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Wang, Shou-Jen, Fu-Shan Jaw, and Yi-Ho Young. "VESTIBULAR AFFERENTS POPULATION ACTIVATED BY VARIOUS MODES FOR ELICITING OCULAR AND CERVICAL VESTIBULAR-EVOKED MYOGENIC POTENTIALS." Biomedical Engineering: Applications, Basis and Communications 23, no. 06 (December 2011): 527–32. http://dx.doi.org/10.4015/s1016237211002864.
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This study compared cervical and ocular vestibular-evoked myogenic potentials (cVEMPs and oVEMPs) between air-conducted sound (ACS) and bone-conducted vibration (BCV) modes to determine whether these two stimulation modes activate the same population of primary vestibular afferents. Fifteen healthy subjects underwent cVEMP and oVEMP tests using ACS stimuli at 127 dB pe SPL and BCV stimuli at 128 dB force level. The characteristic parameters of cVEMPs and oVEMPs were compared between ACS and BCV modes. The mean p13 and n23 latencies of ACS-cVEMPs were significantly longer than those of BCV-cVEMPs. Likewise, the mean nI and pI latencies for ACS-oVEMPs were also significantly longer than those for BCV-oVEMPs. There was no significant difference in the mean amplitude of cVEMPs between the ACS and BCV modes. However, comparing the oVEMP amplitude, a relationship: (Amplitude of BCV-oVEMP) = 2.3 x (Amplitude of ACS-oVEMP) was demonstrated. In conclusion, the population of primary vestibular afferents activated by ACS and BCV stimuli is similar for cVEMPs. In contrast with oVEMPs, BCV mode activates more number of primary vestibular afferents than ACS mode does. In interpreting oVEMP and cVEMP results, stimulation mode should be checked first.
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Di Lazzaro, Giulia, Tommaso Schirinzi, Maria Pia Giambrone, Roberta Di Mauro, Maria Giuseppina Palmieri, Camilla Rocchi, Michele Tinazzi, Nicola Biagio Mercuri, Stefano Di Girolamo, and Antonio Pisani. "Pisa Syndrome in Parkinson’s Disease: Evidence for Bilateral Vestibulospinal Dysfunction." Parkinson's Disease 2018 (October 15, 2018): 1–6. http://dx.doi.org/10.1155/2018/8673486.
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Introduction. Pisa syndrome (PS) is a postural complication of Parkinson’s disease (PD). Yet, its pathophysiology remains unclear, although a multifactorial component is probable. Cervical vestibular evoked myogenic potentials (cVEMPs) explore vestibulospinal pathway, but they have not been measured yet in PD patients with PS (PDPS) to assess a potential vestibular impairment. Materials and Methods. We enrolled 15 PD patients, 15 PDPS patients, and 30 healthy controls (HCs). They underwent neurological examination and were examined with Unified Parkinson’s Disease Rating Scale II-III (UPDRSII-III), audiovestibular workup, and cVEMP recordings. Data were analysed with Chi-square, one-way ANOVA, multinomial regression, nonparametric, and Spearman’s tests. Results. cVEMPs were significantly impaired in both PD and PDPS compared with HCs. PDPS exhibited more severe cVEMP abnormalities with prevalent bilateral loss of potentials, compared with the PD group, in which a prevalent unilateral loss was instead observed. No clinical-neurophysiological correlations emerged. Conclusions. Differently from HC, cVEMPs are altered in PD. Severity of cVEMPs alterations increases from PD without PS to PDPS, suggesting an involvement of vestibulospinal pathway in the pathophysiology of PS. Our results provide evidence for a significant impairment of cVEMPs in PDPS patients and encourage further studies to test validity of cVEMPs as diagnostic and prognostic biomarkers of PD progression.
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Sayed, Sharifah Zainon, and Nor Haniza Abdul Wahat. "Effects of Age on Cervical Vestibular Evoked Myogenic Potentials and Ocular Vestibular Evoked Myogenic Potentials Using 750 Hz Tone Burst Stimuli among Healthy Adults." Malaysian Journal of Medical Sciences 29, no. 4 (August 29, 2022): 53–64. http://dx.doi.org/10.21315/mjms2022.29.4.6.
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Background: The vestibular evoked myogenic potentials (VEMPs) response characteristics depend on age, stimulus and individual anatomical differences. Therefore, normative data are required for accurate VEMPs interpretations. This cross-sectional study investigates VEMPs age-related changes among healthy adults using 750 Hz short alternating tone burst (TB) stimuli. Methods: Fifty adults aged between 23 years old and 76 years old with a mean of 51.56 (SD = 16.44) years old underwent air-conducted (AC) cervical VEMP (cVEMP) and head taps ocular VEMPs (oVEMPs) testing. Results: The cVEMPs and oVEMPs response rates reduced significantly at the age of 50-year-old and above. No significant age trends were observed for both cVEMPs and oVEMPs latencies and asymmetry ratios. However, amplitude reduced with increasing age for both cVEMPs, P < 0.001 and oVEMPs, P = 0.01. No significant differences in cVEMPs and oVEMPs latencies, amplitude or asymmetry ratios were identified between gender. Conclusion: To the best of our knowledge, this is the first published normative data for cVEMPs and oVEMPS in Malaysia and Southeast Asia, obtained among healthy adults aged between 23 years old and 76 years old. Health professionals in the region can use these findings as VEMPs normative references in their clinical settings.
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van Tilburg, Mark J., Barbara S. Herrmann, Steven D. Rauch, Kimberley Noij, and John J. Guinan. "Normalizing cVEMPs." Ear and Hearing 40, no. 4 (2019): 878–86. http://dx.doi.org/10.1097/aud.0000000000000668.
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Takeuti, Alice, Ana Correa, Elisa Leao, and Mariana Favero. "The Relationship between the Etiology of Profound Prelingual Sensorineural Hearing Loss and the Results of Vestibular-Evoked Myogenic Potentials." International Archives of Otorhinolaryngology 23, no. 01 (July 5, 2018): 001–6. http://dx.doi.org/10.1055/s-0038-1649491.
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Introduction Cervical vestibular-evoked myogenic potentials (cVEMPs) are biphasic, short latency potentials, which represent the inhibition of the contraction of the sternocleidomastoid muscle (SCM) mediated by the saccule, the inferior vestibular nerve, the vestibular nuclei and the medial vestibular spinal tract. Objective To evaluate the response of cVEMPs in individuals with profound prelingual bilateral cochlear hearing loss. Methods A prospective case-control study. A total of 64 volunteers, divided into a study group (31 patients with profound prelingual sensorineural hearing loss) and a control group (33 subjects matched for age and gender with psychoacoustic thresholds of ≤ 25 dB HL between 500 and 8,000 Hz) were submitted to the cVEMP exam. The causes of hearing loss were grouped by etiology and the involved period. Results The subjects of the study group are more likely to present changes in cVEMPs compared to the control group (35.5% versus 6.1% respectively; p = 0.003), with an odds ratio (OR) of 8.52 (p = 0.009). It means that they had 8.52-fold higher propensity of presenting altered cVEMP results. There were no statistically significant differences between the latencies, the interamplitude and the asymmetry index. Regarding the etiology, there was a statistically significant difference when the cause was infectious, with an OR of 15.50 (p = 0.005), and when the impairment occurred in the prenatal period, with an OR of 9.86 (p = 0.009). Conclusion The present study showed abnormalities in the sacculocolic pathway in a considerable portion of individuals with profound prelingual sensorineural hearing loss due to infectious and congenital causes, as revealed by the cVEMP results.
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Govender, Sendhil, and James G. Colebatch. "Effects of midline sagittal location on bone-conducted cervical and ocular vestibular evoked myogenic potentials." Journal of Applied Physiology 122, no. 6 (June 1, 2017): 1470–84. http://dx.doi.org/10.1152/japplphysiol.01069.2016.
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We have investigated the effectiveness of two bone-conducted (BC) stimuli in producing vestibular evoked myogenic potentials (VEMPs) following stimulation along midsagittal skull sites. Twenty subjects (mean age 24 yr, range: 18–34 yr; 6 men; 14 women) were studied using a smoothed impulse and a 500-Hz tone burst applied to Nz, Fpz, AFz, Fz, FCz, and Cz with both compressive and rarefactive onset phases. Cervical (cVEMPs) and ocular VEMPs (oVEMPs) were recorded as well as linear acceleration in three axes. cVEMPs evoked by 500 Hz showed no change in response polarity to either stimulus location or phase. cVEMPs evoked by the impulsive stimulus showed larger initial peak amplitudes at AFz and Fz using compressive stimuli and differences in initial peak latency between the two phases. In contrast, amplitude, latency, and response polarity for oVEMPs were markedly affected by stimulus location and phase, which were similar for both BC stimuli, with little correlation with induced acceleration of the head. Latencies were earliest at AFz and Fz where compressive onset stimuli evoked an initial negativity (average latency 8.6–11.0 ms). At other sites compressive onset stimuli usually evoked oVEMPs with an initial positivity. We conclude that both 500 Hz and impulsive stimuli are effective means of evoking cVEMPs and oVEMPs from mid sagittal skull sites. The effects depend upon both location and phase and differ for oVEMPs and cVEMPs. Initial negativities for oVEMPs following compressive stimuli were most consistently obtained using the AFz and Fz sites. NEW & NOTEWORTHY We investigated the effect of stimulus location and phase (compressive and rarefactive) in the midsagittal plane for the cVEMP and oVEMP evoked by bone-conducted (BC) 500 Hz and BC impulsive stimuli. For cVEMPs, location effects were limited but were observed for BC impulses. For oVEMPs, both stimuli affected amplitude, latency, and polarity, depending on stimulus location and phase. Compressive stimuli at Fz and AFz evoked early negative oVEMPs most reliably.
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Lachowska, Magdalena, Beata Zakrzewska-Pniewska, Monika Nojszewska, and Kazimierz Niemczyk. "Air-conducted cervical and ocular vestibular evoked miogenic potentials in patients with Susac’s syndrome." Polski Przegląd Otorynolaryngologiczny 7, no. 2 (June 30, 2018): 6–10. http://dx.doi.org/10.5604/01.3001.0012.1070.
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Aim: To evaluate acoustically evoked cervical and ocular vestibular miogenic potentials (AC cVEMP and oVEMP) findings in patients with Susac’s syndrome. We did not seek for a diagnostic replacement test in those patients, but we investigated if the combined application of AC cVEMP and oVEMPs might be helpful as an additional source of information about the disease. Methods: To record VEMPs the EMG standardization method was used to continuously monitor and minimize the variability of the recordings. The stimuli were presented unilaterally one ear at a time. The waveforms were analyzed for the response presence, latency and amplitude. Results: In the patient #1 stimulation resulted in responses on both sides with latencies within normal and symmetry limits for both c- and oVEMPs; however, the responses presented small amplitudes for cVEMPs. In patient #2, only cVEMPs were present. The P1 latencies were within normative values but amplitudes were low, in addition showing asymmetry between sides with right side amplitude being smaller. Conclusion: The information provided by the combined application of AC cVEMP and oVEMP might be useful in diagnosis of Susac’s syndrome revealing additional information about the affected vestibular system and be of help in treatment and rehabilitation planning.
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Ibraheem, Ola, and Mohammad Hassaan. "Cervical Vestibular-Evoked Myogenic Potentials in Sedated Toddlers." International Archives of Otorhinolaryngology 22, no. 03 (March 21, 2017): 197–202. http://dx.doi.org/10.1055/s-0037-1599151.
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Introduction Cervical vestibular-evoked myogenic potentials (cVEMPs) are difficult to test in toddlers who cannot follow instructions or stay calm. Objective Due to the growing need for vestibular testing in very young children as a part of a delayed walking assessment battery, this study aimed to provide a solution to this problem by recording the cVEMPs in toddlers during sedation. Method The cVEMPs measures were assessed in 30 toddlers aged 12 to 36 months with normal motor milestones. They were sedated with chloral hydrate. Then, the head was retracted ∼ 30° backward with a pillow under the shoulders, and turned 45° contralateral to the side of stimulation to put the sternocleidomastoid (SCM) muscle in a state of tension. Results The P13 and N23 waves of the cVEMPs were recordable in all sedated toddlers. The cVEMPs measures resulted in the following: P13 latency of 17.5 ± 1.41 milliseconds, N23 latency of 25.58 ± 2.02 milliseconds, and peak-to-peak amplitude of 15.39 ± 3.45 µV. One-sample t-test revealed statistically significant longer latencies and smaller amplitude of the toddlers' cVEMPs relative to the normative data for adults. Conclusions The difficulty of cVEMPs testing in toddlers can be overcome by sedating them and attaining a position that contracts the SCM muscle. However, the toddlers' recordings revealed delayed latencies and smaller amplitudes than those of adults.
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Emami, Seyede Faranak, Akram Pourbakht, Kianoush Sheykholeslami, Mohammad Kamali, Fatholah Behnoud, and Ahmad Daneshi. "Vestibular Hearing and Speech Processing." ISRN Otolaryngology 2012 (February 14, 2012): 1–7. http://dx.doi.org/10.5402/2012/850629.
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Vestibular hearing in human is evoked as a result of the auditory sensitivity of the saccule to low-frequency high-intensity tone. The objective was to investigate the relationship between vestibular hearing using cervical vestibular-evoked myogenic potentials (cVEMPs) and speech processing via word recognition scores in white noise (WRSs in wn). Intervention comprised of audiologic examinations, cVEMPs, and WRS in wn. All healthy subjects had detectable cVEMPs (safe vestibular hearing). WRSs in wn were obtained for them (66.9 ± 9.3% in the right ears and 67.5 ± 11.8% in the left ears). Dizzy patients in the affected ears, had the cVEMPs abnormalities (insecure vestibular hearing) and decreased the WRS in wn (51.4 ± 3.8% in the right ears and 52.2 ± 3.5% in the left ears). The comparison of the cVEMPs between the subjects revealed significant differences (P < 0.05). Therefore, the vestibular hearing can improve the speech processing in the competing noisy conditions.
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Emami, Seyede Faranak, and Ahmad Daneshi. "Vestibular Hearing and Neural Synchronization." ISRN Otolaryngology 2012 (March 15, 2012): 1–5. http://dx.doi.org/10.5402/2012/246065.
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Objectives. Vestibular hearing as an auditory sensitivity of the saccule in the human ear is revealed by cervical vestibular evoked myogenic potentials (cVEMPs). The range of the vestibular hearing lies in the low frequency. Also, the amplitude of an auditory brainstem response component depends on the amount of synchronized neural activity, and the auditory nerve fibers' responses have the best synchronization with the low frequency. Thus, the aim of this study was to investigate correlation between vestibular hearing using cVEMPs and neural synchronization via slow wave Auditory Brainstem Responses (sABR). Study Design. This case-control survey was consisted of twenty-two dizzy patients, compared to twenty healthy controls. Methods. Intervention comprised of Pure Tone Audiometry (PTA), Impedance acoustic metry (IA), Videonystagmography (VNG), fast wave ABR (fABR), sABR, and cVEMPs. Results. The affected ears of the dizzy patients had the abnormal findings of cVEMPs (insecure vestibular hearing) and the abnormal findings of sABR (decreased neural synchronization). Comparison of the cVEMPs at affected ears versus unaffected ears and the normal persons revealed significant differences (P<0.05). Conclusion. Safe vestibular hearing was effective in the improvement of the neural synchronization.
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Rosengren, Sally M., James G. Colebatch, Adeniyi Borire, Dominik Straumann, and Konrad P. Weber. "cVEMP morphology changes with recording electrode position, but single motor unit activity remains constant." Journal of Applied Physiology 120, no. 8 (April 15, 2016): 833–42. http://dx.doi.org/10.1152/japplphysiol.00917.2015.
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Cervical vestibular evoked myogenic potentials (cVEMPs) recorded over the lower quarter of the sternocleidomastoid (SCM) muscle in normal subjects may have opposite polarity to those recorded over the midpoint. It has thus been suggested that vestibular projections to the lower part of SCM might be excitatory rather than inhibitory. We tested the hypothesis that the SCM muscle receives both inhibitory and excitatory vestibular inputs. We recorded cVEMPs in 10 normal subjects with surface electrodes placed at multiple sites along the anterior (sternal) component of the SCM muscle. We compared several reference sites: sternum, ipsilateral and contralateral earlobes, and contralateral wrist. In five subjects, single motor unit responses were recorded at the upper, middle, and lower parts of the SCM muscle using concentric needle electrodes. The surface cVEMP had the typical positive-negative polarity at the midpoint of the SCM muscle. In all subjects, as the recording electrode was moved toward each insertion point, p13 amplitude became smaller and p13 latency increased, then the polarity inverted to a negative-positive waveform (n1-p1). Changing the reference site did not affect reflex polarity. There was a significant short-latency change in activity in 61/63 single motor units, and in each case this was a decrease or gap in firing, indicating an inhibitory reflex. Single motor unit recordings showed that the reflex was inhibitory along the entire SCM muscle. The cVEMP surface waveform inversion near the mastoid and sternal insertion points likely reflects volume conduction of the potential occurring with increasing distance from the motor point.
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Oron, Yahav, Ophir Handzel, Zohar Habot-Wilner, Keren Regev, Arnon Karni, Dina Zur, Dana Baraquet, Michaella Goldstein, Ori Elkayam, and Omer J. Ungar. "Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials." Journal of Vestibular Research 30, no. 6 (December 16, 2020): 393–99. http://dx.doi.org/10.3233/ves-200007.
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BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients’ vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.
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Emami, Seyede Faranak. "Hypersensitivity of Vestibular System to Sound and Pseudoconductive Hearing Loss in Deaf Patients." ISRN Otolaryngology 2014 (March 3, 2014): 1–5. http://dx.doi.org/10.1155/2014/817123.
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The objective of this cross-sectional study is to compare bone-conducted low-frequency hearing thresholds (BClf) to cervical vestibular evoked myogenic potentials (cVEMPs) findings in prelingual adult deaf patients. The fifty participants (100 ears) included twenty healthy controls and thirty other subjects selected from patients who presented with bilateral prelingual deafness to Department of Audiology of Hamadan University of Medical Sciences and Health Services (Hamadan, Iran). Assessments comprised of audiological evaluations, cVEMPs, and computerized tomography scans. Twenty deaf patients (forty affected ears) with bilateral decreased vestibular excitability as detected by abnormal cVEMPs revealed that BClf hearing thresholds were completely absent. Ten deaf patients (twenty unaffected ears) with normal cVEMPs reported a sensation of the sound at BClf hearing thresholds (the mean for 250 Hz=41 dBHL and for 500 Hz=57.75 dBHL). Multiple comparisons of mean p 13 latencies, mean n23 latencies and peak-to-peak amplitudes between three groups were significant (P = 0.01 for all, one-way ANOVA test). Multiple Comparisons of mean BClf between three groups were significant (P = 0.00, One-way ANOVA test). Conclusion. Hypersensitivity of vestibular system to sound augments BClf hearing thresholds in deaf patients. The sensation of the sound at low frequencies may be present in patients with total deafness and normal vestibular function (predominantly saccule). This improvement disappears when saccular function is lost.
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McNerney, Kathleen, Mary Lou Coad, and Robert Burkard. "The Influence of Caffeine on Calorics and Cervical Vestibular Evoked Myogenic Potentials (cVEMPs)." Journal of the American Academy of Audiology 25, no. 03 (March 2014): 261–67. http://dx.doi.org/10.3766/jaaa.25.3.5.
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Background: Prior to undergoing vestibular function testing, it is not uncommon for clinicians to request that patients abstain from caffeine 24 hr prior to the administration of the tests. However, there is little evidence that caffeine affects vestibular function. Purpose: To evaluate whether the results from two tests commonly used in a clinical setting to assess vestibular function (i.e., calorics and the cervical vestibular evoked myogenic potential [cVEMP]) are affected by caffeine. Research Design: Subjects were tested with and without consuming a moderate amount of caffeine prior to undergoing calorics and cVEMPs. Study Sample: Thirty young healthy controls (mean = 23.28 yr; females = 21). Subjects were excluded if they reported any history of vestibular/balance impairment. Data Collection and Analysis: The Variotherm Plus Caloric Irrigator was used to administer the water, while the I-Portal VNG software was used to collect and analyze subjects’ eye movements. The TECA Evoked Potential System was used for the cVEMP stimulus presentation as well as for the data collection. During cVEMP collection, subjects were asked to monitor their sternocleidomastoid muscle contraction with a Delsys EMG monitor. IBM SPSS Statistics 20 was used to statistically analyze the results via paired t-tests. Results: Analysis of the data revealed that ingestion of caffeine did not significantly influence the results of either test of vestibular function. Conclusions: The results revealed that a moderate amount of caffeine does not have a clinically significant effect on the results from caloric and cVEMP tests in young healthy adults. Future research is necessary to determine whether similar results would be obtained from individuals with a vestibular impairment, as well as older adults.
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Dlugaiczyk, Julia, Maximilian Habs, and Marianne Dieterich. "Vestibular evoked myogenic potentials in vestibular migraine and Menière’s disease: cVEMPs make the difference." Journal of Neurology 267, S1 (June 3, 2020): 169–80. http://dx.doi.org/10.1007/s00415-020-09902-4.
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Abstract Objective Vestibular evoked myogenic potentials (VEMPs) have been suggested as biomarkers in the differential diagnosis of Menière’s disease (MD) and vestibular migraine (VM). The aim of this study was to compare the degree of asymmetry for ocular (o) and cervical (c) VEMPs in large cohorts of patients with MD and VM and to follow up the responses. Study design Retrospective study in an interdisciplinary tertiary center for vertigo and balance disorders. Methods cVEMPs to air-conducted sound and oVEMPs to bone-conducted vibration were recorded in 100 patients with VM and unilateral MD, respectively. Outcome parameters were asymmetry ratios (ARs) of oVEMP n10p15 and cVEMP p13n23 amplitudes, and of the respective latencies (mean ± SD). Results The AR of cVEMP p13n23 amplitudes was significantly higher for MD (0.43 ± 0.34) than for VM (0.26 ± 0.24; adjusted p = 0.0002). MD—but not VM—patients displayed a higher AR for cVEMP than for oVEMP amplitudes (MD 0.43 ± 0.34 versus 0.23 ± 0.22, p < 0.0001; VM 0.26 ± 0.14 versus 0.19 ± 0.15, p = 0.11). Monitoring of VEMPs in single patients indicated stable or fluctuating amplitude ARs in VM, while ARs in MD appeared to increase or remain stable over time. No differences were observed for latency ARs between MD and VM. Conclusions These results are in line with (1) a more common saccular than utricular dysfunction in MD and (2) a more permanent loss of otolith function in MD versus VM. The different patterns of o- and cVEMP responses, in particular their longitudinal assessment, might add to the differential diagnosis between MD and VM.
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Fowler, Cynthia G., Amanda Sweet, and Emily Steffel. "Effects of Motion Sickness Severity on the Vestibular-Evoked Myogenic Potentials." Journal of the American Academy of Audiology 25, no. 09 (October 2014): 814–22. http://dx.doi.org/10.3766/jaaa.25.9.4.
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Background: Motion sickness is a common debilitating condition associated with both actual and perceived motion. Despite the commonality, little is known about the underlying physiological mechanisms. One theory proposes that motion sickness arises from a mismatch between reality and past experience in vertical motions. Physiological tests of the vestibular system, however, have been inconclusive regarding the underlying pathogenesis. Cervical vestibular-evoked myogenic potentials (cVEMPs) arise from the saccule, which responds to vertical motion. If vertical motion elicits motion sickness, the cVEMP should be affected. Purpose: The purpose of this investigation was to determine if cVEMP characteristics differ among individuals with a range of motion sickness susceptibility from negligible to severe. The hypothesis was that individuals with high susceptibility would have larger cVEMP amplitudes and shorter cVEMP latencies relative to those who are resistant to motion sickness. Research Design: The study had two parts. The first was quasi-experimental in which participants comprised three groups based on susceptibility to motion sickness (low, mild-moderate, high) as identified on the short version of the Motion Sickness Susceptibility Questionnaire (MSSQ-S). The second part of the study was correlational and evaluated the specific relationships between the degree of motion sickness susceptibility and characteristics of the VEMPs. Study Sample: A total of 24 healthy young adults (ages 20–24 yr) were recruited from the university and the community without regard to motion sickness severity. Data Collection and Analysis: Participants took the MSSQ-S, which quantifies susceptibility to motion sickness. The participants had a range of motion sickness susceptibility with MSSQ raw scores from 0.0–36.6, which correspond to percent susceptibility from 0.0–99.3%. VEMPs were elicited by 500 Hz tone-bursts monaurally in both ears at 120 dB pSPL. MSSQ-S percent scores were used to divide the participants into low, mild-moderate, and high susceptibility groups. A fixed general linear model with repeated-measures analysis of variance tested cVEMP characteristics for the susceptibility groups (between participants) and ears (within participants). A univariate analysis of variance tested the cVEMP interaural amplitudes across groups. The second analysis was a regression of the severity of motion sickness in percent on cVEMP characteristics. Significance was defined as p < 0.05. Results: Participants in the high susceptibility group had significantly higher cVEMP amplitudes than those in the low susceptibility group. cVEMP amplitudes did not differ between ears, and latencies did not differ between the two groups or between ears. Regression analysis on MSSQ-S percent susceptibility by VEMP amplitudes revealed a best-fit cubic function in both ears, with r2 values of more than 42%. The interaural asymmetry ratio was negatively associated with motion sickness susceptibility (r2 = 0.389). Conclusions: The current study is the first to report that greater susceptibility to motion sickness is associated with larger cVEMP amplitudes and lower interaural cVEMP asymmetries. Larger interaural asymmetries in cVEMPs did not promote motion sickness susceptibility. The cVEMP findings implicate the saccule and its neural pathways in the production of motion sickness and are consistent with the theory that vertical motions elicit motion sickness. Motion sickness susceptibility may contribute to the variability in normative cVEMP amplitudes.
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Meyer, Nathalie, Bart Vinck, and Barbara Heinze. "cVEMPs: A systematic review and meta-analysis." International Journal of Audiology 54, no. 3 (December 9, 2014): 143–51. http://dx.doi.org/10.3109/14992027.2014.971468.
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Eppsteiner, Robert Walter, Daniel J. Lee, Rachel E. Roditi, and Todd B. Sauter. "cVEMP Testing in Patients with a Third Mobile Window." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P54. http://dx.doi.org/10.1016/j.otohns.2008.05.174.
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Objective To determine the usefulness of cervical vestibular-evoked auditory potential (cVEMP) testing for the evaluation of patients with and without a third mobile window (superior canal dehiscence or large vestibular aqueduct). Methods A retrospective review of charts from patients who underwent cVEMP testing at a single tertiary referral center was performed. The cVEMP is a vestibular reflex generated by an air-conducted stimuli, causing an inhibitory potential in the ipsilateral sternocleidomastoid muscle measured by external electrodes. cVEMP results were correlated with demographic characteristics, hearing testing, diagnosis, and imaging. Mean cVEMP thresholds (at 500 Hz) and amplitudes (@ 95dB nHL and 500 Hz) were compared between ears and between patients with and without a third mobile window (TMW). Unequal variance t-Test was used to determine significance. Patients were excluded if they had a history of Meniere's disease, middle ear disease or otologic surgery. Results 63 patients received cVEMP testing, of which 8 had either unilateral or bilateral TMW. 114 non-TMW ears were compared to 10 ears with TMW. Ears with TMW had a lower mean threshold (68 dB nHL) vs. non-TMW (83 dB nHL) (p<0.003) and a higher mean amplitude (321?V) vs. non-TMW (78?V)(p<0.009). Conclusions Patients with TMW have lower thresholds and higher amplitudes on cVEMP testing. This study supports the use of cVEMPs to diagnose TMW in patients who present with an unexplained air-bone gap, autophony, aural fullness, or dizziness.
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Noij, Kimberley S., Barbara S. Herrmann, Steven D. Rauch, and John J. Guinan Jr. "Toward Optimizing Vestibular Evoked Myogenic Potentials: Normalization Reduces the Need for Strong Neck Muscle Contraction." Audiology and Neurotology 22, no. 4-5 (2017): 282–91. http://dx.doi.org/10.1159/000485022.
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Background: The cervical vestibular evoked myogenic potential (cVEMP) represents an inhibitory reflex of the saccule measured in the ipsilateral sternocleidomastoid muscle (SCM) in response to acoustic or vibrational stimulation. Since the cVEMP is a modulation of SCM electromyographic (EMG) activity, cVEMP amplitude is proportional to muscle EMG amplitude. We sought to evaluate muscle contraction influences on cVEMP peak-to-peak amplitudes (VEMPpp), normalized cVEMP amplitudes (VEMPn), and inhibition depth (VEMPid). Methods: cVEMPs at 500 Hz were measured in 25 healthy subjects for 3 SCM EMG contraction ranges: 45-65, 65-105, and 105-500 μV root mean square (r.m.s.). For each range, we measured cVEMP sound level functions (93-123 dB peSPL) and sound off, meaning that muscle contraction was measured without acoustic stimulation. The effect of muscle contraction amplitude on VEMPpp, VEMPn, and VEMPid and the ability to distinguish cVEMP presence/absence were evaluated. Results: VEMPpp amplitudes were significantly greater at higher muscle contractions. In contrast, VEMPn and VEMPid showed no significant effect of muscle contraction. Cohen's d indicated that for all 3 cVEMP metrics contraction amplitude variations produced little change in the ability to distinguish cVEMP presence/absence. VEMPid more clearly indicated saccular output because when no acoustic stimulus was presented the saccular inhibition estimated by VEMPid was zero, unlike those by VEMPpp and VEMPn. Conclusion: Muscle contraction amplitude strongly affects VEMPpp amplitude, but contractions 45-300 μV r.m.s. produce stable VEMPn and VEMPid values. Clinically, there may be no need for subjects to exert high contraction effort. This is especially beneficial in patients for whom maintaining high SCM contraction amplitudes is challenging.
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Emami, Seyede Faranak, and Nasrin Gohari. "The Vestibular-Auditory Interaction for Auditory Brainstem Response to Low Frequencies." ISRN Otolaryngology 2014 (March 31, 2014): 1–5. http://dx.doi.org/10.1155/2014/103598.
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Since saccular projection is sound sensitive, the objective is to investigate the possibility that the saccular projections may contribute to auditory brainstem response to 500 HZ tone burst (ABR500 HZ). During the case-control research, twenty healthy controls compared to forty selected case groups as having chronic and resistant BPPV were evaluated in the audiology department of Hamadan University of Medical Sciences (Hamadan, Iran). Assessment is comprised of audiologic examinations, cervical vestibular evoked myogenic potentials (cVEMPs), and ABR500 HZ. We found that forty affected ears of BPPV patients with decreased vestibular excitability as detected by abnormal cVEMPs had abnormal results in ABR500 HZ, whereas unaffected ears presented normal findings. Multiple comparisons of mean p13, n23 latencies, and peak-to-peak amplitudes between three groups (affected, unaffected, and healthy ears) were significant. In conclusion, the saccular nerves can be projective to auditory bundles and interact with auditory brainstem response to low frequencies. Combine the cVEMPs and ABR500 HZ in battery approach tests of vestibular assessment and produce valuable data for judgment on the site of lesion. Regarding vestibular cooperation for making of wave V, it is reasonable that the term of ABR500 HZ is not adequate and the new term or vestibular-auditory brainstem response to 500 HZ tone burst is more suitable.
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Emami, Seyede Faranak. "Is All Human Hearing Cochlear?" Scientific World Journal 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/147160.
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The objective of this cross-sectional study was to investigatethe possibility that the saccule may contribute to human hearing. The forty participants included twenty healthy people and twenty other subjects selected from patients who presented with benign paroxysmal positional vertigo to Audiology Department of Hazrat Rasoul Akram hospital (Tehran, Iran). Assessments comprised of audiological evaluations, cervical vestibular evoked myogenic potentials (cVEMPs), recognition of spoken phonemes in white noise (Rsp in wn), and auditory brainstem response to 500 Hz tone burst (ABR500 HZ). Twenty affected ears with decreased vestibular excitability as detected by abnormal cVEMPs revealed decreased scores of Rsp in wn and abnormal findings ofABR500 HZ. Both unaffected and normal ears had normal results. Multiple comparisons of mean values of cVEMPs andABR500 HZbetween three groups were significant (P<0.05, ANOVA). The correlation between RSP in wn and p13 latencies was significant. The peak-to-peak amplitudes showed significant correlation to RSP in wn. The correlation between RSP in wn and the latencies of n23 was significant. In high-level of noisy competing situations, healthy human saccular sensation can mediate the detection of low frequencies and possibly help in cochlear hearing for frequency and intensity discrimination. So, all human hearing is not cochlear.
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Emami, Seyede Faranak, Akram Pourbakht, Ahmad Daneshi, Kianoush Sheykholeslami, Hessamedin Emamjome, and Mohammad Kamali. "Sound Sensitivity of the Saccule for Low Frequencies in Healthy Adults." ISRN Otolaryngology 2013 (October 24, 2013): 1–6. http://dx.doi.org/10.1155/2013/429680.
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Approximately 80 years ago John Tait speculated about a possible auditory role for the otolith organs in humans those days, there was no direct evidence for that idea. This time is for us to review and research. Then, the objective of our study was to investigate saccular hearing in healthy adults. We selected twenty healthy controls and twenty-four dizzy cases. Assessment comprised of audiologic evaluations, cervical vestibular evoked myogenic potentials (cVEMPs), and recognition of spoken phonemes in white noise (Rsp in wn). In the case group (a total of 48 ears), the cVEMPs abnormalities were all unilateral (24 affected ears and 24 contralateral unaffected ears). Affected ears with decreased vestibular excitability as detected by abnormal cVEMPs had decreased Rsp in wn (mean=60.78±8.33), whereas both unaffected (mean=96.24±2.4) and control ears (mean=96.24±2.4) presented normal results. The correlation between RSP in wn and p13 latencies was significant (P<0.05, r=-0.551). The peak-to-peak amplitudes showed significant correlation to RSP in wn (P<0.05, r=0.307). The correlation between RSP in wn and the latencies of n23 was significant (P<0.05, r=-0.493). We concluded in presence of severe competing noise, saccule has a facilitating role for cochlea and can improve to detection of loud low-frequencies.
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Ozeki, Hidenori, Shinichi Iwasaki, Munetaka Ushio, Naonobu Takeuchi, and Toshihisa Murofushi. "The lesion site of vestibular dysfunction in Ramsay Hunt syndrome: A study by click and galvanic VEMP." Journal of Vestibular Research 16, no. 4-5 (February 1, 2007): 217–22. http://dx.doi.org/10.3233/ves-2006-164-508.
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Ramsay Hunt syndrome (RHS) is characterized by vestibulocochlear dysfunction in addition to facial paralysis and auricular vesicles. The present study investigated the lesion site of vestibular dysfunction in a group of 10 RHS patients. Caloric testing, vestibular evoked myogenic potentials by click sound (cVEMP) and by galvanic stimulation (gVEMP) were used to assess the function of the lateral semicircular canal, saccule, and their afferents. The results of caloric testing (all 10 cases showed canal paresis) mean the existence of lesion sites in lateral semicircular canal and/or superior vestibular nerve (SVN). Abnormal cVEMPs in 7 patients mean the existence of lesions in saccule and/or inferior vestibular nerve (IVN). Four of the 6 patients with absent cVEMP also underwent gVEMP. The results of gVEMP (2 absent and 2 normal) mean that the former 2 have lesions of the vestibular nerve, and the latter 2 have only saccular lesions concerning the pathway of VEMPs. Thus, our study suggested that lesion sites of vestibular symptoms in RHS could be in the vestibular nerve and/or labyrinth, and in SVN and/or IVN. In other words, in the light of vestibular symptoms, there is the diversity of lesion sites.
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McCaslin, Devin L., Andrea Fowler, and Gary P. Jacobson. "Amplitude Normalization Reduces Cervical Vestibular Evoked Myogenic Potential (cVEMP) Amplitude Asymmetries in Normal Subjects: Proof of Concept." Journal of the American Academy of Audiology 25, no. 03 (March 2014): 268–77. http://dx.doi.org/10.3766/jaaa.25.3.6.
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Background: The cervical vestibular evoked myogenic potential (cVEMP) is an acoustically synchronized, signal averaged, brief inhibitory response of a contracted muscle usually resulting from an acoustic stimulus. The cVEMP is recorded from the tonically contracted sternocleidomastoid muscle (SCM). The presence and amplitude of the cVEMP is related to both the integrity of the sacculo-collic pathway and magnitude of electromyographic (EMG) activity at the time of recording. Measurement variables include the absolute latency of the primary positive going component (referred to as P13) and interaural (i.e., left versus right) latency differences. Also measured is the peak-to-peak interaural amplitude asymmetry (IAA; percent difference in amplitude, left versus right). It is known that the amplitude of the cVEMP is positively correlated with the magnitude of tonic EMG from which the evoked potential is extracted. Thus, if EMG amplitude is uncontrolled, one cannot determine whether cVEMP asymmetries are occurring due to unilateral end organ disease or asymmetric tonic EMG activity. Two methods have been suggested to control for tonic EMG activity. These include (1) patient self-monitoring of EMG activity with biofeedback and (2) mathematical correction (i.e., amplitude normalization) of the left and right cVEMP waveforms. Currently, it is unknown how effective amplitude normalization techniques are at reducing cVEMP amplitude asymmetry in the presence of varying levels of EMG. Purpose: The purpose of this investigation was to determine whether the use of amplitude correction techniques would reduce significantly the P13-N23 IAA data in otologically and neurologically intact adults when the level of EMG was varied between right and left sides. Research Design: A prospective, repeated measures design was used for three different investigations in which cVEMPs were recorded and then processed using amplitude correction. Study Sample: Subjects were 20 otologically and neurologically health young adults between 21 and 29 yr of age. Intervention: cVEMPs were recorded at four different EMG target levels ranging from 100 to 400 μV. The absolute peak-to-peak amplitude of P13-N23, absolute latency of P13, and the left/right amplitude asymmetry of P13-N23 were measured both with and without the use of EMG amplitude correction techniques. IAAs were calculated using 10 different conditions of varying EMG asymmetry with and without amplitude correction. Data Collection and Analysis: Data were analyzed using repeated measures analysis of variance (ANOVA) to detect tonic EMG level-dependent differences separately for P13 latency, P13-N23 peak-to-peak amplitude, and mean root mean square (RMS) amplitude cVEMP responses. The amplitude of cVEMP responses from the left and right side were used to calculate IAA for subsequent analyses. Linear regression analyses compared level of tonic EMG with cVEMP amplitude. A one-way multivariate analysis of variance (MANOVA) was used to determine if IAAs were significantly reduced following amplitude correction. Any differences found were investigated using unplanned linear contrasts. Results: The uncorrected cVEMP amplitude and RMS EMG all increased significantly with increases in the EMG target levels. With amplitude correction, cVEMP amplitude did not change significantly with changes in RMS EMG or EMG target levels. Conclusions: These findings suggest that the use of amplitude correction techniques represent an effective method of neutralizing the factor of variability in tonic EMG level on the cVEMP that would be otherwise uncontrolled. Indeed when correction is employed in cases of extreme tonic EMG asymmetry, the upper limit of percent IAA is roughly half of that when EMG correction techniques are not used. Our findings are also in agreement with those of Bogle et al (2013) showing that the input/output growth function for P13/N23 amplitude is not linear but, in fact, saturates at supra-maximal stimulation levels. Accordingly, and contrary to what has been published previously, achieving maximum muscle activation may produce a paradoxically inferior signal-to-noise ratio and in some cases result in an artificially small (or undetectable) corrected cVEMP amplitude. cVEMP amplitude either asymptotes (if maximum EMG amplitude saturation occurs at the same stimulus intensity as yields the maximum cVEMP amplitude), or the cVEMP can become smaller if EMG amplitude can increase further beyond the stimulus intensity that yields that largest P1-N1 amplitude. In the latter case the noise increases further to reach maximum and creates a disadvantageous signal (cVEMP) to noise (tonic EMG) ratio.
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Niesten, Marlien E. F., Michael J. McKenna, Barbara S. Herrmann, Wilko Grolman, and Daniel J. Lee. "Utility of cVEMPs in bilateral superior canal dehiscence syndrome." Laryngoscope 123, no. 1 (September 18, 2012): 226–32. http://dx.doi.org/10.1002/lary.23550.
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Jurado, Carlos, and Torsten Marquardt. "On the Effectiveness of airborne infrasound in eliciting vestibular-evoked myogenic responses." Journal of Low Frequency Noise, Vibration and Active Control 39, no. 1 (March 25, 2019): 3–16. http://dx.doi.org/10.1177/1461348419833868.
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The use of airborne infrasound and other stimuli to elicit (cervical) vestibular-evoked myogenic potentials (cVEMPs) was studied to address the common proposition that infrasound may efficiently stimulate the vestibular system, an effect which may underlie the so-called wind-turbine syndrome. cVEMPs were measured for both ears of 15 normal-hearing subjects using three types of airborne sound stimulation: (1) 500-Hz tone bursts (transient); (2) 500-Hz sinusoidally amplitude-modulated tones at a 40-Hz rate (SAM); and (3) low-frequency and infrasound pure tones (LF/IS). The two former stimulation types served as control and allowed a systematic comparison with (3). It was found that SAM stimulation is effective and appears to be comparable to transient stimulation, as was previously observed in a yet small number of studies. Although the vestibular system is reported to be highly sensitive to low-frequency mechanical vibration, airborne LF/IS stimulation at ∼80–90-phon loudness levels did not elicit significant saccular vestibular responses.
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Johnson, Sarah-Anne, Greg A. O’Beirne, Emily Lin, John Gourley, and Jeremy Hornibrook. "oVEMPs and cVEMPs in patients with ‘clinically certain’ Menière’s disease." Acta Oto-Laryngologica 136, no. 10 (April 28, 2016): 1029–34. http://dx.doi.org/10.1080/00016489.2016.1175663.
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Jacobson, Gary P., Devin L. McCaslin, Erin G. Piker, Jill Gruenwald, Sarah L. Grantham, and Lauren Tegel. "Patterns of Abnormality in cVEMP, oVEMP, and Caloric Tests May Provide Topological Information about Vestibular Impairment." Journal of the American Academy of Audiology 22, no. 09 (October 2011): 601–11. http://dx.doi.org/10.3766/jaaa.22.9.5.
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Background: The cervical vestibular evoked myogenic potential (cVEMP) is recorded from the sternocleidomastoid muscle (SCM) and represents a stimulus-evoked attenuation of electromyographic (EMG) activity following activation of the saccule and inferior vestibular nerve. In addition to the cVEMP, it is possible to record a biphasic response from the infraorbital region following stimulation that is identical to that used to record the cVEMP. This response is known as the ocular VEMP (oVEMP). The peripheral vestibular origins of the oVEMP elicited with air conduction remain controversial as some investigators argue the response originates from the saccule and others argue that the response emanates from the utricle. We review several lines of evidence and present several case studies supporting the contention that the oVEMP to air conduction stimulation derives its peripheral origins predominately from the utricle and superior vestibular nerve. Purpose: To review the current evidence regarding the peripheral origins of the oVEMP. Further, a purpose of this report is to present case studies illustrating that the cVEMP and oVEMP to air conduction stimulation may vary independently of one another in patients with peripheral vestibular system impairments. Research Design: A collection of case studies illustrating three common patterns of abnormality observed in patients complaining of vertigo seen in a tertiary care referral center. Study Sample: Retrospective analysis of data from three patients complaining of dizziness and/or vertigo who have undergone vestibular function tests. Results: Each case report illustrates a different pattern of abnormality of caloric, cVEMP, and oVEMP tests results from three patients with a vestibular nerve section, superior vestibular neuritis, and Ménière's disease, respectively. Conclusions: We have shown that the cVEMP and oVEMP can vary independent of one another, and in that way, provide topological information about the sites of impairment. We feel that, with caloric, oVEMP, and cVEMP tests, it is possible to augment the diagnostic information we are able to provide regarding the location, or locations, of vestibular system impairment. These findings suggest that air conduction oVEMPs measure a part of the peripheral vestibular system different from that measured by cVEMPs, perhaps the utricle, and similar to that measured by caloric testing, the superior portion of the vestibular nerve.
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Miśkiewicz-Orczyk, Katarzyna, Atanas Vlaykov, Grażyna Lisowska, Janusz Strzelczyk, and Beata Kos-Kudła. "Does Thyroid Hormone Metabolism Correlate with the Objective Assessment of the Vestibular Organ in Patients with Vertigo?" Journal of Clinical Medicine 11, no. 22 (November 16, 2022): 6771. http://dx.doi.org/10.3390/jcm11226771.
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The aim of this study was to assess the relationship between the results of the objective assessment of the vestibular organ in patients with peripheral vertigo with Hashimoto’s thyroiditis and thyroid hormone metabolism. Twenty eight women with Hashimoto’s thyroiditis and chronic vertigo were enrolled in the study. Patients underwent audiological assessment of hearing, Dix–Hallpike test, videonystagmography with caloric test, head impulse test (HIT) and cervical vestibular-evoked myogenic potentials (cVEMPs). Levels of thyroid hormones and anti-thyroid antibodies were determined. Relationships between age, weight, height, BMI and the results of the objective assessment of the vestibular organ were calculated. The mean age in the study group was 48 years, while the mean BMI was 26.425. The causes of peripheral vertigo in the study group were benign paroxysmal positional vertigo (BPPV) (n = 19), Meniere’s disease (n = 7) and vestibular neuronitis (n = 2). No correlation was found between age, weight, height, BMI and the results of thyroid function tests or the objective assessment of the vestibular organ. The study did not confirm the influence of thyroid metabolism (i.e., thyroid hormone levels or the increase in antithyroid antibodies) on the results of cVEMP or the directional preponderance in the caloric test.
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McNerney, Kathleen M., Kathiravan Kaliyappan, David S. Wack, and Vijaya Prakash Krishnan Muthaiah. "The Influence of Motoric Maneuvers on Cervical Vestibular Evoked Myogenic Potentials (cVEMPs)." Journal of the American Academy of Audiology 33, no. 03 (March 2022): 134–41. http://dx.doi.org/10.1055/s-0041-1739535.
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Abstract Background The cervical vestibular evoked myogenic potential (cVEMP) is a vestibular response that is produced by the saccule in response to intense, often low-frequency, short-duration auditory stimuli, and is typically recorded from a contracted sternocleidomastoid (SCM) muscle. Previous research has shown that the amplitude of the cVEMP is related to the amount of SCM electromyographic (EMG) activity. Purpose The aim of this study was to determine the influence of various remote motoric maneuvers on the amplitude of the cVEMP, as well as whether they influence the level of SCM EMG activity. Research Design The cVEMP was recorded from the left SCM muscle to left ear stimulation, in response to the SCM condition, as well as three different motoric maneuvers (jaw clench, eye closure, and the Jendrassik maneuver). EMG activity was also varied between 50, 75, and 100% of maximal EMG activity. Study Sample Data from 14 healthy subjects, with a mean age of 25.57 years (standard deviation = 5.93 years), was included in the present study. Data Collection and Analysis Mean latency and amplitude of the cVEMP were compared across the four conditions and varying magnitudes of EMG contraction. SPSS 26 was used to statistically analyze the results. Results cVEMP latency did not vary across condition. cVEMP amplitude decreased with decreasing EMG magnitude. SCM contraction with jaw clench produced the largest increase in cVEMP amplitude; however, this condition was not significantly different from the SCM condition alone. SCM contraction with the Jendrassik maneuver produced a cVEMP amplitude that was similar and not statistically different from SCM contraction alone, and the addition of the eye closure maneuver to SCM contraction resulted in the lowest cVEMP amplitude, which was found to be statistically different from the standard SCM condition at 100 and 75% EMG activity. The amplitude relationship across the conditions was not found to vary with changes in EMG activity; however, a significant increase in EMG amplitude was found during the 50% muscle contraction condition when subjects performed the Jendrassik maneuver in addition to the standard SCM contraction. Conclusions The addition of the eye closure maneuver to SCM contraction resulted in a significant decrease in cVEMP amplitude, while the addition of the Jendrassik maneuver resulted in a significant increase in EMG activity at the lowest level of SCM activation (i.e., 50%). Additional research is necessary to determine how motoric maneuvers influence the cVEMP amplitude, and whether the results are also dependent on how SCM contraction is being produced (e.g., while supine vs. sitting).
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Luecke, Vivien Nancy, Laura Buchwieser, Peter zu Eulenburg, Torsten Marquardt, and Markus Drexl. "Ocular and cervical vestibular evoked myogenic potentials elicited by air-conducted, low-frequency sound." Journal of Vestibular Research 30, no. 4 (October 17, 2020): 235–47. http://dx.doi.org/10.3233/ves-200712.
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BACKGROUND: Sound is not only detected by the cochlea, but also, at high intensities, by the vestibular system. Acoustic activation of the vestibular system can manifest itself in vestibular evoked myogenic potentials (VEMPs). In a clinical setting, VEMPs are usually evoked with rather high-frequency sound (500 Hz and higher), despite the fact that only a fraction of saccular and utricular hair cells in the striolar region is available for high-frequency stimulation. OBJECTIVE: As a growing proportion of the population complains about low-frequency environmental noise, including reports on vestibular symptoms, the activation of the vestibular system by low-frequency sound deserves better understanding. METHODS: We recorded growth functions of oVEMPs and cVEMPs evoked with air-conducted sound at 120 Hz and below. We estimated VEMP thresholds and tested whether phase changes of the stimulus carrier result in changes of VEMP amplitude and latency. RESULTS: The VEMP response of the otholith organs to low-frequency sound is uniform and not tuned when corrected for middle ear attenuation by A-weighting the stimulus level. Different stimulus carrier phases result in phase-correlated changes of cVEMP latencies and amplitudes. CONCLUSIONS: VEMPs can be evoked with rather low-frequency sound, but high thresholds suggest that they are unlikely to be triggered by environmental sounds.
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Ahmad, Siti Aisyah, Nor Haniza Abdul Wahat, Mohd Normani Zakaria, Sylvette R. Wiener-Vacher, and Nurul Ain Abdullah. "cVEMPs and oVEMPs normative data in Malaysian preschool and primary school-aged children." International Journal of Pediatric Otorhinolaryngology 135 (August 2020): 110132. http://dx.doi.org/10.1016/j.ijporl.2020.110132.
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Roberts, Lauren, and Anthony T. Cacace. "Jendrassik Maneuver Facilitates cVEMP Amplitude: Some Preliminary Observations." Journal of the American Academy of Audiology 25, no. 03 (March 2014): 237–43. http://dx.doi.org/10.3766/jaaa.25.3.2.
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Background: The cervical vestibular evoked myogenic potential (cVEMP) is an acoustically driven electrophysiological measure of saccular and inferior nerve function that requires tonic sternocleidomastoid muscle (SCM) activity in order to be elicited. The cVEMP is gaining increased interest in the clinical and research communities based on the anatomical specificity it adds to vestibular test batteries, because it is noninvasive, and since it can be performed with instrumentation commonly found in audiology clinics worldwide. Purpose: Because maintaining a constant level of tonic background electromyography (EMG) over the entire course of the recording epoch is a requirement for response elicitation, active participation for some individuals including the elderly and those with cervical problems can be difficult. As a way to facilitate the response for some clinical populations, this study addressed whether cVEMPs could be modulated by remote or local changes in EMG related neural activity by applying various maneuvers during the course of the recording epoch. Research Design: Keeping acoustic stimulation and recording parameters constant, three separate experimental conditions, Jendrassik maneuver, jaw (teeth) clenching, and forced-eye closure, were used to determine whether cVEMP amplitudes could be enhanced from the control condition. Study Sample: Nine adults (2 males; 7 females) ranging in age from 24 to 42 yr with normal pure-tone hearing sensitivity and a negative history of otological disease, neurological disease, and head trauma. Data Collection and Analysis: Cervical vestibular evoked myogenic potentials were recorded from the SCM using surface electrodes in response to suprathreshold 500 Hz Blackman windowed tone bursts under a control and three experimental conditions. Three separate one-way repeated measures analyses of variance (ANOVAs) were used to evaluate the effects of these maneuvers on P1/N1 peak-to-peak amplitudes and P1 and N1 peak latencies. Results: A significant main effect of experimental condition was shown to increase P1/N1 peak-to-peak cVEMP amplitude. Post hoc analysis found that Jendrassik maneuver versus control was the only the condition that produced significantly increased response amplitudes in comparison to all other post hoc contrasts. P1 and N1 peak latencies were unchanged across the various experimental conditions. Conclusions: In adults with normal hearing sensitivity and a negative history of otological disease, neurological disease, and head trauma, Jendrassik maneuver increased cVEMP amplitude by over 39% in comparison to the control condition. Such a simple modulation effect warrants further investigation for application in clinical studies.
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Shaikh, Aasef G., Sarah Marti, Alexander A. Tarnutzer, Antonella Palla, Thomas O. Crawford, Dominik Straumann, John P. Carey, Kimanh D. Nguyen, and David S. Zee. "Ataxia telangiectasia: a “disease model” to understand the cerebellar control of vestibular reflexes." Journal of Neurophysiology 105, no. 6 (June 2011): 3034–41. http://dx.doi.org/10.1152/jn.00721.2010.
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Experimental animal models have suggested that the modulation of the amplitude and direction of vestibular reflexes are important functions of the vestibulocerebellum and contribute to the control of gaze and balance. These critical vestibular functions have been infrequently quantified in human cerebellar disease. In 13 subjects with ataxia telangiectasia (A-T), a disease associated with profound cerebellar cortical degeneration, we found abnormalities of several key vestibular reflexes. The vestibuloocular reflex (VOR) was measured by eye movement responses to changes in head rotation. The vestibulocollic reflex (VCR) was assessed with cervical vestibular-evoked myogenic potentials (cVEMPs), in which auditory clicks led to electromyographic activity of the sternocleidomastoid muscle. The VOR gain (eye velocity/head velocity) was increased in all subjects with A-T. An increase of the VCR, paralleling that of the VOR, was indirectly suggested by an increase in cVEMP amplitude. In A-T subjects, alignment of the axis of eye rotation was not with that of head rotation. Subjects with A-T thus manifested VOR cross-coupling, abnormal eye movements directed along axes orthogonal to that of head rotation. Degeneration of the Purkinje neurons in the vestibulocerebellum probably underlie these deficits. This study offers insights into how the vestibulocerebellum functions in healthy humans. It may also be of value to the design of treatment trials as a surrogate biomarker of cerebellar function that does not require controlling for motivation or occult changes in motor strategy on the part of experimental subjects.
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Roditi, Rachel E., Robert W. Eppsteiner, Todd B. Sauter, and Daniel J. Lee. "Cervical vestibular evoked myogenic potentials (cVEMPs) in patients with superior canal dehiscence syndrome (SCDS)." Otolaryngology–Head and Neck Surgery 141, no. 1 (July 2009): 24–28. http://dx.doi.org/10.1016/j.otohns.2009.03.012.
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Murnane, Owen D., Faith W. Akin, J. Kip Kelly, and Stephanie Byrd. "Effects of Stimulus and Recording Parameters on the Air Conduction Ocular Vestibular Evoked Myogenic Potential." Journal of the American Academy of Audiology 22, no. 07 (July 2011): 469–80. http://dx.doi.org/10.3766/jaaa.22.7.7.
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Background: Vestibular evoked myogenic potentials (VEMPs) have been recorded from the sternocleidomastoid muscle (cervical VEMP or cVEMP) and more recently from the eye muscles (ocular VEMP or oVEMP) in response to air conduction and bone conduction stimuli. Both cVEMPs and oVEMPs are mediated by the otoliths and thereby provide diagnostic information that is complementary to videonystagmography and rotational chair tests. In contrast to the air conduction cVEMP, which originates from the saccule/inferior vestibular nerve, recent evidence suggests the possibility that the air conduction oVEMP may be mediated by the utricle/superior vestibular nerve. The oVEMP, therefore, may provide complementary diagnostic information relative to the cVEMP. There are relatively few studies, however, that have quantified the effects of stimulus and recording parameters on the air conduction oVEMP, and there is a paucity of normative data. Purpose: To evaluate the effects of several stimulus and recording parameters on the air conduction oVEMP and to establish normative data for clinical use. Research Design: A prospective repeated measures design was utilized. Study Sample: Forty-seven young adults with no history of neurologic disease, hearing loss, middle ear pathology, open or closed head injury, cervical injury, or audiovestibular disorder participated in the study. Data Collection and Analysis: The effects of stimulus frequency, stimulus level, gaze elevation, and recording electrode location on the amplitude and latency of the oVEMP for monaural air conduction stimuli were assessed using repeated measures analyses of variance in an initial group of 17 participants. The optimal stimulus and recording parameters obtained in the initial group were used subsequently to obtain oVEMPs from 30 additional participants. Results: The effects of stimulus frequency, stimulus level, gaze elevation, and electrode location on the response prevalence, amplitude, and latency of the oVEMP for monaural air conduction stimuli were significant. The maximum N1-P1 amplitude and response prevalence were obtained for contralateral oVEMPs using a 500 Hz tone burst presented at 125 dB peak SPL during upward gaze at an elevation of 30°. Conclusions: The optimal stimulus and recording parameters quantified in this study were used to establish normative data that may be useful for the clinical application of the air conduction oVEMP.
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Ciodaro, Francesco, Francesco Freni, Giuseppe Alberti, Marco Forelli, Francesco Gazia, Rocco Bruno, Enrique Perello Sherdell, Bruno Galletti, and Francesco Galletti. "Application of Cervical Vestibular-Evoked Myogenic Potentials in Adults with Moderate to Profound Sensorineural Hearing Loss: A Preliminary Study." International Archives of Otorhinolaryngology 24, no. 01 (January 2020): e5-e10. http://dx.doi.org/10.1055/s-0039-1697988.
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Abstract Introduction The cochlea and the vestibular receptors are closely related in terms of anatomy and phylogeny. Patients with moderate to profound sensorineural hearing loss (MPSHL) should have their vestibular organ functions tested. Objective To evaluate the incidence of vestibular abnormalities in patients with MPSHL and to study the correlation between the etiology of hearing loss (HL) and a possible damage to the labyrinth. Methods A case-control retrospective study was performed. In the case group, 20 adults with MPSHL of known etiology were included. The control group was composed of 15 adults with normal hearing. The case group was divided into 4 subgroups based on the etiology (bacterial meningitis, virus, vascular disease, congenital). Cervical vestibular-evoked myogenic potentials (cVEMPs) were used to rate the saccular function and lower vestibular nerve. Results The study was performed in 70 ears, and it highlighted the presence of early biphasic P1-N1 complex in 29 (71.5%) out of 40 ears in the study group, and in all of the 30 ears in the control group (p = 0.001). Regarding the presence or absence of cVEMPs among the four subgroups of patients with MPSHL, the data were statistically significant (p < 0.001). The comparison between the latencies and amplitude of P1-N1 in case and control groups from other studies and in the four subgroups of cases in the present study did not detect statistically significant differences. Conclusion The present study demonstrates that patients with MPSHL have a high incidence of damage to the labyrinthine organs, and it increases the current knowledge about the etiopathogenesis of sensorineural HL, which is often of unknown nature.
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McCaslin, Devin L., Gary P. Jacobson, Sarah L. Grantham, Erin G. Piker, and Susha Verghese. "The Influence of Unilateral Saccular Impairment on Functional Balance Performance and Self-Report Dizziness." Journal of the American Academy of Audiology 22, no. 08 (September 2011): 542–49. http://dx.doi.org/10.3766/jaaa.22.8.6.
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Background: Postural stability in humans is largely maintained by vestibular, visual, and somatosensory inputs to the central nervous system. Recent clinical advances in the assessment of otolith function (e.g., cervical and ocular vestibular evoked myogenic potentials [cVEMPs and oVEMPs], subjective visual vertical [SVV] during eccentric rotation) have enabled investigators to identify patients with unilateral otolith impairments. This research has suggested that patients with unilateral otolith impairments perform worse than normal healthy controls on measures of postural stability. It is not yet known if patients with unilateral impairments of the saccule and/or inferior vestibular nerve (i.e., unilaterally abnormal cVEMP) perform differently on measures of postural stability than patients with unilateral impairments of the horizontal SCC (semicircular canal) and/or superior vestibular nerve (i.e., unilateral caloric weakness). Further, it is not known what relationship exists, if any, between otolith system impairment and self-report dizziness handicap. Purpose: The purpose of this investigation was to determine the extent to which saccular impairments (defined by a unilaterally absent cVEMP) and impairments of the horizontal semicircular canal (as measured by the results of caloric testing) affect vestibulospinal function as measured through the Sensory Organization Test (SOT) of the computerized dynamic posturography (CDP). A secondary objective of this investigation was to measure the effects, if any, that saccular impairment has on a modality-specific measure of health-related quality of life. Research Design: A retrospective cohort study. Subjects were assigned to one of four groups based on results from balance function testing: Group 1 (abnormal cVEMP response only), Group 2 (abnormal caloric response only), Group 3 (abnormal cVEMP and abnormal caloric response), and Group 4 (normal control group). Study Sample: Subjects were 92 adult patients: 62 were seen for balance function testing due to complaints of dizziness, vertigo, or unsteadiness, and 30 served as controls. Intervention: All subjects underwent videonystagmography or electronystagmography (VNG/ENG), vestibular evoked myogenic potentials (VEMPs), self-report measures of self-perceived dizziness disability/handicap (Dizziness Handicap Inventory), and tests of postural control (Neurocom Equitest). Data Collection and Analysis: Subjects were categorized into one of four groups based on balance function test results. All variables were subjected to a multifactor analysis of variance (ANOVA). The Dizziness Handicap Inventory (DHI) total scores and equilibrium scores served as the dependent variables. Results: Results showed that patients with abnormal unilateral saccular or inferior vestibular nerve function (i.e., abnormal cVEMP) demonstrated significantly impaired postural control when compared to normal participants. However, this group demonstrated significantly better postural stability when compared to the group with abnormal caloric responses alone and the group with abnormal caloric responses and abnormal cVEMP results. Patients with an abnormal cVEMP did not differ significantly on the DHI compared to the other two impaired groups. Conclusions: We interpret these findings as evidence that a significantly asymmetrical cVEMP in isolation negatively impacts performance on measures of postural control compared to normal subjects but not compared to patients with significant caloric weaknesses. However, patients with a unilaterally abnormal cVEMP do not differ from patients with significant caloric weaknesses in regard to self-perceived dizziness handicap.
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Govender, Sendhil, Danielle L. Dennis, and James G. Colebatch. "Frequency and phase effects on cervical vestibular evoked myogenic potentials (cVEMPs) to air-conducted sound." Experimental Brain Research 234, no. 9 (May 5, 2016): 2567–74. http://dx.doi.org/10.1007/s00221-016-4661-1.
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Iwasaki, Shinichi. "How to record cVEMPs and oVEMPs in response to air-conducted sound and bone-conducted vibration." Equilibrium Research 72, no. 3 (2013): 198–203. http://dx.doi.org/10.3757/jser.72.198.
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Govender, Sendhil, and James G. Colebatch. "Location and phase effects for ocular and cervical vestibular-evoked myogenic potentials evoked by bone-conducted stimuli at midline skull sites." Journal of Neurophysiology 119, no. 3 (March 1, 2018): 1045–56. http://dx.doi.org/10.1152/jn.00695.2017.
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Our object was to investigate the effect of location and phase on the properties of oVEMPs and cVEMPs evoked by two bone conducted (BC) stimuli, 500 Hz and an impulsive stimulus for midline skull sites from Nz to Iz, in normal volunteers. Compressive and rarefactive onset phases were used and the induced linear and rotational accelerations measured. We confirmed our previous finding of marked changes in the polarity of oVEMPs with location. For cVEMPs using the 500Hz stimulus there were few changes with location or phase, but the impulsive stimulus showed clear phase-related changes at several locations, with the shortest latencies occurring with compressive stimuli at AFz and Fz and the largest amplitudes at Iz. For oVEMPs, both stimuli showed clear effects of phase, with the shortest latencies with compressive stimuli at AFz and Fz and with the largest negativity at Oz or Iz. Whereas the effectiveness at Iz is consistent with a role in the linear VOR, the inversion of polarity and shorter latency around AFz and Fz is not and could not be explained by changes in acceleration of the head. The latency for BC 500Hz oVEMPs for AFz was the same as that for air-conducted (AC) stimuli. We suggest that whereas BC stimuli at most sites work through displacement of the otolith membrane, BC oVEMPs evoked at AFz and Fz may work through a direct action on utricular hair cells. Our findings have implications for clinical testing of VEMPs using midline BC stimuli. NEW & NOTEWORTHY We investigated VEMPs evoked from multiple midline skull sites. Large oVEMP responses were obtained with compressive stimuli at Iz, consistent with a role in the linear VOR, but we also showed inversion of polarity and the shortest latency for stimuli given at AFz and Fz. We propose that BC stimuli given at AFz and Fz may have a direct effect on otolith hair cells, whereas at other sites they work through displacement of the otolith membrane.
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Demirhan, Hasan, Bahtiyar Hamit, and Özgür Yiğit. "Cervical Vestibular Evoked Myogenic Potentials (cVEMPs) Evoked by Air-Conducted Stimuli in Patients with Functional Neck Dissection." Journal of the National Medical Association 110, no. 3 (June 2018): 281–86. http://dx.doi.org/10.1016/j.jnma.2017.06.009.
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Masuda, Kanako, Koichiro Wasano, Yoshiharu Yamanobe, Kohei Mizuno, Shujiro Minami, and Tatsuo Matsunaga. "The Importance of Choosing Head and Neck MeasurementPositions for Eliciting Cervical Vestibular-evokedMyogenic Potentials (cVEMPs) in Patients." Equilibrium Research 81, no. 6 (December 31, 2022): 491–501. http://dx.doi.org/10.3757/jser.81.491.
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Tamaki, Chizuko, Kristen Maul, Daniel S. Talian, and Sarah Sparks. "Deaf Individuals Who Report Having Good Balance Function Present with Significant Vestibular Deficits." Journal of the American Academy of Audiology 32, no. 08 (September 2021): 510–20. http://dx.doi.org/10.1055/s-0041-1731732.
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Abstract Background Vestibular and/or balance deficits are well documented in deaf individuals. In the adult population, poor vestibular and/or balance function can lead to activity limitations and increased risk of falling. An effective case history by health care providers to probe for potential balance concerns is necessary for appropriate referral; however, patients may not consistently report vestibular and balance symptoms. Currently, there is little information available as to how deaf individuals report these symptoms and how their reported balance ability relates to measures of balance and vestibular functions. Purpose The aim of the current study was to evaluate self-perceived balance ability in participants who self-identify as either deaf or hearing, and compare these results to measures of balance and vestibular functions. Research Design This is a prospective, between-group design. Study Sample Data from 57 adults between the ages of 18 to 29 years who self-reported as deaf (39) or hearing (18) were evaluated. Participants completed the activities-specific balance confidence (ABC) scale, a brief case history, self-report rating of balance (SRRB), the Modified Clinical Test of Sensory Integration of Balance (mCTSIB), along with both ocular vestibular-evoked myogenic potentials (oVEMPs) and cervical vestibular-evoked myogenic potentials (cVEMPs). Only participants with SRRBs of good or excellent were included in the inferential analyses. Results Proportions of participants rating their balance ability as either good or excellent were similar between both groups, as were the results on the ABC scale. Statistical analyses revealed significant associations between the groups on both oVEMPs and cVEMPs. No significant differences were observed on sway velocities in any of the mCTSIB conditions; however, more than one-third of deaf participants had mCTSIB Condition 4—on foam, eyes closed—scores above 2 standard deviations of the hearing group. Conclusion Deaf participants self-report similar ratings of balance ability as hearing participants despite significant differences in vestibular function. A relatively large subset of deaf participants had increased sway velocity on balance function testing that required increased reliance on vestibular cues. A thorough discussion of balance and vestibular symptoms should be completed when a patient who self-identifies as deaf is seen by a health care provider so that appropriate screenings or referrals can be completed as necessary.
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Ashford, Alexander, Jun Huang, Chunming Zhang, Wei Wei, William Mustain, Thomas Eby, Hong Zhu, and Wu Zhou. "The Cervical Vestibular-Evoked Myogenic Potentials (cVEMPs) Recorded Along the Sternocleidomastoid Muscles During Head Rotation and Flexion in Normal Human Subjects." Journal of the Association for Research in Otolaryngology 17, no. 4 (April 22, 2016): 303–11. http://dx.doi.org/10.1007/s10162-016-0566-8.
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Ocal, F. Ceyda Akin, Ceren Karacayli, Volkan Kenan Coban, and Bulent Satar. "Can Narrow Band Chirp Stimulus Shake the Throne of 500 Hz Tone Burst Stimulus for Cervical Vestibular Myogenic Potentials?" Journal of Audiology and Otology 25, no. 2 (April 10, 2021): 98–103. http://dx.doi.org/10.7874/jao.2020.00486.
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Background and Objectives: The aim of the study was to compare effects of tone-burst (TB) and narrow-band (NB) Claus Elberling (CE)-chirp stimuli on amplitude, latency and interaural asymmetry ratio (IAR) of cervical vestibular evoked myogenic potentials (cVEMP) in healthy individuals.Subjects and Methods: The study included 50 healthy volunteers. cVEMP procedure was carried out using 500 Hz TB and NB-CE-chirp stimulus (360-720 Hz, up-chirp) in random order. cVEMP were recorded at 100 dB nHL. For each ear and each stimulus, P1 latency, N1 latency and P1N1 amplitude were measured. IAR was also calculated.Results: Mean age was 26.66±9.48 years. cVEMP’s in response to both TB and NB CE-chirp stimuli were obtained in all subjects. No statistically significant difference in P1 latency, N1 latency, and P1N1 amplitude was found between the right and left ears for both TB and NB CE-chirp stimuli (<i>p</i>>0.05). In both sides, P1 and N1 latencies were significantly shorter in NB CE-chirp stimulation compared to TB stimulation (<i>p</i>=0.000). In both sides, no statistically significant difference was found in P1N1 amplitude between two types of stimuli (<i>p</i>>0.05).Conclusions: The chirp stimulus produces robust but earlier cVEMP than TB does. This largest series study on NB chirp cVEMP shows that NB chirp is a good and new reliable alternative.
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Scarpa, A., F. M. Gioacchini, E. Cassandro, M. Tulli, M. Ralli, M. Re, and C. Cassandro. "Clinical application of cVEMPs and oVEMPs in patients affected by Ménière’s disease, vestibular neuritis and benign paroxysmal positional vertigo: a systematic review." Acta Otorhinolaryngologica Italica 39, no. 5 (October 2019): 298–307. http://dx.doi.org/10.14639/0392-100x-2104.
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Hochet, Baptiste, Sophie Achard, Mark Brandt Lorenz, Marc Baroncini, Amine Berama, Frederic Gabanou, Marion Devambez, Jean-Paul Lejeune, Christophe Vincent, and Nicolas-Xavier Bonne. "Preoperative Assessment of Cervical Vestibular Evoked Myogenic Potentials (cVEMPs) Help in Predicting Hearing Preservation After Removal of Vestibular Schwannomas Through a Middle Fossa Craniotomy." Otology & Neurotology 39, no. 10 (December 2018): e1143-e1149. http://dx.doi.org/10.1097/mao.0000000000002017.
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Dennis, Danielle L., Sendhil Govender, and James G. Colebatch. "Properties of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) evoked by 500 Hz and 100 Hz bone vibration at the mastoid." Clinical Neurophysiology 127, no. 1 (January 2016): 848–57. http://dx.doi.org/10.1016/j.clinph.2015.06.027.
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Manzari, L., A. M. Burgess, and I. S. Curthoys. "P1.4 Ocular and cervical vestibular-evoked myogenic potentials (oVEMPS and cVEMPS) to bone conducted vibration (BCV) in Ménière's disease during quiescence vs during acute attack." Clinical Neurophysiology 122 (June 2011): S59—S60. http://dx.doi.org/10.1016/s1388-2457(11)60195-8.
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