in 137 consecutive VS patients assigned to a wait‐and‐scan protocol in the period 2017 to 2019. Results: The sensitivity of 6‐canal vHIT, caloric test, cVEMP, and oVEMP to detect vestibulopathy in VS patients was 51%, 47%, 39%, and 25%, respectively. Normal tests were found in 21% of the patients. The results of vHIT and caloric test were related to tumor volume, but this was not found for cVEMP and oVEMP. Conclusion: The caloric test and 6‐canal vHIT showed the highest sensitivity in detecting vestibulopathy in untreated VS patients. vHIT, and particularly the posterior canal, was limited with a high prevalence of abnormal results on the nontumor side. A combination of cVEMP and caloric test was favorable in terms of a relatively high sensitivity and low prevalence of abnormal results on the nontumor side. Larger tumors had a higher rate of pathology on caloric testing and vHIT. [ABSTRACT FROM AUTHOR]

Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness in the general population. BPPV is known to be closely related to the serum vitamin D level. This study aimed to examine the relationship between serum vitamin D levels and BPPV recurrence. A retrospective chart review was conducted on 50 patients diagnosed with posterior and lateral canal BPPV. The diagnosis of BPPV was based on the finding of vertigo and nystagmus induced by certain head positions (The Dix–Hallpike maneuver and head roll tests). The patients were classified into BPPV recurrence (Group A) and non-recurrence groups (Group B). Otolith function was assessed by cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP), and their association with vitamin D levels was evaluated. There were 19 subjects in Group A and 31 in Group B. There were no significant differences in age, sex, cVEMP, and oVEMP between the two groups. The average vitamin D level was 12.9 ± 8.0 ng/mL for Group A and 19.2 ± 8.2 ng/mL for Group B, and the difference between the groups was significant (p = 0.011). In the receiver operating characteristic curve analysis for BPPV recurrence with the best sensitivity and specificity, the optimal cut-off value of total serum vitamin D was determined as 12.74 ng/mL. Furthermore, reclassifying the patients based on the cut-off value showed a significantly higher recurrence rate in the group with a lower serum vitamin D level (70.5% vs. 22.5%, p = 0.007). This complex finding highlights the importance of measuring serum vitamin D levels to monitor and evaluate patients at risk of BPPV recurrence. [ABSTRACT FROM AUTHOR]

• Subjective visual horizontal (SVH) correlated moderately with oVEMPs and weakly with cVEMPs. • The SVH and oVEMP correlation was present within multiple diagnostic subgroups. • cVEMPs showed a significant correlation with SVH in the vestibular neuritis subgroup alone. To examine the relationship between widely used otolith function tests: the Subjective Visual Horizontal (SVH) and Vestibular Evoked Myogenic Potentials (VEMP). A retrospective analysis was performed on 301 patients who underwent SVH, ocular and cervical VEMP (oVEMP and cVEMP) tests on the same day. Correlations between the mean SVH tilt and amplitude asymmetry ratios for bone-conducted (BC) oVEMP and air-conducted (AC) cVEMP were examined. Diagnoses included vestibular neuritis, stroke, vestibular migraine, Meniere's disease, sudden sensorineural hearing loss (SSNHL) and vestibular schwannoma. SVH results were concordant with the oVEMP in 64% of cases and the cVEMP in 51%. Across all patients, SVH demonstrated a significant moderate correlation with BC oVEMP amplitude asymmetry ratios (r = 0.55, p < 0.001) and a weak correlation with AC cVEMP amplitude asymmetry ratios (r = 0.35, p < 0.001). A stronger correlation between SVH and oVEMPs was observed in patients with vestibular neuritis (r = 0.67, p < 0.001) and SSNHL (r = 0.76, p = 0.001). SVH correlates better with oVEMP than cVEMP symmetry. This finding reinforces the hypothesis of a common utricular origin for both SVH and oVEMPs which is distinct from the saccular origin of cVEMPs. [ABSTRACT FROM AUTHOR]

Angular acceleration stimulation of a semicircular canal causes an increased firing rate in primary canal afferent neurons that result in nystagmus in healthy adult animals. However, increased firing rate in canal afferent neurons can also be caused by sound or vibration in patients after a semicircular canal dehiscence, and so these unusual stimuli will also cause nystagmus. The recent data and model by Iversen and Rabbitt show that sound or vibration may increase firing rate either by neural activation locked to the individual cycles of the stimulus or by slow changes in firing rate due to fluid pumping ("acoustic streaming"), which causes cupula deflection. Both mechanisms will act to increase the primary afferent firing rate and so trigger nystagmus. The primary afferent data in guinea pigs indicate that in some situations, these two mechanisms may oppose each other. This review has shown how these three clinical phenomena—skull vibration-induced nystagmus, enhanced vestibular evoked myogenic potentials, and the Tullio phenomenon—have a common tie: they are caused by the new response of semicircular canal afferent neurons to sound and vibration after a semicircular canal dehiscence. [ABSTRACT FROM AUTHOR]

As previously reported, a single test measuring oVEMP n10 to 4000 Hz stimuli (bone-conducted vibration (BCV) or air-conducted sound (ACS)) provides a definitive diagnosis of semicircular canal dehiscence (SCD) in 22 CT-verified patients, with a sensitivity of 1.0 and specificity of 1.0. This single short screening test has great advantages of speed, minimizing testing time, and the exposure of patients to stimulation. However, a few studies of the 4000 Hz test for SCD have reported sensitivity and specificity values which are slightly less than reported previously. We hypothesized that the rise time of the stimulus is important for detecting the oVEMP n10 to 4000 Hz, similarly to what we had shown for 500 and 750 Hz BCV. We measured oVEMP n10 in 15 patients with CT-verified SCD in response to 4000 Hz ACS or BCV stimuli with rise times of 0, 1, and 2 ms. As a result, increasing the rise time of the stimulus reduced the oVEMP n10 amplitude. This outcome is expected from the physiological evidence of guinea pig primary vestibular afferents, which are activated by sound or vibration. Therefore, for clinical VEMP testing, short rise times are optimal (preferably 0 ms).

Introduction: More than 50% of pregnant women experience dizziness frequently in the first two gestational trimesters. During pregnancy, the changes in the metabolism of hormones are responsible for the ovarian cycle resulting in either peripheral or central vestibular alterations. The need for the study is to focus on the effect of changes during pregnancy on the vestibular evoked myogenic potential, an electrophysiological measure that investigates functions of the otolith structures. Objectives: The aim is to investigate the vestibular evoked myogenic potential responses during the first trimester of pregnancy. Methods: A total of 17 pregnant women and 17 non-pregnant women with age matched took part in this study. The cervical vestibular evoked myogenic potential were recorded from the ipsilateral sternocleridomastoid muscle and the ocular vestibular evoked myogenic potential were recorded from contralateral extraocular muscle in both groups. Results: Peak to peak amplitude of cervical vestibular evoked myogenic potential and ocular vestibular evoked myogenic potential was found to be significantly reduced in the responses obtained from first-trimester pregnant women when compared to that of non-pregnant women. Conclusions: Vestibular evoked myogenic potential tests exhibits a clinically significant reduced peak to peak amplitude in the first trimester of pregnancy, which indicates dysfunction in the otolith reflex pathway.

Background There is limited evidence demonstrating the ability of audiometric bone vibrators to elicit ocular vestibular evoked myogenic potentials (oVEMPs). The RadioEar B71 bone vibrator has insufficient power output to reliably evoke oVEMPs, which has previously left nonaudiometric and nonmedically approved devices such as the Brüel & Kjær Mini-shaker 4810 as the only feasible alternative. The newer RadioEar B81 model has a higher power output than its predecessor, but evidence for its suitability for eliciting oVEMPs has so far been mixed. This variability may be due to factors other than simply the power output, such as whether sufficient static force is applied to hold the transducer in place and transfer vibratory energy into the bone. Purpose This study aimed to test the hypothesis that bone-conducted oVEMPs can be obtained with the B81 that are equivalent to those from the Mini-shaker, the de facto gold-standard transducer for this response, when the outputs of the two transducers are matched and they are coupled with sufficient static force. Research Design oVEMPs elicited by both transducers were recorded in a counterbalanced within-groups design. Study Sample Sixteen healthy adults (12 female; 22–47 years) with no history of hearing, balance, or neurological disorders were included in the study. Data collection and analysis One-cycle alternating tone-burst stimuli at 500 Hz were delivered to the mastoid from each transducer. The vibratory force levels were matched at 127 dB peak-to-peak equivalent force levels, and both were held in place with a static force around 10 N. oVEMP waveforms were gathered from the contralateral eye using the belly-tendon montage and were assessed for statistical equivalence. Results There was an absence of any statistically significant difference in N10 and N10–P15 amplitudes in oVEMPs from each transducer. Conclusions Our results indicate that B81 can elicit oVEMPs with no meaningful differences to those from the Mini-shaker, provided effective stimulus levels are matched and static force is sufficient. Although further work is necessary to investigate equivalence at other stimulus frequencies and stimulation sites, the results support the use of the B81 to elicit 500Hz oVEMPs at the mastoid in a clinical setting. [ABSTRACT FROM AUTHOR]

Purpose: To compare ocular vestibular evoked myogenic potential (oVEMP) responses obtained with superomedial and oblique gaze positions. Material and Methods: The oVEMP test was applied in 59 healthy subjects at superomedial, right oblique, and left oblique gaze positions. Stimuli were presented at 110 dB nHL with a frequency of 500 Hz. oVEMP responses were recorded via electrodes placed on the lower eyelids. Results: Higher N1-P1 amplitudes were obtained in oblique gaze positions in the stimulated ear direction compared to the superomedial position (p<0.05). The asymmetry values obtained in the superomedial gaze position were lower than those obtained in oblique gaze positions (p<0.05). Superomedial and oblique gaze positions had no effect on the N1, P1, and N1-P1 latencies of the waves obtained from the right ear, left ear, and both ears (p>0.05). Conclusion: Superomedial and oblique gaze positions affect oVEMP waves. In patients in whom vestibular hypofunction is suspected, it is recommended to control oVEMP responses in oblique gaze positions as well as in superomedial gaze positions in the evaluation of the residual vestibular functions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study is to find the functions of vestibular reflexes in individuals' with normal hearing and tinnitus, to identify vestibular dysfunctions earlier, and helps with the management of the same. Method: The present study aimed to administer cVEMP and oVEMP to all the participants having a normal hearing with tinnitus (experimental group) and without tinnitus (Control group) and compared p13, n23 latencies and peak-to-peak amplitude of cVEMP; n10, p15 latencies of oVEMP and peak-to-peak amplitude between two groups and within tinnitus group. Results: The present study stated that there is no statistically significant difference seen in cVEMP except n23 latency of bilateral tinnitus than control group. However, there is statistically significant difference in left ear p15 latency, left ear peak-to-peak amplitude, bilateral peak-to-peak amplitude between the two groups and Right Vs Left ear peak-to-peak amplitude in within the tinnitus group was seen in oVEMP. T-test was used to compare the latencies of p13, n23, and peak-to-peak amplitude of cVEMP and n10, p15 latencies and peak-to-peak amplitude of oVEMP between the experimental and control group and within the tinnitus group. Conclusion: There is no significant difference seen in cVEMP except n23 latency of bilateral tinnitus than control group and However, there is statistically significant difference in left ear p15 latency, left ear peak-to-peak amplitude, bilateral peak-to-peak amplitude between the two groups and Right Vs Left ear peak-to-peak amplitude in within the tinnitus group was seen in oVEMP and the current study concluded that the significant results with several parameters and no significant results with other parameters in cVEMP and oVEMP recording might be Presymptomatic tinnitus is regarded to occur in ears with normal hearing and abnormal VEMP, while asymptomatic tinnitus may occur in ears with normal VEMP. Tinnitus may be the first signs of secondary or delayed endolymphatic hydrops. If this is demonstrated to be accurate, we should anticipate that such patients will gradually develop other endolymphatic hydrops symptoms like SNHL and clinical vestibular dysfunction. [ABSTRACT FROM AUTHOR]

As previously reported, a single test measuring oVEMP n10 to 4000 Hz stimuli (bone-conducted vibration (BCV) or air-conducted sound (ACS)) provides a definitive diagnosis of semicircular canal dehiscence (SCD) in 22 CT-verified patients, with a sensitivity of 1.0 and specificity of 1.0. This single short screening test has great advantages of speed, minimizing testing time, and the exposure of patients to stimulation. However, a few studies of the 4000 Hz test for SCD have reported sensitivity and specificity values which are slightly less than reported previously. We hypothesized that the rise time of the stimulus is important for detecting the oVEMP n10 to 4000 Hz, similarly to what we had shown for 500 and 750 Hz BCV. We measured oVEMP n10 in 15 patients with CT-verified SCD in response to 4000 Hz ACS or BCV stimuli with rise times of 0, 1, and 2 ms. As a result, increasing the rise time of the stimulus reduced the oVEMP n10 amplitude. This outcome is expected from the physiological evidence of guinea pig primary vestibular afferents, which are activated by sound or vibration. Therefore, for clinical VEMP testing, short rise times are optimal (preferably 0 ms). [ABSTRACT FROM AUTHOR]

Purpose: Aging is a process associated with degeneration and dysfunction of peripheral vestibular system or apparatus. This study aimed to investigate the influence of aging on ocular vestibular-evoked myogenic potential (oVEMP) response rates and recording parameters using the B81 bone vibrator and compare them with air conduction stimuli (ACS) oVEMP response characteristics. Methods: In 60 healthy participants aged 10–71 years (mean age 39.9; 29 male participants), the oVEMP response was elicited using a B81 bone vibrator and an ER-3A insert earphone. The effects of age and stimulus on oVEMP response rates and recording parameters were evaluated. Results: Response rates and amplitudes declined with aging using either ACS or bone-conducted vibration (BCV) stimulation, particularly in individuals over 60 years of age, whereas thresholds increased and N1 latencies were prolonged. BCV showed fewer risks of absent oVEMP response than ACS (p = 0.002). BCV acquired higher amplitudes (p < 0.001), lower thresholds, and shorter N1 and P1 latencies (all p < 0.001) than ACS. Conclusions: The absence of an oVEMP response may be attributed to aging rather than a concurrent vestibular disorder. B81-BCV likely produces higher mechanical drives to the vestibular hair cells at safer and non-traumatic levels compared with ACS and therefore may be more likely to evoke a response in the elderly cohort, whose vestibular function and mechanical sensitivity have declined. Thus, B81-BCV stimulation is more effective and safer to elicit oVEMPs, and it should be recommended when ACS fails in the clinic, particularly in the elderly population. [ABSTRACT FROM AUTHOR]

Objective: Because of the anatomically close relationship between the cochlea and the vestibular organs, cochlear function disorders may be accompanied by vestibular disorders. This study aimed to evaluate vestibular functions in patients with idiopathic sudden sensorineural hearing loss using VEMP, caloric test, and VNG test battery and its relation to prognosis.Materials and Methods: For this study, 42 patients aged 18-55 years with idiopathic sudden sensorineural hearing loss and 30 volunteers who had no hearing and balance problems were included. Audiometry, cVEMP, oVEMP, caloric tests, and VNG tests were performed. Moreover, the effects of age, sex, time of admission, degree and configuration of hearing loss, accompanying vertigo, tinnitus, and ear fullness on improvement in hearing were evaluated.Results: Of the 42 patients in the study group, 26 (56.52%) were male, 20 (43.48%) were female, and the mean age was 41.54 ± 12.23 years. Of the 30 individuals in the control group, 19 (63.3%) were male, 11 (36.7%) were female, and the mean age was 39.53 ± 13.03 years. There was no significant difference in the incidence of sudden sensorineural hearing loss in terms of sex and age, and the prognosis was better for female patients. Early admission to treatment was a factor of good prognosis; profound hearing loss, bilateral hearing loss and vertigo were factors of poor prognosis. Prognosis was better in patients with rising type audiogram configuration, while the prognosis was worse in patients with flat, descending and total hearing loss. Tinnitus and ear fullness had no effect on the prognosis. No anomalies were observed in VNG findings. Moreover, abnormal caloric response was higher in patients with profound hearing loss and total hearing configuration. Shortening was observed in cVEMP / oVEMP P1 and N1 latency after treatment. Furthermore, there was an improvement in abnormal responses after treatment.Conclusion: In this study, vestibular function was affected in patients with idiopathic sudden sensorineural hearing loss. The present study can help the development of a clinical strategy in the evaluation of the vestibular system in idiopathic SSNHL, patient follow-up, patient information, and the implementation of vestibular rehabilitation. Note that additional studies involving larger patients series are required. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of chirp and tone burst stimuli in oVEMP and cVEMP testing for healthy adults Methods: This study was conducted in 56 healthy volunteers (112 ears). Ocular and cervical VEMP (oVEMP, cVEMP) tests were performed for each participant using tone burst and chirp stimuli. VEMP response rates, latency of each peak (p1–n1, n1–p1), peak to peak amplitude (p1–n1 amplitude and n1–p1 amplitude), and rectified amplitudes were measured and compared between these two different stimuli. Results: VEMP response rates with chirp stimuli are higher than the tone burst stimuli for both cVEMP and oVEMP tests (The difference was statistically significant for oVEMP, p = 0.001). Chirp stimuli have higher p1n1 amplitude and rectified amplitude and shorter p1and n1 latency then tone burst stimuli for cVEMP (p = 0.015, p = 0.007, p < 0.001, p < 0.001, respectively). Chirp stimuli also have higher n1p1 amplitude and shorter n1and p1 latency then tone burst stimuli for oVEMP (p = 0.006, p < 0.001, p < 0.001, respectively). Conclusion: The present findings show that the chirp stimulus triggers earlier VEMP responses with higher amplitudes than the tone burst stimulus during cVEMP and oVEMP testing. VEMP response rate with chirp stimulus is also higher than the tone burst. Therefore chirp stimulus can be used in VEMP testing as effectively as, if not more than, tone burst stimulus in clinical practice. [ABSTRACT FROM AUTHOR]

Background Upward shift in the air conducted (AC) frequency tuning of vestibular evoked myogenic potentials (VEMPs) as an effect of aging is hypothesized to be due to the microstructural stiffening changes in the inner ear. However, with an AC stimulus, it may be possible that the shift in the frequency tuning of VEMPs as an effect of aging may also be due to contributions from the middle ear. Purpose The main aim of this study was to examine the effects of age on the frequency tuning of the cervical VEMP (cVEMP) and ocular VEMP (oVEMP) and determine the role of middle ear transmission characteristics in shaping these effects. Research Design Standard group comparison. Study Sample One-hundred seven participants divided in three groups: young adult, middle-age, and older adults with "normal" middle ear and negative history of neurological or vestibular complaints. Data Collection and Analyses Middle ear measures included static admittance and middle ear resonant frequency. cVEMP and oVEMPs were elicited with AC tone bursts at 500, 750, and 1,000 Hz. Results No significant effect of age was observed on any of the middle ear measures. There was a significant effect of age on the amplitude of the cVEMP, but this effect was frequency specific. The age-related reduction in cVEMP corrected amplitude was only observed when the eliciting stimulus was 500 or 750 Hz, with no significant effect observed with a 1,000 Hz stimulus. For the oVEMP, the effects of age were apparent at all stimulus frequencies. We also observed a general upward shift in the frequency tuning of both the cVEMP and oVEMP for middle-age and older adults, with 750 and 1,000 Hz yielding higher response rates and larger amplitudes among middle-aged and older adults. Measurements of middle ear did not significantly contribute to the observed findings. Conclusions The upward shift in frequency tuning of VEMPs among middle age and older adults could be due to the changes in the vestibular system and not from the middle ear. These results support the use of different frequency stimuli (i.e., 750 or 1,000 Hz) to elicit a VEMP if a response is absent using a 500 Hz stimulus, especially in patients over the age of 40. [ABSTRACT FROM AUTHOR]

Background  Frequency tuning of ocular vestibular evoked myogenic potential (oVEMP) refers to the frequency of tone burst that produces the largest amplitude oVEMP. There is an ever-growing pool of published studies that found the frequency tuning of oVEMP distinctly different in Ménière's disease than the age-matched controls and benign paroxysmal positional vertigo. However, recording oVEMP in response to many frequencies makes an already lengthy vestibular test battery even more cumbersome and time-consuming. Purpose  The aim of this study was to develop a novel time-saving stimulus that produces reliable results. Research Design  Prospective study. Study Sample  The study included 25 young, healthy adults. Data Collection  The tone-bursts of 2000, 1500, 1000, 750, 500, and 250 Hz were generated and sequenced in this order to prepare a stimulus for simultaneous multifrequency (SiMFy) oVEMP. The response parameters of SiMFy and conventional oVEMP methods were compared. Results  No significant difference in peak-to-peak amplitude and frequency tuning existed between conventional and SiMFy oVEMP (p > 0.05). SiMFy had better test–retest reliability and was less time-consuming than the conventional oVEMP. Conclusions  SiMFy is a time-saving and reliable stimulus for obtaining frequency tuning of oVEMP with no compromise on the outcomes. It can be immediately applied in most commercially available evoked potential systems with a facility for loading an external stimulus. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the rate of endolymphatic hydrops (EH) on MRI and the rate of otolithic dysfunction with cVEMP and oVEMP, in patients with recurrent vertigo such as Menière's disease (MD), vestibular migraine (VM) and vestibular Menière's disease (vMD). Methods: In this retrospective study, we performed 3D-FLAIR sequences with delayed acquisition in 20 MD, 20 VM and 20 vMD patients. Each subject was then assessed for the presence of EH on MRI. All patients underwent pure-tone audiometry, cVEMP and oVEMP. Results: In MD patients, EH was observed in 18 (90%) out of 20 patients while EH was observed in only 1 MV (5%) and 1 vMD (5%) patients. We found significant differences between groups for the presence of EH on MRI (p = 0.001). MD patients had significant higher PTA level (p < 0.001) and oVEMP impairment than MV and vMD (p = 0.08 and p = 0.06, respectively). However, no significant differences were observed for cVEMP impairment, either asymmetric ratio (p = 0.36) and 1000/500 ratio (p = 0.20). Conclusions: Concerning cVEMP, we observed no significant differences between VM, vMD and MD. However, we observed higher oVEMP impairment, PTA level and EH on MRI in MD patients. We believe that MRI could be used to differentiate MD from VM patients with cochlear symptoms. However, in cases of migraine associated with recurrent vertigo and without cochlear symptoms, we believe that MRI is not a useful tool to differentiate between VM and vMD. [ABSTRACT FROM AUTHOR]

Purpose: Ageing is process that brings about steady decline in most of the systems, and vestibular system is no different. Although the effects of advancing age on the functioning of the semicircular canals and saccule has been well explored, its impact on the utricle remains the least studied component. While some researchers have investigated the effect of advancing age on the utricular functioning by virtue of studying ocular–vestibular evoked myogenic potentials (oVEMP), the use of smaller sample sizes would hamper the generalization of their results. Therefore, the present study aimed at investigating the effect of advancing age on oVEMP using a substantially larger sample size than the predecessors. Methods: A total of 480 individuals in the age range of 10–70 years were used as participants and were divided into six age groups, each one defined as a decade. Contralateral oVEMPs were elicited by 500-Hz tone-bursts and averaged over 200 sweeps to obtain the final waveform. Results: There was a significant decline in the response rates, prolongation of latencies and reduction of peak-to-peak amplitude of oVEMP with increasing age after 50 years (p < 0.05). However, there was no significant difference among the age groups until 50 years of age on any of these parameters (p > 0.05). Further, there was no significant change in inter-aural amplitude difference ratio with increasing age (p > 0.05). Conclusion: The results of the study confirm significant impact of the ageing process on oVEMP after the age of 50 years and, therefore, age appropriate norms should be considered when using oVEMP for investigating utricular functioning in an individual, especially after the age of 50 years. [ABSTRACT FROM AUTHOR]

There is limited evidence to provide an insight on the VEMP characteristics to explain the association between chronic renal disease (CRD) and its effect on otolith structures. To compare the otolithic function of individuals with CRD and individuals with no known CRD. To investigate the relationship between disease duration and VEMP and creatine level and VEMP among individuals with CRD. A cross-sectional study design using convenient sampling method was adapted for the present study. A total of 50 adults aged between 40 and 60 years participated in the study. Group 1 included 25 individuals with CRD undergoing hemodialysis and Group 2 included 25 individuals with no known CRD. cVEMP and oVEMP were recorded from participants in both groups. cVEMP and oVEMP was absent in 28% and 44% of individuals with CRD respectively, while, both VEMPs were present among all participants in group 2. Further, peak-to-peak amplitude of VEMP was reduced in individuals with CRD suggesting abnormal otolith function. In addition, a negative correlation was found between disease duration and the peak-to-peak amplitude of VEMP. The abnormal VEMP findings in individuals with CRD shows presence of otolithic dysfunction along with amplitude is found to decrease with an increase in the disease duration. [ABSTRACT FROM AUTHOR]

Vestibular evoked myogenic potentials are short-latency myogenic responses recorded with electrodes placed on neck or eye muscles in response to high-intensity stimulus. In addition to common vestibular system diseases, abnormal VEMP findings have been reported in various central pathologies that cause balance disorders. The VEMP test is considered to be useful in the diagnosis of many vestibular and central disorders. In this review, the clinical use of VEMP test in the differential diagnosis of various diseases has been revealed by reviewing the relevant literature. [ABSTRACT FROM AUTHOR]

To facilitate more reliable recordings of the ocular vestibular evoked myogenic potentials (oVEMP) induced by bone-conducted sound using the B81 bone conduction transducer, we preliminarily studied the effects of external auditory meatus occlusion using an earplug on such oVEMP. Eight healthy volunteers (four males and four females, 26–48 years of age, mean age: 34. 5 years) and 14 patients with vestibular disease (2 males and 12 females, 18–59 years of age, mean age: 41.5 years) were enrolled. oVEMP testing was performed using a B81 placed on the temple. Tone bursts (500 Hz, rise/fall time: 2 ms, plateau time: 2 ms, and 70 dB nHL) were presented at a rate of 5.1 Hz. N1-P1 amplitudes were measured and analyzed. Occlusion resulted in significantly larger N1-P1 amplitudes [mean ± SE (SD): 12.3 ± 1.67 (6.71) μV vs. 9.55 ± 1.55 (6.21) μV; p = 0.020, paired t-test]. While four patients did not exhibit any response on either side in the absence of occlusion, all of them showed unilateral or bilateral responses when occlusion was employed. In any patient occlusion did not result in loss of oVEMP responses. External auditory meatus occlusion using an earplug could allow more reliable recordings of bone conduction transducer-induced oVEMP.

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique.Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria).Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA.Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.

Background How significant asymmetries in otolith organ function in the presence of symmetrical and asymmetrical semicircular canal function influence skull vibration- induced nystagmus testing (SVINT) has not been well described. Purpose The aim of the study is to examine the agreement between SVINT and caloric testing, ocular vestibular-evoked myogenic potentials (oVEMP), and cervical vestibular- evoked myogenic potentials (cVEMP) for detecting asymmetric vestibular function. Research Design This is a retrospective study of patients presenting with the chief complaint of vertigo, dizziness, or imbalance. Study Sample A total of 812 patients were studied with a median age at testing of 59 years (interquartile range 46-70; range 18-93) and included 475 (59%) women. Intervention Either the monothermal warm caloric test or alternate binaural bithermal caloric test, oVEMP, and cVEMP tests were administered to all patients. All patients underwent the SVINT prior to vestibular laboratory testing. Data Collection and Analysis Agreement between tests categorized as normal versus abnormal was summarized using percent concordance (PC). Sensitivity and specificity values were calculated for SVINT compared with other tests of vestibular function. Results There was higheragreement between ipsilateral and contralateral SVINT with the caloric test (PC = 80% and 81%, respectively) compared with oVEMP (PC = 63% and 64%, respectively) and cVEMP (PC = 76% and 78%, respectively). Ipsilateral and contralateral SVINT showed higher sensitivity for the caloric test (sensitivity = 47% and 36%, respectively) compared with oVEMP (sensitivity = 26% and 21%, respectively), or cVEMP (sensitivity = 33% vs. 27%, respectively). Specificity of SVINTwas high (>80%) for all assessments of vestibular function. [ABSTRACT FROM AUTHOR]

The clinical utility of cervical and ocular vestibular-evoked myogenic potential (cVEMP and oVEMP) is limited by variability of testing protocols and a dearth of normative data using contemporary methods for amplitude scaling. To investigate the effect of body position and electrode montage on VEMP responses and to establish normative values. This is a repeated measures study of 44 healthy young adult subjects (22 men and 22 women). The highest response rate (99%) for cVEMP was achieved in the supine position with the head elevated and turned. For oVEMP, the highest response rate (90%) was achieved using nasal alar electrode montage with the subject in a sitting position. Scaled peak-to-peak amplitude was higher in males than in females for both cVEMP and oVEMP. Normative data for 44 young healthy adults was successfully collected for two body positions for cVEMP and two head positions and two electrode montages for oVEMP. Our findings describe VEMP protocols that efficiently detect VEMP responses, and we provide normative VEMP response data for young healthy subjects. We describe a potential difference in response between males and females, which may be clinically important [ABSTRACT FROM AUTHOR]

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique. Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria). Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA. Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function. [ABSTRACT FROM AUTHOR]

To facilitate more reliable recordings of the ocular vestibular evoked myogenic potentials (oVEMP) induced by bone-conducted sound using the B81 bone conduction transducer, we preliminarily studied the effects of external auditory meatus occlusion using an earplug on such oVEMP. Eight healthy volunteers (four males and four females, 26–48 years of age, mean age: 34. 5 years) and 14 patients with vestibular disease (2 males and 12 females, 18–59 years of age, mean age: 41.5 years) were enrolled. oVEMP testing was performed using a B81 placed on the temple. Tone bursts (500 Hz, rise/fall time: 2 ms, plateau time: 2 ms, and 70 dB nHL) were presented at a rate of 5.1 Hz. N1-P1 amplitudes were measured and analyzed. Occlusion resulted in significantly larger N1-P1 amplitudes [mean ± SE (SD): 12.3 ± 1.67 (6.71) μV vs. 9.55 ± 1.55 (6.21) μV; p = 0.020, paired t -test]. While four patients did not exhibit any response on either side in the absence of occlusion, all of them showed unilateral or bilateral responses when occlusion was employed. In any patient occlusion did not result in loss of oVEMP responses. External auditory meatus occlusion using an earplug could allow more reliable recordings of bone conduction transducer-induced oVEMP. [ABSTRACT FROM AUTHOR]

Background: Early brainstem neurodegeneration is common in Parkinson's disease (PD) and progressive supranuclear palsy (PSP). While previous work showed abnormalities in vestibular evoked myogenic potentials (VEMPs) in patients with either disorder as compared to healthy humans, it remains unclear whether ocular and cervical VEMPs differ between PD and PSP patients.Methods: We prospectively included 12 PD and 11 PSP patients, performed ocular and cervical VEMPs, and calculated specific VEMP scores (0 = normal, 12 = most pathological) based on latencies, amplitude, and absent responses. In addition, we assessed disease duration, presence of imbalance, motor asymmetry, and motor disability using the Movement Disorder Society Unified Parkinson's Disease Rating Scale, part III (MDS-UPDRS III). Moreover, we ascertained various sleep parameters by video-polysomnography.Results: PSP and PD patients had similar oVEMP scores (6 [3–6] vs. 3 [1.3–6], p = 0.06), but PSP patients had higher cVEMP scores (3 [0–6] vs. 0 [0–2.8], p = 0.03) and total VEMP scores (9 [5–12] vs. 4 [2–7.5], p = 0.01). Moreover, total VEMP scores >10 were only observed in PSP patients (45%, p = 0.01). MDS-UPDRS III correlated with cVEMP scores (rho = 0.77, p = 0.01) in PSP, but not in PD. In PD, but not in PSP, polysomnographic markers of disturbed sleep, including decreased rapid eye movement sleep, showed significant correlations with VEMP scores.Conclusions: Our findings suggest that central vestibular pathways are more severely damaged in PSP than in PD, as indicated by higher cervical and total VEMP scores in PSP than PD in a between-groups analysis. Meaningful correlations between VEMPs and motor and non-motor symptoms further encourage its use in neurodegenerative Parkinsonian syndromes.

Background: Early brainstem neurodegeneration is common in Parkinson's disease (PD) and progressive supranuclear palsy (PSP). While previous work showed abnormalities in vestibular evoked myogenic potentials (VEMPs) in patients with either disorder as compared to healthy humans, it remains unclear whether ocular and cervical VEMPs differ between PD and PSP patients. Methods: We prospectively included 12 PD and 11 PSP patients, performed ocular and cervical VEMPs, and calculated specific VEMP scores (0 = normal, 12 = most pathological) based on latencies, amplitude, and absent responses. In addition, we assessed disease duration, presence of imbalance, motor asymmetry, and motor disability using the Movement Disorder Society Unified Parkinson's Disease Rating Scale, part III (MDS-UPDRS III). Moreover, we ascertained various sleep parameters by video-polysomnography. Results: PSP and PD patients had similar oVEMP scores (6 [3–6] vs. 3 [1.3–6], p = 0.06), but PSP patients had higher cVEMP scores (3 [0–6] vs. 0 [0–2.8], p = 0.03) and total VEMP scores (9 [5–12] vs. 4 [2–7.5], p = 0.01). Moreover, total VEMP scores >10 were only observed in PSP patients (45%, p = 0.01). MDS-UPDRS III correlated with cVEMP scores (rho = 0.77, p = 0.01) in PSP, but not in PD. In PD, but not in PSP, polysomnographic markers of disturbed sleep, including decreased rapid eye movement sleep, showed significant correlations with VEMP scores. Conclusions: Our findings suggest that central vestibular pathways are more severely damaged in PSP than in PD, as indicated by higher cervical and total VEMP scores in PSP than PD in a between-groups analysis. Meaningful correlations between VEMPs and motor and non-motor symptoms further encourage its use in neurodegenerative Parkinsonian syndromes. [ABSTRACT FROM AUTHOR]

Introduction: Unilateral vestibular atelectasis (UVA), an entity first described by Merchant and Schuknecht in 1988, has rarely been reported in vivo as of yet. We specify here the clinical characteristics of 22 patients diagnosed with UVA. Materials and methods: Patients with a radiological diagnosis of UVA who underwent delayed inner ear MRI were included between April 2017 and January 2020. Full clinical testing including ocular infrared video-oculography, oVEMPs, cVEMPs, vHIT, bithermal caloric testing and auditory testing was performed. Results: There were 13 men and 9 women, of mean age 58.6 ± 13.7 years. Onset was more frequently sudden (73%) than insidious (27%) though both clinical presentations were reported, and positional vertigo was described in 41% of cases. There were only two (9%) patients reporting Tullio's phenomenon. Vestibular testing showed that in 90% of cases, there was utricular dysfunction on oVEMP, while in 77% of cases, saccular function was preserved on cVEMP. vHIT showed high-velocity canal function impairment in all 22 patients: 8 patients (36%) had one impaired canal, 5 (23%) had two and 9 (41%) had all three canals affected. Caloric tests found complete unilateral areflexia, in 65% of tested cases, and partial deficiency in 35% of cases. Nine patients (40%) displayed asymmetrical hearing. Conclusion: We described in this study the various clinical presentations of a disease rarely reported in vivo, UVA. Initial clinical presentation can appear similar to an acute vestibular deficit, a recurrent positional vertigo, or fluctuating dizziness. [ABSTRACT FROM AUTHOR]

Clinical Relevance: The visual system plays an important role in the development of the vestibular-ocular reflex (VOR). In clinical practice, the ocular vestibular evoked myogenic potential (oVEMP) test is used to assess contralateral VOR., Background: This study sought to compare the oVEMP in patients with anisometropic, strabismic, and mixed amblyopia using unilateral and bilateral (simultaneous binaural) stimulation., Methods: Forty-two amblyopic patients (20 males and 22 females) with a mean age of 10.48 ± 4.00 years (range: 5 - 20 years) were examined. The Titmus stereopsis test, alternate cover test, and best-corrected visual acuity were evaluated. Patients were divided into three groups: anisometropic, strabismic, and mixed amblyopia. The oVEMP responses including the amplitude of electrical activity (n1-p1 complex) and the latencies (n1 and p1) of the VOR responses were recorded under unilateral and bilateral stimulations., Results: In the anisometropic and strabismic group, n1 latency was significantly faster in the non-amblyopic eyes compared to amblyopic eyes (Z = -2.04, p  = 0.042, andZ = -2.54, p  = 0.024 respectively). Mean p1 latency was significantly faster in the non-amblyopic eyes compared to the amblyopic eyes of the strabismic group (Z = -2.31, p  = 0.011)In all groups, the p1 latency was faster in the non-amblyopic eye compared to bilateral stimulation (all, p  < 0.05). In all groups, the n1-p1 amplitude was not significantly different between the two eyes, and between each eye and bilateral stimulation (all, p  > 0.05). No significant correlation was found between the depth of amblyopia and n1 and p1 responses (all, p  > 0.05). In all groups there was no significant difference in the latency of n1 and p1 between the amblyopic eye and bilateral stimulation (all, p  > 0.05)., Conclusion: Regardless of its type, amblyopia affects vestibular-ocular reflex responses. Further research is warranted to clarify the effect of the disease and its treatment on the ocular-vestibular system.

Bo Håkansson,1 Karl-Johan Fredén Jansson,1 Tomas Tengstrand,2 Leif Johannsen,3 Måns Eeg-Olofsson,4 Cristina Rigato,1 Elisabeth Dahlström,4 Sabine Reinfeldt1 1Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden; 2Department of Audiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Ortofon A/S, Nakskov, Denmark; 4Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Objective: A new prototype bone conduction (BC) transducer B250, with an emphasized low-frequency response, is evaluated in vestibular evoked myogenic potential (VEMP) investigations. The aim was to compare cervical (cVEMP) and ocular (oVEMP) responses using tone bursts at 250 and 500 Hz with BC stimulation using the B250 and the conventional B81 transducer and by using air conduction (AC) stimulation.Methods: Three normal subjects were investigated in a pilot study. BC stimulation was applied to the mastoids in cVEMP, and both mastoid and forehead in oVEMP investigations.Results: BC stimulation was found to reach VEMP thresholds at considerably lower hearing levels than in AC stimulation (30–40 dB lower oVEMP threshold at 250 Hz). Three or more cVEMP and oVEMP responses at consecutive 5 dB increasing mastoid stimulation levels were only obtained in all subjects using the B250 transducer at 250 Hz. Similar BC thresholds were obtained for both ipsilateral and contralateral mastoid stimulation. Forehead stimulation, if needed, may require a more powerful vibration output.Conclusion: Viable VEMP responses can be obtained at a considerably lower hearing level with BC stimulation than by AC stimulation. The cVEMP and oVEMP responses were similar when measured on one side and with the B250 attached to both ipsilateral and contralateral mastoids. Keywords: vestibular investigation, air conduction, bone conduction, VEMP, cVEMP, oVEMP

Background: Arnold--Chiari malformation is defined as a congenital neuroanatomic deformity of the craniocervical junction, which is characterized by herniation of contents from the posterior cranial fossa through the foramen magnum into the cervical spinal canal. There is limited literature on audiological and vestibular evaluation on individuals with Arnold--Chiari malformation. Thus, the present study reports the results of a detailed audio-vestibular evaluation in an adult female diagnosed with Arnold--Chiari malformation. Case report: A detailed audio-vestibular evaluation was carried out in an adult female diagnosed with Arnold--Chiari malformation. Pure tone audiometry, immittance evaluation, otoacoustic emissions, auditory brainstem response (ABR), cervical vestibular evoked myogenic potential (cVEMP), ocular vestibular evoked myogenic potential (oVEMP), and video head impulse test (vHIT) were recorded, and the results were analyzed. The results of the study showed an abnormal prolongation of inter-peak latencies in the ABR, which was seen in both ears. Also, cVEMP and oVEMP was absent in both ears. The results suggest possible compression of the cerebellar tonsils on the cochlear and vestibular nuclei. Conclusions: The study suggests that individuals with Arnold--Chiari malformation should undergo a detailed audio-vestibular evaluation to understand the pathophysiology of the disorder, which can guide further management. [ABSTRACT FROM AUTHOR]

Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo, caused by otoconia falling from the utricle into a semicircular canal (SCC). After successful repositioning maneuvers residual dizziness (RD) has been described and several reasons are used to explain RD. It can last for only a few days or weeks, but also much longer. We present a patient with a severe traumatic loss of otoconia from both maculae utriculi and a persistent imbalance more than 9 years. We think that the loss of otoconia from the utricular and probably also saccular macula induced a sudden reduction of her ability to sense gravity thus logically explaining her symptoms. We show the vestibular test results also supporting our hypothesis and we extrapolate this support to other forms of so far unexplained dizziness especially increasing imbalance with aging. We also discuss the normal c- and oVEMP indicating intact haircell function and supporting our hypothesis of isolated otoconial loss as the major cause for imbalance. [ABSTRACT FROM AUTHOR]

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BACKGROUND: The ocular vestibular evoked myogenic potential is otolith-dependent and has been suggested to be a manifestation of the linear vestibulo-ocular reflex (L-VOR). A characteristic feature of the translational LVOR (t-LVOR) is its dependence on the distance of a target. OBJECTIVE: To assess if viewing distance affects amplitude and latency properties of the ocular vestibular evoked myogenic potential (oVEMPs). METHODS: Bone- and air-conducted (BC and AC) stimuli were used to evoke oVEMPs in 10 healthy subjects. BC stimuli consisted of impulsive accelerations applied at the mastoids, AFz, Oz and Iz. AC stimuli consisted of 500 Hz tones delivered unilaterally to each ear. Target distances of 40 cm (near), 190 cm (intermediate) and 340 cm (far) were used for all stimuli. RESULTS: The largest amplitude oVEMP was obtained from Iz and the latency for AFz was shorter than for BC stimulation at other sites. We found no significant effect of target distance on oVEMP amplitudes for any of the stimuli used. There was a small but significant effect on latency with the nearest target having a longer latency (overall 12.4 ms vs 12.0 ms for the 2 more distant sites). CONCLUSIONS: Previously reported differences between latencies and stimulus sites for midline BC stimulation were confirmed. Target distance had no significant effect on oVEMP amplitude, which suggests it is not modified like other components of the t-LVOR. [ABSTRACT FROM AUTHOR]

Aim: We aimed to show the effectivity of chirp stimulus and to compare with tone-burst and click stimulus during ocular VEMP (oVEMP) and also to exhibit same stimulation response pattern in utricle as seen in cochlea. Material and Methods: A total of 85 healthy volunteers without any vestibular and otologic disease history were enrolled in this study. Three different types of air conduction stimuli (tone-burst, click and chirp) were used for the oVEMP test. N1, P1 latencies, N1P1 amplitudes and asymmetry ratios were investigated for each stimulus type according to age subgroups and sex. Results: The ratio of presence of oVEMP response was found to be 94.1%, 82.1% and 98.8% with tone-burst, click and chirp stimuli respectively. The latencies were significantly shorter in chirp stimulus with respect to others in both ears. The amplitudes were also significantly larger in chirp stimulus with respect to other in both ears. According to analysis of N1P1 asymmetry ratios, N1 and P1 latency asymmetry, there were no statistically significant difference in these values within each stimulus types. Conclusion: oVEMP is more practical, easier, faster and less invasive method. oVEMP results with chirp stimulus have shorter latency and higher amplitude and more clear waveform morphology with higher ratio of response when compared to click and toneburst stimulus. As a result, chirp is a reliable and suitable stimulus type for oVEMP analysis. In the light of these unique results with chirp stimulus, utricular hair cells may have similar frequency specific tonotopic organization as seen in cochlea. [ABSTRACT FROM AUTHOR]

Recent advances in vestibular testing now permit functional testing of all peripheral vestibular sense organs (all three semicircular canals, utricle, and saccule). This makes it possible to identify patients with isolated dysfunction of the utricle or saccule, even though parallel pathways for vestibular information are ultimately integrated centrally. Selective, isolated unilateral loss of utricular function as measured by ocular vestibular-evoked myogenic potentials (VEMPs) has been observed in patients with normal semicircular canal function as measured by the video head impulse test of all six semicircular canals, and normal bilateral saccular function as determined by symmetrical cervical VEMPs. How these patients present clinically and how they recover is discussed and contrasted with acute vestibular neuritis. In some patients, the unilateral loss of otolith organ (utricle or saccule) function persists and yet the patient recovers functionally to their usual lifestyle. Until the testing of all peripheral vestibular sense organs is routine, the frequency of isolated loss of otolith function cannot be gauged. [ABSTRACT FROM AUTHOR]

• Repetitive oVEMPs reliably differentiate MG patients from controls. • Inferior oblique muscle recordings at 30 Hz were most sensitive and specific. • At higher repetition rates, the decrement occurred with later stimulus repetitions. To determine the most effective stimulation parameters for the diagnosis of ocular myasthenia gravis (MG) using repetitive ocular vestibular evoked myogenic potentials (oVEMP) for quantification of the extraocular muscle response decrement. Repetitive bone-conducted oVEMPs were elicited in 18 MG patients and 20 healthy subjects. We compared four different stimulus repetition rates (20 Hz, 30 Hz, 40 Hz, 50 Hz) and 100 Hz continuous stimulation, as well as recordings from the inferior oblique muscles and the lateral rectus muscles to determine the most sensitive and specific oVEMP parameters for decrement detection. Repetitive stimulation at all tested repetition rates with recordings from inferior oblique muscles allowed for effective differentiation between MG patients and healthy subjects. Among all repetition rates, 30 Hz showed a trend towards superiority, with a sensitivity of 71% and a specificity of 94% (area under the curve (AUC) 0.88) when using the smaller decrement of the two eyes and −10% as cutoff. Considering the larger decrement for analysis (−9% as cutoff), sensitivity increased to 82%, but specificity decreased to 78% (AUC 0.81). Our study demonstrates, that repetitive oVEMP stimulation elicits a robust decrement in the inferior oblique muscles of MG patients at repetition rates between 20 Hz and 50 Hz, with a probable optimum at 30 Hz. Repetitive inferior oblique oVEMP stimulation with optimal stimulus parameters facilitates early and accurate diagnosis of ocular MG. [ABSTRACT FROM AUTHOR]

The aim the present study is to evaluate ocular and cervical Vestibular Evoked Myogenic Potentials (VEMPs) of adult individuals with and without tinnitus who have normal hearing. Thirty one patients who have normal hearing, complaining about unilateral or bilateral subjective tinnitus and 30 volunteers who without tinnitus and vestibular complains were enrolled into the present study. Following examination by of Ear Nose Throat (ENT) physician, Tinnitus Disability Questionnaire (TDQ), pure tone audiometry (125-16.000 Hz) speech tests, oVEMP and cVEMP tests were applied to all participants. Fourteen individuals with normal hearing and tinnitus were male (44%) and 17 (56%) were female with an age average of 35.8 ± 10.2.30 years; the control group consisted of 16 males (53%) and 14 females (47%) with an age average of 37.5 ± 12 years. Two individuals of the tinnitus group had bilateral tinnitus and 29 individuals had unilateral tinnitus. A statistically significant difference in individuals without tinnitus and tinnitus must be normal at work between test answers that are not available 125-16000 Hz range Air Conduction (AC) hearing thresholds, speech tests, cVEMP and oVEMP responses. Tinnitus may appear due to many reasons. Vestibular system is one of the conditions that can cause tinnitus. According to the findings obtained from adult individuals with normal hearing, the vestibular system does not cause tinnitus. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this investigation was to evaluate the sensitivity and specificity of the ocular vestibular evoked myogenic potential (oVEMP) using two electrode montages in patients with confirmed unilateral superior semicircular canal dehiscence syndrome (SCDS). Study Design: This study evaluated oVEMP response characteristics measured using two different electrode montages from 12 unilateral SCDS ears and 36 age-matched control ears (age range = 23-66). The oVEMP responses were elicited using 500 Hz tone-burst air conduction stimuli presented at an intensity of 95 dB nHL and a rate of 5.1/sec. The two electrode montages used are described as an "infraorbital" montage and a "belly-tendon" montage. Setting: Balance function laboratory embedded in a large, tertiary care otology clinic. Results: The belly-tendon electrode montage resulted in significantly larger amplitude responses than the infraorbital electrode montage for the ears with SCDS and the normal control ears. For both electrode montages the ear with SCDS exhibited a significantly larger amplitude response, ~50% larger than the response amplitude from the normal control ear. The belly-tendon montage additionally produced larger median increases in amplitude compared with the infraorbital montage. Specifically, the median increase in oVEMP N1-P1 amplitudes using the belly-tendon montage was 39% greater in control ears, 76% greater in the SCDS ears, and 17% greater in the contralateral SCDS ears. Conclusions: The belly-tendon electrode montage yields significantly larger oVEMP amplitude responses for participants with SCDS and normal control participants. [ABSTRACT FROM AUTHOR]

Objective: The study aimed at examining the usefulness of inter-frequency amplitude ratio (IFAR) of ocular vestibular evoked myogenic potential (oVEMP) in identifying Meniere's disease (MD) and differentiating it from benign paroxysmal positional vertigo (BPPV). Design: A case-control design was used with a double blind approach. Phase 1 included 70 healthy individuals and 36 individuals each with MD and BPPV and Phase 2 included 20 individuals each with MD and BPPV. The age range of the participants in both phases was 15-50 years. All participants underwent oVEMP testing using 500 and 1000 Hz tone bursts and IFAR was obtained. Results: The results in phase 1 revealed significantly higher IFARs in Meniere's disease than BPPV and healthy individuals (p < 0.001). An optimum criterion point of IFAR ≥1.11 for diagnosing MD was found which yielded 80% sensitivity and 98% specificity. The results in phase 2 demonstrated 85% correct identification of MD and 95% correct rejection of BPPV as non-MD. Conclusions: IFAR of oVEMP appears highly sensitive and specific parameter for identifying MD and a clinically valid tool for differentiating MD from BPPV. [ABSTRACT FROM AUTHOR]