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Journal articles on the topic 'VEMP'

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Published: 4 June 2021
Last updated: 1 February 2022

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1

Zapala, David. "The VEMP." Hearing Journal 60, no. 3 (March 2007): 10. http://dx.doi.org/10.1097/01.hj.0000286711.70790.1c.

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2

Akin, Faith Wurm, Owen D. Murnane, and Tina M. Proffitt. "The Effects of Click and Tone-Burst Stimulus Parameters on the Vestibular Evoked Myogenic Potential (VEMP)." Journal of the American Academy of Audiology 14, no. 09 (October 2003): 500–509. http://dx.doi.org/10.3766/jaaa.14.9.5.

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Vestibular evoked myogenic potentials (VEMP) are short latency electromyograms (EMG) evoked by high-level acoustic stimuli and recorded from surface electrodes over the tonically contracted sternocleidomastoid (SCM) muscle and are presumed to originate in the saccule. The present experiments examined the effects of click and tone-burst level and stimulus frequency on the latency, amplitude, and threshold of the VEMP in subjects with normal hearing sensitivity and no history of vestibular disease. VEMPs were recorded in all subjects using 100 dB nHL click stimuli. Most subjects had VEMPs present at 500, 750, and 1000 Hz, and few subjects had VEMPs present at 2000 Hz. The response amplitude of the VEMP increased with click and tone-burst level, whereas VEMP latency was not influenced by the stimulus level. The largest tone-burst-evoked VEMPs and lowest thresholds were obtained at 500 and 750 Hz. VEMP latency was independent of stimulus frequency when tone-burst duration was held constant.
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3

Noij, Kimberley S., Mark J. van Tilburg, Barbara S. Herrmann, Piotr Marciniak, Steven D. Rauch, and John J. Guinan. "Toward Optimizing VEMP." Ear and Hearing 39, no. 6 (2018): 1199–206. http://dx.doi.org/10.1097/aud.0000000000000579.

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4

Dlugaiczyk, J. "Evidenzbasierte VEMP-Diagnostik." HNO 68, no. 5 (October 2, 2019): 324–35. http://dx.doi.org/10.1007/s00106-019-00757-4.

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5

McCaslin, Devin L., Gary P. Jacobson, and Todd Harry. "The Recordability of Two Sonomotor Responses in Young Normal Subjects." Journal of the American Academy of Audiology 19, no. 07 (July 2008): 542–47. http://dx.doi.org/10.3766/jaaa.19.7.3.

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Background: It has been reported that up to 40% of patients over age 60 fail to generate a vestibular evoked myogenic potential (VEMP; Su et al, 2004). When this occurs it is difficult to determine whether the absent VEMP represents evidence of bilateral impairment of the vestibulocollic reflex pathway or a normal age-related variant (i.e., idiopathic absence). Purpose: The purpose of the present investigation was to determine whether both VEMPs and PAMs could be recorded reliably in a sample of neurologically and otologically intact young adults. If both could be obtained with high reliability in normal subjects, then the bilateral presence of PAM in the bilateral absence of VEMP, at least in younger patients, could be used to support the contention that the absent VEMP represented evidence of bilateral impairment. Research Design: A descriptive study. Study Sample: Attempts were made to record both the VEMP and a second sonomotor response, the postauricular muscle potential (PAM) from 20 young adults. Results: Results showed both the VEMP and the PAM were present in 90% of the ears. Both the VEMP and PAM responses were bilaterally absent for one subject. Also, the VEMP and PAM were unilaterally absent for two subjects. Subjects who generated VEMPs also generated a PAM in at least one ear. Conclusions: The present investigation represents an initial step in the determination of whether the presence of PAMs in the absence of VEMPs can be used as a method of validating the presence of an impairment affecting the vestibulocollic reflex pathway.
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6

Seo, Toru. "Clinical application of VEMP." Equilibrium Research 76, no. 3 (2017): 219–24. http://dx.doi.org/10.3757/jser.76.219.

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7

Lundy, Larry, David Zapala, and Ketil Olsholt. "Dorsolateral Medullary Infarction: A Neurogenic Cause of a Contralateral, Large-Amplitude Vestibular Evoked Myogenic Potential." Journal of the American Academy of Audiology 19, no. 03 (March 2008): 246–56. http://dx.doi.org/10.3766/jaaa.19.3.9.

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The vestibular evoked myogenic potential (VEMP) has become a useful tool to assess the saccule and inferior vestibular nerve function. Vestibulopathies involving the saccule or inferior vestibular nerve typically result in VEMP responses that are diminished or absent on the involved side. Abnormally large VEMPs are rare. Large VEMPs have been associated with superior canal dehiscence, Ménière's disease, and labyrinthine fistula. In all of these cases, the abnormally large VEMP can be explained on the basis of labyrinthine hydromechanical changes that result in excessive saccular displacement in response to intense sound. In this report, a case is presented of a 74-year-old male with dorsal lateral medullary infarction (Wallenberg's syndrome) who presented with an enlarged VEMP—a finding that has not been reported to date as a result of a brain stem lesion. Particularly perplexing, the enlarged VEMP was on the contralesional side. A proposed mechanism of contralateral vestibular nuclei disinhibition secondary to the brain stem stroke is discussed. El potencial miogénico vestibular evocado (VEMP) se ha convertido en una herramienta útil para evaluar el sáculo y la función del nervio vestibular inferior. Las vestibulopatías que involucran el sáculo y el nervio vestibular inferior típicamente generan respuestas del VEMP que están disminuidas o ausentes en lado involucrado. Los VEMP anormalmente grandes son raros. Los VEMP grandes se han asociado con dehiscencia del canal superior, con enfermedad de Ménière y con fístula del laberinto. En todos estos casos, el VEMP anormalmente grande puede explicarse sobre la base de cambios hidromecánicos del laberinto, que producen un desplazamiento excesivo del sáculo, en respuesta a un estímulo sonoro intenso. En este reporte, se presenta un caso de un hombre de 74 años de edad con un infarto medular dorsolateral (Síndrome de Wallenberg), quien mostró un VEMP grande—un hallazgo que a la fecha no ha sido reportado como resultado de una lesión del tallo cerebral. Sorprendentemente, el VEMP agrandado estaba en el lado contrario a la lesión. Se discute un mecanismo propuesto de desinhibición de los núcleos vestibulares contralaterales, producto de la apoplejía en el tallo cerebral.
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8

Portnuff, Cory D. F., Samantha Kleindienst, and Jamie M. Bogle. "Safe Use of Acoustic Vestibular-Evoked Myogenic Potential Stimuli: Protocol and Patient-Specific Considerations." Journal of the American Academy of Audiology 28, no. 08 (September 2017): 708–17. http://dx.doi.org/10.3766/jaaa.16071.

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AbstractVestibular-evoked myogenic potentials (VEMPs) are commonly used clinical assessments for patients with complaints of dizziness. However, relatively high air-conducted stimuli are required to elicit the VEMP, and ultimately may compromise safe noise exposure limits. Recently, research has reported the potential for noise-induced hearing loss (NIHL) from VEMP stimulus exposure through studies of reduced otoacoustic emission levels after VEMP testing, as well as a recent case study showing permanent sensorineural hearing loss associated with VEMP exposure.The purpose of this report is to review the potential for hazardous noise exposure from VEMP stimuli and to suggest clinical parameters for safe VEMP testing.Literature review with presentation of clinical guidelines and a clinical tool for estimating noise exposure.The literature surrounding VEMP stimulus-induced hearing loss is reviewed, including several cases of overexposure. The article then presents a clinical calculation tool for the estimation of a patient’s safe noise exposure from VEMP stimuli, considering stimulus parameters, and includes a discussion of how varying stimulus parameters affect a patient’s noise exposure. Finally, recommendations are provided for recognizing and managing specific patient populations who may be at higher risk for NIHL from VEMP stimulus exposure. A sample protocol is provided that allows for safe noise exposure.VEMP stimuli have the potential to cause NIHL due to high sound exposure levels. However, with proper safety protocols in place, clinicians may reduce or eliminate this risk to their patients. Use of the tools provided, including the noise exposure calculation tool and sample protocols, may help clinicians to understand and ensure safe use of VEMP stimuli.
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9

Bonsu, Angela N., Sofia Nousi, Rhannon Lobo, Paul H. Strutton, Qadeer Arshad, and Adolfo M. Bronstein. "Vestibulo-perceptual influences upon the vestibulo-spinal reflex." Experimental Brain Research 239, no. 7 (May 9, 2021): 2141–49. http://dx.doi.org/10.1007/s00221-021-06123-7.

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AbstractThe vestibular system facilitates gaze and postural stability via the vestibulo-ocular (VOR) and vestibulo-spinal reflexes, respectively. Cortical and perceptual mechanisms can modulate long-duration VOR responses, but little is known about whether high-order neural phenomena can modulate short-latency vestibulo-spinal responses. Here, we investigate this by assessing click-evoked cervical vestibular myogenic-evoked potentials (VEMPS) during visual roll motion that elicited an illusionary sensation of self-motion (i.e. vection). We observed that during vection, the amplitude of the VEMPs was enhanced when compared to baseline measures. This modulation in VEMP amplitude was positively correlated with the subjective reports of vection strength. That is, those subjects reporting greater subjective vection scores exhibited a greater increase in VEMP amplitude. Control experiments showed that simple arousal (cold-induced discomfort) also increased VEMP amplitude but that, unlike vection, it did not modulate VEMP amplitude linearly. In agreement, small-field visual roll motion that did not induce vection failed to increase VEMP amplitude. Taken together, our results demonstrate that vection can modify the response of vestibulo-collic reflexes. Even short-latency brainstem vestibulo-spinal reflexes are influenced by high-order mechanisms, illustrating the functional importance of perceptual mechanisms in human postural control. As VEMPs are inhibitory responses, we argue that the findings may represent a mechanism whereby high-order CNS mechanisms reduce activity levels in vestibulo-collic reflexes, necessary for instance when voluntary head movements need to be performed.
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10

Lee, Kang Jin, Min Soo Kim, Eun Jin Son, Hye Jin Lim, Jung Hwan Bang, and Jae Goo Kang. "The Usefulness of Rectified VEMP." Clinical and Experimental Otorhinolaryngology 1, no. 3 (2008): 143. http://dx.doi.org/10.3342/ceo.2008.1.3.143.

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11

Seo, Toru. "Clinical application of the VEMP." Equilibrium Research 69, no. 3 (2010): 176–81. http://dx.doi.org/10.3757/jser.69.176.

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12

Basta, Dietmar, Ingo Todt, and Arne Ernst. "Characterization of age-related changes in vestibular evoked myogenic potentials." Journal of Vestibular Research 17, no. 2-3 (March 1, 2008): 93–98. http://dx.doi.org/10.3233/ves-2007-172-304.

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A tone-burst stimulation of 500 Hz seems to be clinically most appropriate to elicit vestibular evoked myogenic potentials (VEMPs) because those VEMPs can be recorded at the lowest stimulus intensity possible. However, little is known about gender and age-related changes of the amplitude in tone-burst (500 Hz) evoked VEMPs. The aim of the present paper was therefore to investigate the influence of gender and age on VEMP amplitude in relation to the tonic muscle activity. VEMPs of 64 healthy subjects were recorded ipsilaterally during air- or bone-conducted tone burst stimulation. The EMG of the tonically activated sternocleidomastoid muscle was recorded ipsilaterally with surface electrodes. Averages were taken for P1/N1 amplitudes of male and female volunteers within 3 different age groups. Although the amplitude decreased with increasing age the tonic activity was not significant different between the age groups. Consequently the relation between VEMP amplitude and tonic muscle activity decreased with increasing age. The normative values of the age-dependent relation between VEMP amplitude and tonic muscle activity were described by the 90% confidence interval of the individual values. Normative thresholds were calculated. Normal saccular receptor function could be diagnosed if the VEMP amplitude is above (or equal to) the normative value at a given tonic muscle activity and age. Normative data as described above are required to diagnose isolated saccular defects, which are indicative of a vestibular disorder.
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13

Kuo, Shih-Wei, Ting-Hua Yang, and Yi-Ho Young. "Changes in Vestibular Evoked Myogenic Potentials after Meniere Attacks." Annals of Otology, Rhinology & Laryngology 114, no. 9 (September 2005): 717–21. http://dx.doi.org/10.1177/000348940511400911.

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Objectives: The aim of this study was to apply videonystagmography (VNG) and vestibular evoked myogenic potential (VEMP) tests to patients with Meniere attacks, to explore the mechanics of where saccular disorders may affect the semicircular canals. Methods: From January 2001 to December 2003, 12 consecutive patients with unilateral definite Meniere's disease with vertiginous attacks underwent VNG for recording spontaneous nystagmus, as well as VEMP tests. Results: At the very beginning of the Meniere attack, the spontaneous nystagmus beat toward the lesion side in 5 patients (42%) and toward the healthy side in 7 patients (58%). Twenty-four hours later, only 6 patients (50%) showed spontaneous nystagmus beating toward the healthy side. Nevertheless, spontaneous nystagmus subsided in all patients within 48 hours. The VEMP test was performed within 24 hours of a Meniere attack; the VEMPs were normal in 4 patients and abnormal in 8 patients (67%). After 48 hours, 4 patients with initially abnormal VEMPs had resolution and return to normal VEMPs, and the other 4 patients still had absent VEMPs. Conclusions: Most patients (67%) with Meniere attacks revealed abnormal VEMPs, indicating that the saccule participates in a Meniere attack. This is an important idea that stimulates consideration of the mechanism of Meniere attacks.
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14

Bhansali, Sanjay. "Clinical Usefulness of the VEMP Test in Vestibular Diagnosis." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P53. http://dx.doi.org/10.1016/j.otohns.2008.05.171.

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Objective 1) Assess the clinical usefulness of the VEMP test in identifying vestibular disease. 2) Evaluate the criteria used for a positive VEMP test. Methods We prospectively evaluated 166 consecutive patients complaining of dizziness with a neurotologic examination including spontaneous nystagmus, head-shake testing, gaze testing, and Hallpike maneuver. ENG testing and MRI scanning were done when indicated. All underwent VEMP testing. We considered 30% and 40% amplitude asymmetry criteria as abnormal for peripheral, and 17 msec latency abnormal for central disease and compared these with the complete clinical evaluation. Results 44 patients had no VEMP response and were excluded. Analysis of the remaining 122 patients showed that 47% of patients with a peripheral vestibular disorder had an abnormal VEMP, using the 30% amplitude asymmetry criterion (p<0.001) (Fisher Exact Test), and 29% had an abnormal VEMP using the 40% criterion (p<0.001). The likelihood of a false positive was very low (3%, p<0.001). 42% of patients diagnosed with central vestibular dysfunction had delayed latency responses and the false positive rate was 2% (p<0.001). Conclusions The very low false positive rate (high specificity) indicates that an abnormal VEMP test is a good predictor of the presence of vestibular dysfunction, but a normal VEMP test does not exclude it. More patients with vestibular disease are identified (47% vs. 29%) just as accurately using a 30% rather than 40% criterion for a positive test. VEMP testing appears to be a valuable addition to the vestibular test battery and should be considered in the evaluation of dizzy patients.
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15

Patkó, T., M. Simó, and Z. Arányi. "Vestibular click-evoked myogenic potentials: sensitivity and factors determining abnormality in patients with multiple sclerosis." Multiple Sclerosis Journal 13, no. 2 (March 2007): 193–98. http://dx.doi.org/10.1177/1352458506070940.

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Vestibular evoked myogenic potential (VEMP) assesses the sacculo-spinal pathway. The aim of our study was to examine sensitivity and factors determining abnormality of VEMP, indicative of brainstem dysfunction, in patients with multiple sclerosis (MS). Thirty healthy subjects and 30 MS patients were examined. All healthy subjects showed a normal biphasic response. Twelve of the 30 MS patients (40%) had abnormal recordings. There was a significant difference between MS patients and control subjects with respect to P13 latency (longer in the MS group) and P13-N23 amplitude (lower in the MS group). VEMP abnormalities were statistically significantly related to the presence of brainstem demyelinative lesions and a weaker correlation was found with disease duration. Clinical signs of vestibular dysfunction at any point during the course of the disease did not seem to affect the chances of obtaining abnormal VEMPs. Although the sensitivity of VEMP in detecting abnormality in MS patients is relatively low, its significance is evident in that it is the only electrophysiological method that is able to detect dysfunction in central vestibular pathways. Multiple Sclerosis 2007; 13: 193–198. http://msj.sagepub.com
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16

Zapala, David A., and Robert H. Brey. "Clinical Experience with the Vestibular Evoked Myogenic Potential." Journal of the American Academy of Audiology 15, no. 03 (March 2004): 198–215. http://dx.doi.org/10.3766/jaaa.15.3.3.

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The vestibular evoked myogenic potential (VEMP) is a promising test of the descending vestibulocollic system. Our aim was to determine whether the VEMP can be applied to an older patient population and can detect lesions in descending vestibulospinal pathways. We also compared VEMP clinical performance with that of the standard caloric test. VEMP test performance was retrospectively analyzed in relation to clinical diagnosis and other vestibular test performance in 62 patients (age, 30–85 years) referred for vestibular testing to Mayo Clinic, Jacksonville, Florida. The VEMP was evoked using a 250 Hz tone burst. Results suggest age-related changes in VEMP amplitude and latency in this patient population. VEMP tests were sensitive to lesions not detected by electronystagmography. VEMP and caloric sensitivity and specificity were essentially equal (d′ = 1). Combining both tests improved sensitivity. However, VEMP false-positive rates hampered specificity. VEMP testing may be refined to improve false-positive rates and clinical utility.
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17

Taylor, Rachael L., Miriam S. Welgampola, Benjamin Nham, and Sally M. Rosengren. "Vestibular-Evoked Myogenic Potential Testing in Vestibular Localization and Diagnosis." Seminars in Neurology 40, no. 01 (January 14, 2020): 018–32. http://dx.doi.org/10.1055/s-0039-3402068.

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AbstractVestibular-evoked myogenic potentials (VEMPs) are short-latency, otolith-dependent reflexes recorded from the neck and eye muscles. They are widely used in neuro-otology clinics as tests of otolith function. Cervical VEMPs are recorded from the neck muscles and reflect predominantly saccular function, while ocular VEMPs are reflexes of the extraocular muscles and reflect utricular function. They have an important role in the diagnosis of superior canal dehiscence syndrome and provide complementary information about otolith function that is useful in the diagnosis of other vestibular disorders. Like other evoked potentials, they can provide important localizing information about lesions that may occur along the VEMP pathway. This review will describe the VEMP abnormalities seen in common disorders of the vestibular system and its pathways.
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18

Jacobson, Gary P. "Safe Stimulus Intensities for VEMP Testing." Journal of the American Academy of Audiology 28, no. 08 (September 2017): 678. http://dx.doi.org/10.3766/jaaa.28.8.1.

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19

Isaradisaikul, Suwicha, Niramon Navacharoen, and Charuk Hanprasertpong. "Cervical VEMP: Its Sensitivity and Specificity." Otolaryngology–Head and Neck Surgery 145, no. 2_suppl (August 2011): P205—P206. http://dx.doi.org/10.1177/0194599811415823a233.

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20

Bhansali, Sanjay. "S242 – Comparing the VEMP and ENG Tests in Vestibular Diagnosis." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P156. http://dx.doi.org/10.1016/j.otohns.2008.05.417.

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Objectives 1) Compare the VEMP to the ENG test in the diagnosis of vestibular disease. 2) Learn clinical usefulness of the VEMP test. Methods We prospectively evaluated 166 patients complaining of dizziness with a complete neurotologic examination. VEMP and ENG testing were done on 160 patients. Brain scans were done when indicated. We compared the clinical diagnosis to the VEMP and ENG test results separately for 4 commonly seen vestibular conditions. Results 44 patients had no VEMP response and were excluded. Of the 116 patients there were 32 cases of Vestibular Neuronitis, 17 of Meniere's disease, 15 of BPPV, 12 of central vestibular dysfunction, 13 other vestibular diagnoses, and 27 with no vestibular diagnosis. Using a 2×2 contingency table and Fisher Exact Probability Test, there was a statistical difference between the VEMP and ENG tests only in diagnosis of Vestibular Neuronitis (p<0.001) when analyzed individually, and because this difference was so strong, there was a statistical difference with the diagnoses taken all together (p<0.001). Conclusions The ENG test remains the gold standard for diagnosis of vestibular disease. The VEMP test is useful in diagnosis of several vestibular disorders, including the 4 considered in this study. There is a strong bias toward the ENG test mainly because the diagnosis of vestibular neuronitis relies heavily on an abnormal caloric response. The VEMP test is administered in a much shorter time than the ENG test and provides valuable information regarding the inferior vestibular nerve and it has a lower false positive rate than the ENG test.
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21

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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22

Fife, Terry D., Saty Satya-Murti, Robert F. Burkard, and John P. Carey. "Vestibular evoked myogenic potential testing." Neurology: Clinical Practice 8, no. 2 (March 2, 2018): 129–34. http://dx.doi.org/10.1212/cpj.0000000000000430.

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Purpose of reviewA recent American Academy of Neurology Evidence-Based Practice Guideline on vestibular myogenic evoked potential (VEMP) testing has described superior canal dehiscence syndrome (SCDS) and evaluated the merits of VEMP in its diagnosis. SCDS is an uncommon but now well-recognized cause of dizziness and auditory symptoms. This article familiarizes health care providers with this syndrome and the utility and shortcomings of VEMP as a diagnostic test and also explores payment policies for VEMP.Recent findingsIn carefully selected patients with documented history compatible with the SCDS, both high-resolution temporal bone CT scan and VEMP are valuable aids for diagnosis. Payers might be unfamiliar with both this syndrome and VEMP testing.SummaryIt is important to raise awareness of VEMP and its possible indications and the rationale for coverage of VEMP testing. Payers may not be readily receptive to VEMP coverage if this test is used in an undifferentiated manner for all common vestibular and auditory symptoms.
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23

Brantberg, Krister, and Tiit Mathiesen. "Preservation of tap vestibular evoked myogenic potentials despite resection of the inferior vestibular nerve." Journal of Vestibular Research 14, no. 4 (October 14, 2004): 347–51. http://dx.doi.org/10.3233/ves-2004-14404.

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Sound and skull-tap induced vestibular evoked myogenic potentials (VEMP) were studied in a 43-year-old man following inferior vestibular neurectomy. Surgery was performed because of a small acoustic neuroma. Postoperative caloric testing suggested sparing of superior vestibular nerve function on the operated side. In response to sound stimulation there were no VEMP on the operated side, irrespective of whether sounds were presented by air- or bone-conduction. This suggests sound-induced VEMP to be critically dependent on inferior vestibular nerve function and this is in agreement with present knowledge. However, VEMP were obtained in response to forehead skull taps, i.e. positive-negative VEMP not only on the healthy side but also on the operated side. This suggests remnant vestibular function on the operated side of importance for forehead skull tap VEMP, because with complete unilateral vestibular loss there are no (positive-negative) VEMP on the lesioned side. Thus, forehead skull-tap VEMP depend, at least partly, on the superior vestibular nerve function.
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Brantberg, Krister, Arne Tribukait, and Per-Anders Fransson. "Vestibular evoked myogenic potentials in response to skull taps for patients with vestibular neuritis." Journal of Vestibular Research 13, no. 2-3 (October 1, 2003): 121–30. http://dx.doi.org/10.3233/ves-2003-132-307.

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In recent years it has been demonstrated that loud clicks generate short latency vestibular evoked myogenic potentials (VEMP). It has also been demonstrated that skull tap stimulation evokes similar VEMP. In the present study, the differences between the click-induced and the skull-tap induced VEMP were studied in 18 patients at onset of vestibular neuritis. Gentle skull taps were delivered manually above each ear on the side of the skull and on the forehead midline. The muscular responses were recorded over both sternocleidomastoid muscles using skin electrodes. Abnormal skull tap VEMP were found in the majority of the patients (10/18, 56%). However, only 4/18 (22%) showed asymmetry in the click-induced VEMP. The high percentage of abnormal skull tap VEMP might suggest that this response is not only dependent on the inferior division of the vestibular nerve, because the inferior division of this nerve is usually spared in vestibular neuritis. Moreover, the patients with abnormals kull tap VEMP differed from those with normal VEMP in their settings of the subjective visual horizontal with static head tilt in the roll plane. This might suggest that skull tap VEMP are (also) related to utricular function.
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25

Isaradisaikul, Suwicha, Niramon Navacharoen, Charuk Hanprasertpong, and Jaran Kangsanarak. "Cervical Vestibular-Evoked Myogenic Potentials: Norms and Protocols." International Journal of Otolaryngology 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/913515.

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Vestibular-evoked myogenic potential (VEMP) testing is a vestibular function test used for evaluating saccular and inferior vestibular nerve function. Parameters of VEMP testing include VEMP threshold, latencies of p1 and n1, and p1-n1 interamplitude. Less commonly used parameters were p1-n1 interlatency, interaural difference of p1 and n1 latency, and interaural amplitude difference (IAD) ratio. This paper recommends using air-conducted 500 Hz tone burst auditory stimulation presented monoaurally via an inserted ear phone while the subject is turning his head to the contralateral side in the sitting position and recording the responses from the ipsilateral sternocleidomastoid muscle. Normative values of VEMP responses in 50 normal audiovestibular volunteers were presented. VEMP testing protocols and normative values in other literature were reviewed and compared. The study is beneficial to clinicians as a reference guide to set up VEMP testing and interpretation of the VEMP responses.
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26

Tutar, Belgin. "Evaluation of vestibular system using c-VEMP and o-VEMP in patients with relapsing-remitting multiple sclerosis." Turkish Journal of Ear Nose and Throat 29, no. 3 (October 11, 2019): 119–25. http://dx.doi.org/10.5606/tr-ent.2019.51423.

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27

Madzharova, Kalina I., and Ana P. Beshkova. "Diagnostic capabilities of the vestibular evoked myogenic potential test in children with vestibular dysfunction." International Journal of Otorhinolaryngology and Head and Neck Surgery 6, no. 4 (March 25, 2020): 606. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20201275.

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<p class="abstract"><strong>Background:</strong> Vestibular evoked myogenic potential (VEMP) testing is used in the diagnosis of vestibular disorders. It is an objective method for testing the the otolith organs of the vestibular system. VEMP test is an additional method for diagnosing vestibular neuritis (VN). The combination of cervical VEMP (cVEMP) and ocular VEMP (oVEMP) testing has an advantage in long-term monitoring of patients with VN. The VEMP test is well-studied for adults but studies involving children are insufficient. The aim of this study was to analysis and evaluation of the results from VEMP testing of children diagnosed with vestibular dysfunction. Analysis and evaluation of the results from VEMP testing of children diagnosed with vestibular dysfunction.</p><p class="abstract"><strong>Methods:</strong> History, examination of ENT organs, tone threshold audiometry, tympanometry, otoneurological examination, VEMP test. </p><p class="abstract"><strong>Results:</strong> Children with vestibular dysfunction who were examined showed changes predominantly in the oVEMP test. The upper branch of the vestibular nerve is affected. </p><p class="abstract"><strong>Conclusions:</strong> The VEMP test is an additional method for diagnosing patients with vestibular dysfunction. It is safe when used for children.</p>
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Hunter, Jacob B., Neil S. Patel, Brendan P. O’Connell, Matthew L. Carlson, Neil T. Shepard, Devin L. McCaslin, and George B. Wanna. "Cervical and Ocular VEMP Testing in Diagnosing Superior Semicircular Canal Dehiscence." Otolaryngology–Head and Neck Surgery 156, no. 5 (February 7, 2017): 917–23. http://dx.doi.org/10.1177/0194599817690720.

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Objective To determine the sensitivity and specificity of ocular and cervical vestibular evoked myogenic potentials (VEMPs) in the diagnosis of superior semicircular canal dehiscence (SCD) and to describe the VEMP response characteristics that are most sensitive to SCD and compare the findings to previous reports. Study Design Case series with chart review. Setting Two tertiary neurotologic referral centers. Subjects and Methods Cervical and ocular VEMP peak-to-peak amplitudes and thresholds from 39 adult patients older than 18 years with surgically confirmed SCD were compared with 84 age-matched controls. Results Using receiver operating characteristic (ROC) curves, cervical VEMP (cVEMP) amplitudes, cVEMP thresholds, and ocular VEMP (oVEMP) amplitudes had areas under the curve of 0.731, 0.912, and 0.856, respectively, all of which were statistically significant ( P < .0001). For cVEMP thresholds, at the clinical equivalent ≤85-dB normalized hearing level (nHL) threshold, the sensitivity and specificity were 97.3% and 31.3%, respectively. At the ≤70-dB nHL threshold, the sensitivity and specificity were 73.0% and 94.0%, respectively. For oVEMP amplitudes >12.0 µV, the sensitivity and specificity were 78.6% and 81.7%, respectively. Conclusion Data from this multicenter study suggest that both cVEMP thresholds and oVEMP amplitudes remain good diagnostic tests for identifying SCD, with each test dependent on a number of factors. The sensitivity and specificity of these individual tests may vary slightly between centers depending on testing parameters used.
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Murofushi, Toshihisa. "VEMP: from the origin to the future." Equilibrium Research 79, no. 2 (April 30, 2020): 53–61. http://dx.doi.org/10.3757/jser.79.53.

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Colebatch, James G. "Mapping the vestibular evoked myogenic potential (VEMP)." Journal of Vestibular Research 22, no. 1 (2012): 27–32. http://dx.doi.org/10.3233/ves-2011-0438.

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31

Walther, L. E., H. Schaaf, D. Sommer, and K. Hörmann. "Luftleitungsinduzierte oculäre VEMP: II. Erste klinische Untersuchungen." Laryngo-Rhino-Otologie 90, no. 10 (July 4, 2011): 596–603. http://dx.doi.org/10.1055/s-0031-1280751.

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32

Madzharova, Kalina. "Peculiarities of the VEMP test in children." International Bulletin of Otorhinolaryngology 15, no. 4 (December 31, 2019): 10. http://dx.doi.org/10.14748/orl.v15i4.6356.

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Youm, Hye-Youn, Min Beom Kim, Jeesun Choi, Ha-Young Byun, Ga-Young Park, and Won-Ho Chung. "Clinical Value of VEMP in Ménière’s Disease." Otolaryngology–Head and Neck Surgery 147, no. 2_suppl (August 2012): P202. http://dx.doi.org/10.1177/0194599812451426a243.

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Magliulo, Giuseppe, Donato Parrotto, Silvia Gagliardi, Giuseppe Cuiuli, and Concetta Novello. "Vestibular Evoked Periocular Potentials in Meniere's Disease after Glycerol Testing." Annals of Otology, Rhinology & Laryngology 117, no. 11 (November 2008): 800–804. http://dx.doi.org/10.1177/000348940811701102.

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Objectives: The present investigation was specifically designed to evaluate the clinical application of vestibular evoked periocular potentials (VEPPs) in the diagnosis of endolymphatic hydrops. Methods: We compared the results of the traditional pure tone audiometry glycerol test with those of the vestibular evoked myogenic potential (VEMP) glycerol test and the VEPP glycerol test in 22 patients affected by unilateral endolymphatic hydrops. Results: Some patients had positive depletive tests with both VEMPs and VEPPs, and other patients had positive tests with either VEMPs or VEPPs. Conclusions: Our outcomes confirmed that vestibular evoked potentials represent a useful additional diagnostic tool in the diagnosis of endolymphatic hydrops. The role of VEPPs in this particular issue was not inferior to that of VEMPs. The outcomes also suggested that not only the saccule, but also the utriculus, may be involved in the genesis of VEPPs.
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Versino, Maurizio, Laura Ranza, Silvia Colnaghi, Roberto Alloni, Roberto Callieco, Alfredo Romani, Roberto Bergamaschi, Anna Pichiecchio, Stefano Bastianello, and Vittorio Cosi. "The N3 potential compared to sound and galvanic vestibular evoked myogenic potential in healthy subjects and in multiple sclerosis patients." Journal of Vestibular Research 17, no. 1 (September 1, 2007): 39–46. http://dx.doi.org/10.3233/ves-2007-17105.

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Both sound (s-) and galvanic (g-) vestibular-evoked myogenic potential (VEMP) enable us to study the saccular pathways. However, the VEMP can be abnormal for non-vestibular factors, such as insufficient activation of the sterno-cleido-mastoid (SCM) muscle or a lesion that involves the accessory nucleus and/or nerve or the SCM muscle. These drawbacks do not affect another technique that evaluates the saccular function: the N3 potential. We recorded both the s- and the g-VEMP and the N3 potential in a group of 31 healthy subjects to establish a reference range. The N3 potential and the s-VEMP were recordable bilaterally from all the subjects, whereas the g-VEMP was undetectable uni- or bilaterally in 7 subjects. The latency and amplitude values of the s-VEMP did not differ from those of the g-VEMP. For all three techniques, the latency and amplitude values from the right and from the left recording and/or stimulation side were the same. We suggest using normative latency and amplitude values based on the mean and ratio of the right- and left-side values. The s-VEMP, the N3 potential and the auditory evoked response (ABR) were compared in 15 subjects suffering from multiple sclerosis. The three techniques detected a similar number of abnormalities, but these abnormalities were not correlated. This suggests that these different techniques should be regarded as complementary in evaluating saccular function.
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Kim, Shin Hye, Sang-Yeon Lee, Ji-Soo Kim, and Ja-Won Koo. "Parameters of Off-Vertical Axis Rotation in Unilateral and Bilateral Vestibulopathy and Their Correlation with Vestibular Evoked Myogenic Potentials." Journal of Clinical Medicine 10, no. 4 (February 13, 2021): 756. http://dx.doi.org/10.3390/jcm10040756.

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Off-vertical axis rotation (OVAR) is a laboratory test to assess the otolith function. This study aimed to analyze the parameters of OVAR in patients with unilateral vestibular hypofunction (UVH) and bilateral vestibulopathy (BVP), and to correlate the parameters of OVAR with those of VEMPs. Ten healthy volunteers, 41 UVH, and 13 BVP patients performed OVAR. Bias component (BIC) and modulation component (MOC) of UVH and BVP patients were compared with those of healthy controls. BIC and MOC were correlated with amplitude and interaural difference (IAD) of cervical VEMP (cVEMP) and ocular VEMP (oVEMP). In UVH patients, the direction of BICs to affected side rotation were reversed and the absolute value of BICs were decreased when they were compared to healthy controls. In BVP patients, BICs were markedly attenuated. MOCs were not changed in UVH and BVP patients. There was no statistically significant correlation between VEMPs and OVAR.
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KAVRUK, Hatice, Ayşenur AYKUL, and Burak ÖZTÜRK. "Vestibüler uyarılmış miyojenik potansiyeller: Klinik kullanımı." Turkish Journal of Audiology And Hearing Research 4, no. 2 (August 2021): 51–58. http://dx.doi.org/10.34034/tjahr.23290.

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Vestibular evoked myogenic potentials: Clinical applications 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. Keywords: VEMP, cVEMP, oVEMP, vestibular system, central disorders
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Zhou, Guangwei, and L. Clarke Cox. "Vestibular Evoked Myogenic Potentials." American Journal of Audiology 13, no. 2 (December 2004): 135–43. http://dx.doi.org/10.1044/1059-0889(2004/018).

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Vestibular evoked myogenic potential (VEMP) testing is a relatively new diagnostic tool that is in the process of being investigated in patients with specific vestibular disorders. In this review, we will outline the history and provide a current review of VEMP research. Briefly, the VEMP is a biphasic response elicited by loud clicks or tone bursts recorded from the tonically contracted sternocleidomastoid muscle. Current data suggest that the VEMP is a vestibulo-collic reflex whose afferent limb arises from acoustically sensitive cells in the saccule, with signals conducted via the inferior vestibular nerve. We will review the history of the response and detail the anatomy and physiology associated with the test. We will discuss specific VEMP applications in the diagnosis of Meniere's disease, vestibular schwannoma, vestibular hypersensitivity disorders, vestibular neuritis, multiple sclerosis, and other brainstem lesions.
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Oh, Sun-Young, Hyun-June Shin, Rainer Boegle, Matthias Ertl, Peter zu Eulenburg, Ji-Soo Kim, and Marianne Dieterich. "Simultaneous recording of cervical and ocular vestibular-evoked myogenic potentials." Neurology 90, no. 3 (December 20, 2017): e230-e238. http://dx.doi.org/10.1212/wnl.0000000000004835.

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ObjectiveTo increase clinical application of vestibular-evoked myogenic potentials (VEMPs) by reducing the testing time by evaluating whether a simultaneous recording of ocular and cervical VEMPs can be achieved without a loss in diagnostic sensitivity and specificity.MethodsSimultaneous recording of ocular and cervical VEMPs on each side during monaural stimulation, bilateral simultaneous recording of ocular VEMPs and cervical VEMPs during binaural stimulation, and conventional sequential recording of ocular and cervical VEMPs on each side using air-conducted sound (500 Hz, 5-millisecond tone burst) were compared in 40 healthy participants (HPs) and 20 patients with acute vestibular neuritis.ResultsEither simultaneous recording during monaural and binaural stimulation effectively reduced the recording time by ≈55% of that for conventional sequential recordings in both the HP and patient groups. The simultaneous recording with monaural stimulation resulted in latencies and thresholds of both VEMPs and the amplitude of cervical VEMPs similar to those found during the conventional recordings but larger ocular VEMP amplitudes (156%) in both groups. In contrast, compared to the conventional recording, simultaneous recording of each VEMP during binaural stimulation showed reduced amplitudes (31%) and increased thresholds for cervical VEMPs in both groups.ConclusionsThe results of simultaneous recording of cervical and ocular VEMPs during monaural stimulation were comparable to those obtained from the conventional recording while reducing the time to record both VEMPs on each side.ClinicalTrials.gov identifierNCT03049683.
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Colebatch, James G., and Sally M. Rosengren. "Investigating short latency subcortical vestibular projections in humans: what have we learned?" Journal of Neurophysiology 122, no. 5 (November 1, 2019): 2000–2015. http://dx.doi.org/10.1152/jn.00157.2019.

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Vestibular evoked myogenic potentials (VEMPs) are now widely used for the noninvasive assessment of vestibular function and diagnosis in humans. This review focuses on the origin, properties, and mechanisms of cervical VEMPs and ocular VEMPs; how these reflexes relate to reports of vestibular projections to brain stem and cervical targets; and the physiological role of (otolithic) cervical and ocular reflexes. The evidence suggests that both VEMPs are likely to represent the effects of excitation of irregularly firing otolith afferents. While the air-conducted cervical VEMP appears to mainly arise from excitation of saccular receptors, the ocular VEMP evoked by bone-conducted stimulation, including impulsive bone-conducted stimuli, mainly arises from utricular afferents. The surface responses are generated by brief changes in motor unit firing. The effects that have been demonstrated are likely to represent otolith-dependent vestibulocollic and vestibulo-ocular reflexes, both linear and torsional. These observations add to previous reports of short latency otolith projections to the target muscles in the neck (sternocleidomastoid and splenius) and extraocular muscles (the inferior oblique). New insights have been provided by the investigation and application of these techniques.
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41

McNerney, Kathleen M., Alan H. Lockwood, Mary Lou Coad, David S. Wack, and Robert F. Burkard. "Use of 64-Channel Electroencephalography to Study Neural Otolith-Evoked Responses." Journal of the American Academy of Audiology 22, no. 03 (March 2011): 143–55. http://dx.doi.org/10.3766/jaaa.22.3.3.

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Background: The vestibular evoked myogenic potential (VEMP) is a myogenic response that can be used clinically to evaluate the function of the saccule. However, to date, little is known about the thalamo-cortical representation of saccular activation. It is important to understand all aspects of the VEMP, as this test is currently used clinically in the evaluation of saccular function. Purpose: To identify the areas of the brain that are activated in response to stimuli used clinically to evoke the VEMP. Research Design: Electroencephalography (EEG) recordings combined with current density analyses were used to identify the areas of the brain that are activated in response to stimuli presented above VEMP threshold (500 Hz, 120 dB peak SPL [pSPL] tone bursts), as compared to stimuli presented below VEMP threshold (90 dB pSPL, 500 Hz tone bursts). Ten subjects without any history of balance or hearing impairment participated in the study. Results: The neural otolith-evoked responses (NOERs) recorded in response to stimuli presented below VEMP threshold were absent or smaller than NOERs that were recorded in response to stimuli presented above VEMP threshold. Subsequent analyses with source localization techniques, followed by statistical analysis with SPM5 (Statistical Parametric Mapping), revealed several areas that were activated in response to the 120 dB pSPL tone bursts. These areas included the primary visual cortex, the precuneus, the precentral gyrus, the medial temporal gyrus, and the superior temporal gyrus. Conclusions: The present study found a number of specific brain areas that may be activated by otolith stimulation. Given the findings and source localization techniques (which required limited input from the investigator as to where the sources are believed to be located in the brain) used in the present study as well as the similarity in findings between studies employing galvanic stimuli, fMRI (functional magnetic resonance imaging), and scalp-recorded potentials in response to VEMP-eliciting stimuli, our study provides additional evidence that these brain regions are activated in response to stimuli that can be used clinically to evoke the VEMP.
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Murofushi, T., H. Ozeki, A. Inoue, and A. Sakata. "Does Migraine-Associated Vertigo Share a Common Pathophysiology With Meniere's Disease? Study With Vestibular-Evoked Myogenic Potential." Cephalalgia 29, no. 12 (December 2009): 1259–66. http://dx.doi.org/10.1111/j.1468-2982.2009.01860.x.

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To clarify if migraine-associated vertigo (MAV) and Meniere's disease (MD) share a common pathophysiology, vestibular-evoked myogenic potentials (VEMP) were measured in 11 patients with MAV, 11 with unilateral MD and eight healthy subjects. As acoustic stimuli, tone bursts (TB; 250, 500, 1000 and 2000 Hz) were presented. In healthy subjects, 500-Hz TB evoked the largest amplitude. To quantify this tendency, 500-1000 VEMP slope was calculated, and 500-1000 VEMP slope was the smallest on the affected side of MD patients. Among the 11 MD patients, five had significantly decreased 500-1000 VEMP asymmetry (shift of the tuning to 1000 Hz). Three of the 11 MAV patients also showed a significantly decreased 500-1000 VEMP slope. This finding suggests that MAV might share a common pathophysiology with MD. In addition to this finding, four of the other eight MAV patients showed prolonged p13 latencies. This suggests that MAV could consist of patients with different lesion sites.
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43

Fujiwara, Keishi, Shinya Morita, Kimiko Hoshino, Atsushi Fukuda, Yuji Nakamaru, and Akihiro Homma. "Evaluation of Vestibular Functions in Patients with Vogt-Koyanagi-Harada Disease." Audiology and Neurotology 22, no. 3 (2017): 190–95. http://dx.doi.org/10.1159/000481426.

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Vogt-Koyanagi-Harada (VKH) disease is an idiopathic, multisystem autoimmune disorder characterized by bilateral, diffuse granulomatous uveitis associated with neurological, audiovestibular, and dermatological manifestations. The purpose of this study is to investigate vestibular functions in patients with VKH disease. A total of 43 patients with VKH disease in Hokkaido University Hospital were enrolled in this study. Subjective symptoms such as dizziness or vertigo and the results of various vestibular examinations including nystagmus testing, caloric testing, and vestibular-evoked myogenic potential (VEMP) testing were investigated. Eight of 42 patients (19.0%) complained of subjective vestibular symptoms. On the other hand, 12 of 28 patients (42.9%) showed nystagmus, and 7 of 15 patients (46.7%) showed unilateral or bilateral weakness in the caloric test. VEMP testing was performed for 16 patients. Seven (43.8%) and 8 (50.0%) patients were evaluated as abnormal in cervical VEMP and ocular VEMP testing, respectively. The rate of detection of nystagmus was significantly higher than that of subjective symptoms. As vestibular dysfunction in patients with VKH disease cannot be detected through history taking alone, nystagmus testing, caloric testing, and VEMP testing should be performed to evaluate vestibular functions associated with VKH disease. It is considered that abnormal VEMP findings are associated with otolith organ dysfunction.
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Janky, Kristen L., and Neil Shepard. "Vestibular Evoked Myogenic Potential (VEMP) Testing: Normative Threshold Response Curves and Effects of Age." Journal of the American Academy of Audiology 20, no. 08 (September 2009): 514–22. http://dx.doi.org/10.3766/jaaa.20.8.6.

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Background: Vestibular evoked myogenic potential (VEMP) testing has gained increased interest in the diagnosis of a variety of vestibular etiologies. P13/N23 latency, amplitude and threshold response curves have been used to compare pathologic groups to normal controls. Appropriate characterization of these etiologies requires normative data across the frequency spectrum and age range. Purpose: The objective of the current study was to test the hypothesis that significant changes in VEMP responses occur as a function of increased age across all test stimuli as well as characterize the VEMP threshold response curve across age. Research Design: This project incorporated a prospective study design using a sample of convenience. Openly recruited subjects were assigned to groups according to age. Study Sample: Forty-six normal controls ranging between 20 and 76 years of age participated in the study. Participants were separated by decade into five age categories from 20 to 60 plus years. Normal participants were characterized by having normal hearing sensitivity, no history of neurologic or balance/dizziness involvement, and negative results on a direct office vestibular examination. Intervention: VEMP responses were measured at threshold to click and 250, 500, 750, and 1000 Hz tone burst stimuli and at a suprathreshold level to 500 Hz toneburst stimuli at123 dB SPL. Data Collection and Analysis: A mixed group factorial ANOVA (analysis of variance) and linear regression were performed to examine the effects of VEMP characteristics on age. Results: There were no significant differences between ears for any of the test parameters. There were no significant differences between age groups for n23 latency or amplitude in response to any of the stimuli. Significant mean differences did exist between age groups for p13 latency (250, 750, and 1000 Hz) and threshold (500 and 750 Hz). Age was significantly correlated with VEMP parameters. VEMP threshold was positively correlated (250, 500, 750, 1000 Hz); and amplitude was negatively correlated (500 Hz maximum). The threshold response curves revealed best frequency tuning at 500 Hz with the highest thresholds in response to click stimuli. However, this best frequency tuning dissipated with increased age. VEMP response rates also decreased with increased age. Conclusion: We have demonstrated that minor differences in VEMP responses occur with age. Given the reduced response rates and flattened frequency tuning curve for individuals over the age of 60, frequency tuning curves may not be a good diagnostic indicator for this age group.
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David, Ricardo, and José F. Colafêmina. "Potenciais miogênico evocados vestibulares (VEMP): uma revisão bibliográfica." Revista Brasileira de Otorrinolaringologia 68, no. 1 (May 13, 2002): 113–17. http://dx.doi.org/10.1590/s0034-72992002000100020.

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Este artigo traz um breve resumo da literatura referente ao assunto VEMP, compreendendo os tópicos essenciais indicativos para uma pesquisa mais aprofundada. Para tanto, foram revistos 80 artigos e uma tese com referência direta ao tema, compondo uma historiação desde o descobrimento, desenvolvimento de técnicas de aquisição, aplicações clínicas e posição atual.
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46

Isaradisaikul, Suwicha, Carol Ann Foster, Sandra Gabbard, and Darcy Strong. "R081: VEMP Absence, Caloric Weakness, and Hearing Loss." Otolaryngology–Head and Neck Surgery 135, no. 2_suppl (August 2006): P132. http://dx.doi.org/10.1016/j.otohns.2006.06.834.

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47

Angeli, Simon I., and Stefania Goncalves. "Cervical VEMP tuning changes by Meniere's disease stages." Laryngoscope Investigative Otolaryngology 4, no. 5 (September 18, 2019): 543–49. http://dx.doi.org/10.1002/lio2.309.

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48

Murofushi, Toshihisa. "Clinical application of vestibular evoked myogenic potential (VEMP)." Auris Nasus Larynx 43, no. 4 (August 2016): 367–76. http://dx.doi.org/10.1016/j.anl.2015.12.006.

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49

Colebatch, J. G., S. Govender, and S. M. Rosengren. "Two distinct patterns of VEMP changes with age." Clinical Neurophysiology 124, no. 10 (October 2013): 2066–68. http://dx.doi.org/10.1016/j.clinph.2013.04.337.

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50

Fredén Jansson, Karl-Johan, Bo Håkansson, Sabine Reinfeldt, Ann-Charlotte Persson, and Måns Eeg-Olofsson. "Bone Conduction Stimulated VEMP Using the B250 Transducer." Medical Devices: Evidence and Research Volume 14 (July 2021): 225–37. http://dx.doi.org/10.2147/mder.s317072.

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