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Nilsen KS, Nordahl SHG, Berge JE, Dhayalan D, Goplen FK. Vestibular Tests Related to Tumor Volume in 137 Patients With Small to Medium-Sized Vestibular Schwannoma. Otolaryngol Head Neck Surg 2023; 169:1268-1275. [PMID: 37337472 DOI: 10.1002/ohn.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/06/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE The video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) are new methods for measuring peripheral vestibular function. The objectives of this study were to compare these tests and the traditionally used caloric test in patients with small and medium-sized untreated vestibular schwannoma (VS) and to measure the correlation between the tests' results and tumor volume. STUDY DESIGN National cross-sectional study. SETTING Tertiary university clinic. METHODS Prevalence of abnormal cVEMP, oVEMP, caloric test, and 6-canal vHIT results on the tumor side and the nontumor side were compared and related to tumor volume with regression analyses in 137 consecutive VS patients assigned to a wait-and-scan protocol in the period 2017 to 2019. RESULTS The sensitivity of 6-canal vHIT, caloric test, cVEMP, and oVEMP to detect vestibulopathy in VS patients was 51%, 47%, 39%, and 25%, respectively. Normal tests were found in 21% of the patients. The results of vHIT and caloric test were related to tumor volume, but this was not found for cVEMP and oVEMP. CONCLUSION The caloric test and 6-canal vHIT showed the highest sensitivity in detecting vestibulopathy in untreated VS patients. vHIT, and particularly the posterior canal, was limited with a high prevalence of abnormal results on the nontumor side. A combination of cVEMP and caloric test was favorable in terms of a relatively high sensitivity and low prevalence of abnormal results on the nontumor side. Larger tumors had a higher rate of pathology on caloric testing and vHIT.
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Affiliation(s)
- Kathrin Skorpa Nilsen
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Stein Helge Glad Nordahl
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Jan Erik Berge
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Dhanushan Dhayalan
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Frederik Kragerud Goplen
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
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Azami M, Fushiki H, Tsunoda R, Kamo T, Ogihara H, Tanaka R, Kato T. Clinical features of persistent postural-perceptual dizziness with isolated otolith dysfunction as revealed by VEMP and vHIT findings. Front Neurol 2023; 14:1129569. [PMID: 37006499 PMCID: PMC10060848 DOI: 10.3389/fneur.2023.1129569] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundPersistent postural-perceptual dizziness (PPPD) is a relatively new disease entity, with diagnostic criteria published by the Bárány Society. PPPD is often preceded by a peripheral or central vestibular disorder. It is not clear how coexisting deficits due to preceding vestibular disorders affect PPPD symptoms.ObjectiveThis study aimed to characterize the clinical features of PPPD with or without isolated otolith dysfunction using vestibular function tests.MethodsThe study included 43 patients (12 males and 31 females) who were diagnosed with PPPD and completed oculomotor-vestibular function tests. The Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), Niigata PPPD Questionnaire (NPQ), and Romberg test for stabilometry were examined. The 43 patients with PPPD were classified into four categories based on vestibular evoked myogenic potential (VEMP) and video head impulse test (vHIT) results: normal function for both semicircular canals and otoliths (normal), isolated otolith dysfunction (iOtoDys), isolated semicircular canal dysfunction (iCanalDys), and dysfunction of both otoliths and semicircular canals (OtoCanalDys).ResultsAmong the 43 patients with PPPD, the iOtoDys group was the largest (44.2%), followed by the normal group (37.2%), iCanalDys group (9.3%), and OtoCanalDys group (9.3%). Eight of the 19 iOtoDys patients showed both abnormal cVEMP and oVEMP responses unilaterally or bilaterally (both sacculus and utriculus damage type), whereas 11 showed either an abnormal cVEMP or an abnormal oVEMP response (either sacculus or utriculus damage type). In a three-group comparison of the both sacculus and utriculus damage type, the either sacculus or utriculus damage type, and the normal group, the mean total, functional, and emotional DHI scores were significantly higher for the both sacculus and utriculus damage type than for the either sacculus or utriculus damage type. The Romberg ratio, a measure of stabilometry, was significantly higher for the normal group than for the both sacculus and utriculus damage type and the sacculus or utriculus damage type in the iOtoDys group.ConclusionsThe coexistence of sacculus and utriculus damage may exacerbate dizziness symptoms in patients with PPPD. Determining the presence and extent of otolith damage in PPPD may provide useful information on the pathophysiology and treatment strategies of PPPD.
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Affiliation(s)
- Masato Azami
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Japan University of Health Sciences, Satte, Japan
| | - Hiroaki Fushiki
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- *Correspondence: Hiroaki Fushiki
| | - Reiko Tsunoda
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
| | - Tomohiko Kamo
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Takasaki, Japan
| | - Hirofumi Ogihara
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Ryozo Tanaka
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Mejiro University, Saitama, Japan
| | - Takumi Kato
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
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Zwierzyńska K, Lachowska M, Sokołowski J, Niemczyk K. Cervical and ocular vestibular evoked myogenic potentials in determining nerve division involvement in patients with a tumor located in the internal auditory canal. Auris Nasus Larynx 2020; 48:383-393. [PMID: 32972774 DOI: 10.1016/j.anl.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/20/2020] [Accepted: 09/11/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study aimed at the analysis of the parameters of acoustic cervical and ocular vestibular evoked myogenic potentials (AC-cVEMP and AC-oVEMP) response in patients with a confirmed tumor located in the internal auditory canal. It also aimed to assess to what degree a combination of these tests may be of benefit in the preoperative indication of the affected nerve division via preoperative determination whether the tumor originated from the superior or inferior division of the vestibular nerve, both divisions, or if it originated from a different nerve in the internal auditory canal. METHODS The study group included 50 patients. Preoperative MRI scans were used to measure tumor diameter. AC-cVEMP and AC-oVEMP testing were performed before tumor resection. The surgeon was asked for a detailed description of the tumor origin. RESULTS The corrected amplitude of cVEMP was significantly lower on the tumor side than on the non-affected side and in the control group. The corrected Asymmetry Ratio (AR) of cVEMPs in patients with the tumor was significantly elevated above the reference values with the mean being 58.29% and the mean AR of oVEMPs in patients the tumor was 71.78% which made both results significantly higher than in the control group. Neither cVEMP nor oVEMP latency was significantly correlated with tumor size. Data obtained from cVEMP and oVEMP tests was an effective indicator of tumor origin in 74% of patients showing which division (or both divisions) of the VIIIth nerve was affected in comparison with information obtained from the surgeon. CONCLUSIONS The combined use of AC-cVEMP and AC-oVEMP tests may be useful in surgical planning in patients the tumor located in the internal auditory canal, providing a highly probable determination of the division of the affected nerve. Such information is valuable for the surgeon as it offers additional knowledge about the tumor before the procedure. cVEMP and oVEMP results may not be used as the basis for the calculation of tumor size in patients.
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Affiliation(s)
- Klaudyna Zwierzyńska
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa (Warsaw), Poland
| | - Magdalena Lachowska
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa (Warsaw), Poland.
| | - Jacek Sokołowski
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa (Warsaw), Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa (Warsaw), Poland
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Tarnutzer AA, Bockisch CJ, Buffone E, Weber KP. Vestibular mapping in patients with unilateral peripheral-vestibular deficits. Neurology 2020; 95:e2988-e3001. [PMID: 32913014 DOI: 10.1212/wnl.0000000000010812] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/10/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To test the hypothesis that patterns of semicircular canal (SCC) and otolith impairment in unilateral vestibular loss depend on the underlying disorders, we analyzed peripheral-vestibular function of all 5 vestibular sensors. METHODS For this retrospective case series, we screened the hospital video-head-impulse test database (n = 4,983) for patients with unilaterally impaired SCC function who also received ocular vestibular-evoked myogenic potentials and cervical vestibular-evoked myogenic potentials (n = 302). Frequency of impairment of vestibular end organs (horizontal/anterior/posterior SCC, utriculus/sacculus) was analyzed with hierarchical cluster analysis and correlated with the underlying etiology. RESULTS Acute vestibular neuropathy (AVN) (37.4%, 113 of 302), vestibular schwannoma (18.2%, 55 of 302), and acute cochleovestibular neuropathy (6.6%, 20 of 302) were most frequent. Horizontal SCC impairment (87.4%, 264 of 302) was more frequent (p < 0.001) than posterior (47.4%, 143 of 302) and anterior (37.8%, 114 of 302) SCC impairment. Utricular damage (58%, 175 of 302) was noted more often (p = 0.003) than saccular impairment (32%, 98 of 302). On average, 2.6 (95% confidence interval 2.48-2.78) vestibular sensors were deficient, with higher numbers (p ≤ 0.017) for acute cochleovestibular neuropathy and vestibular schwannoma than for AVN, Menière disease, and episodic vestibular syndrome. In hierarchical cluster analysis, early mergers (posterior SCC/sacculus; anterior SCC/utriculus) pointed to closer pathophysiologic association of these sensors, whereas the late merger of the horizontal canal indicated a more distinct state. CONCLUSIONS While the extent and pattern of vestibular impairment critically depended on the underlying disorder, more limited damage in AVN and Menière disease was noted, emphasizing the individual range of loss of function and the value of vestibular mapping. Likely, both the anatomic properties of the different vestibular end organs and their vulnerability to external factors contribute to the relative sparing of the vertical canals and the sacculus.
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Affiliation(s)
- Alexander A Tarnutzer
- From the Cantonal Hospital Baden (A.A.T.); Faculty of Medicine (A.A.T., C.J.B., K.P.W.), University of Zurich; Departments of Neurology (A.A.T., C.J.B., E.B., K.P.W.), Ophthalmology (C.J.B., K.P.W.), and Otorhinolaryngology (C.J.B.), University Hospital Zurich; and Clinical Neuroscience Center (A.A.T., C.J.B., K.P.W.), Zurich, Switzerland.
| | - Christopher J Bockisch
- From the Cantonal Hospital Baden (A.A.T.); Faculty of Medicine (A.A.T., C.J.B., K.P.W.), University of Zurich; Departments of Neurology (A.A.T., C.J.B., E.B., K.P.W.), Ophthalmology (C.J.B., K.P.W.), and Otorhinolaryngology (C.J.B.), University Hospital Zurich; and Clinical Neuroscience Center (A.A.T., C.J.B., K.P.W.), Zurich, Switzerland
| | - Elena Buffone
- From the Cantonal Hospital Baden (A.A.T.); Faculty of Medicine (A.A.T., C.J.B., K.P.W.), University of Zurich; Departments of Neurology (A.A.T., C.J.B., E.B., K.P.W.), Ophthalmology (C.J.B., K.P.W.), and Otorhinolaryngology (C.J.B.), University Hospital Zurich; and Clinical Neuroscience Center (A.A.T., C.J.B., K.P.W.), Zurich, Switzerland
| | - Konrad P Weber
- From the Cantonal Hospital Baden (A.A.T.); Faculty of Medicine (A.A.T., C.J.B., K.P.W.), University of Zurich; Departments of Neurology (A.A.T., C.J.B., E.B., K.P.W.), Ophthalmology (C.J.B., K.P.W.), and Otorhinolaryngology (C.J.B.), University Hospital Zurich; and Clinical Neuroscience Center (A.A.T., C.J.B., K.P.W.), Zurich, Switzerland
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Greenwalt NL, Patterson JN, Rodriguez AI, Fitzpatrick D, Gordon KR, Janky KL. Bone Conduction Vibration Vestibular Evoked Myogenic Potential (VEMP) Testing: Reliability in Children, Adolescents, and Young Adults. Ear Hear 2020; 42:355-363. [PMID: 32701728 DOI: 10.1097/aud.0000000000000925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Bone conduction vibration (BCV) vestibular evoked myogenic potentials (VEMP) are clinically desirable in children for multiple reasons. However, no accepted standard exists for stimulus type and the reliability of BCV devices has not been investigated in children. The objective of the current study was to determine which BCV VEMP method (B-71, impulse hammer, or Mini-shaker) yields the highest response rates and reliability in a group of adults, adolescents, and children. It was hypothesized that the Mini-shaker would yield the highest response rates and reliability because it provides frequency specificity, higher output levels without distortion, and the most consistent force output as compared to the impulse hammer and B-71. DESIGN Participants included 10 child (ages 5 to 10), 11 adolescent (ages 11 to 18), and 11 young adult (ages 23 to 39) normal controls. Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) were measured in response to suprathreshold air-conducted, 500 Hz tone bursts and 3 types of BCV (B-71, impulse hammer, and Mini-shaker) across 2 test sessions to assess reliability. RESULTS For cVEMP, response rates were 100% for all methods in all groups with the exception of the adult group in response to the impulse hammer (95%). For oVEMP, response rates varied by group and BCV method. For cVEMP, reliability was highest in adults using the Mini-shaker, in adolescents using the impulse hammer, and in children using the B-71. For oVEMP, reliability was highest in adults using the Mini-shaker, in adolescents using the Mini-shaker or impulse hammer, and in children using the impulse hammer. Age positively correlated with air-conducted oVEMP amplitude, but not cVEMP amplitude or cVEMP corrected amplitude. Age negatively correlated with all BCV VEMP amplitudes with the exception of cVEMP corrected amplitude in response to the Mini-shaker. CONCLUSIONS All BCV methods resulted in consistent cVEMP responses (response rates 95 to 100%) with at least moderate reliability (intraclass correlation coefficient ≥ 0.5) for all groups. Similarly, all BCV methods resulted in consistent oVEMP responses (89 to 100%) with at least moderate reliability (intraclass correlation coefficient ≥ 0.5) except for the B-71 in adults.
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Affiliation(s)
- Nicole L Greenwalt
- The Ohio State University, Ohio, USA.,Boys Town National Research Hospital, Omaha, Nebraska, USA
| | | | - Amanda I Rodriguez
- Boys Town National Research Hospital, Omaha, Nebraska, USA.,University of Nebraska-Lincoln, Nebraska, USA
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Ogawa Y, Otsuka K, Inagaki T, Nagai N, Itani S, Kondo T, Kohno M, Suzuki M. Comparison of cervical vestibular evoked potentials evoked by air-conducted sound and bone-conducted vibration in vestibular Schwannoma patients. Acta Otolaryngol 2018; 138:898-903. [PMID: 30261801 DOI: 10.1080/00016489.2018.1490815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The vestibular evoked myogenic potential (VEMP) is associated with otolithic afferents and can be used to evaluate the function of the saccule and utricle. In this study, we compared cervical VEMP evoked by stimulation with Air-conducted sound (ACS) and bone-conducted vibration (BCV) to the forehead and investigated whether BCV can be used as a substitute for ACS. METHODS Data were obtained from 33 patients with vestibular schwannoma. Vestibular examinations were performed preoperatively. VEMP was obtained upon stimulation with ACS (ACS cVEMP) and BCV to the forehead using a minishaker (BCV cVEMP). Vestibular function was also analyzed using the caloric test and ocular VEMP (oVEMP) testing. oVEMP was measured using bone-conductive vibration to the forehead. The results of BCV cVEMP, ACS cVEMP, and oVEMP were compared by the caloric test. RESULTS Rates of patients with abnormal ACS cVEMP, BCV cVEMP, oVEMP, and caloric test results were 78.8%, 75.8%, 78.8%, and 69.7%, respectively. BCV cVEMP did not correlate with ACS cVEMP, but correlated with oVEMP and caloric test results. CONCLUSION BCV cVEMP did not correlate with ACS cVEMP. Therefore, BCV cVEMP cannot be used as a substitute for ACS cVEMP.
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Affiliation(s)
- Yasuo Ogawa
- Department of Otorhinolaryngology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Koji Otsuka
- Department of Otorhinolaryngology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Taro Inagaki
- Department of Otorhinolaryngology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Noriko Nagai
- Department of Otorhinolaryngology, Kosei Chuo General Hospital, Meguro-ku, Japan
| | - Shigeto Itani
- Department of Otorhinolaryngology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Takahito Kondo
- Department of Otorhinolaryngology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | | | - Mamoru Suzuki
- Department of Otorhinolaryngology, Tokyo Medical University, Shinjuku-ku, Japan
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Curthoys IS, MacDougall HG, Vidal PP, de Waele C. Sustained and Transient Vestibular Systems: A Physiological Basis for Interpreting Vestibular Function. Front Neurol 2017; 8:117. [PMID: 28424655 PMCID: PMC5371610 DOI: 10.3389/fneur.2017.00117] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/14/2017] [Indexed: 01/17/2023] Open
Abstract
Otolithic afferents with regular resting discharge respond to gravity or low-frequency linear accelerations, and we term these the static or sustained otolithic system. However, in the otolithic sense organs, there is anatomical differentiation across the maculae and corresponding physiological differentiation. A specialized band of receptors called the striola consists of mainly type I receptors whose hair bundles are weakly tethered to the overlying otolithic membrane. The afferent neurons, which form calyx synapses on type I striolar receptors, have irregular resting discharge and have low thresholds to high frequency (e.g., 500 Hz) bone-conducted vibration and air-conducted sound. High-frequency sound and vibration likely causes fluid displacement which deflects the weakly tethered hair bundles of the very fast type I receptors. Irregular vestibular afferents show phase locking, similar to cochlear afferents, up to stimulus frequencies of kilohertz. We term these irregular afferents the transient system signaling dynamic otolithic stimulation. A 500-Hz vibration preferentially activates the otolith irregular afferents, since regular afferents are not activated at intensities used in clinical testing, whereas irregular afferents have low thresholds. We show how this sustained and transient distinction applies at the vestibular nuclei. The two systems have differential responses to vibration and sound, to ototoxic antibiotics, to galvanic stimulation, and to natural linear acceleration, and such differential sensitivity allows probing of the two systems. A 500-Hz vibration that selectively activates irregular otolithic afferents results in stimulus-locked eye movements in animals and humans. The preparatory myogenic potentials for these eye movements are measured in the new clinical test of otolith function—ocular vestibular-evoked myogenic potentials. We suggest 500-Hz vibration may identify the contribution of the transient system to vestibular controlled responses, such as vestibulo-ocular, vestibulo-spinal, and vestibulo-sympathetic responses. The prospect of particular treatments targeting one or the other of the transient or sustained systems is now being realized in the clinic by the use of intratympanic gentamicin which preferentially attacks type I receptors. We suggest that it is valuable to view vestibular responses by this sustained-transient distinction.
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Affiliation(s)
- Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Hamish G MacDougall
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Pierre-Paul Vidal
- Cognition and Action Group, CNRS UMR8257, Centre Universitaire des Saints-Pères, University Paris Descartes, Paris, France
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von Kirschbaum C, Gürkov R. Audiovestibular Function Deficits in Vestibular Schwannoma. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4980562. [PMID: 27747231 PMCID: PMC5055915 DOI: 10.1155/2016/4980562] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/12/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Abstract
Introduction. Vestibular schwannomas (VS) are benign tumours of the vestibular nerve and can lead to hearing loss, tinnitus, vertigo, facial palsy, and brainstem compression. Audiovestibular diagnostic tests are essential for detection and treatment planning. Methods. Medline was used to perform a systematic literature review with regard to how audiovestibular test parameters correlate with symptoms, tumour size, and tumour location. Results. The auditory brainstem response can be used to diagnose retrocochlear lesions caused by VS. Since hearing loss correlates poorly with tumour size, a retrocochlear lesion is probably not the only cause for hearing loss. Also cochlear mechanisms seem to play a role. This can be revealed by abnormal otoacoustic emissions, despite normal ABR and new MRI techniques which have demonstrated endolymphatic hydrops of the inner ear. Caloric and head impulse tests show frequency specific dynamics and vestibular evoked myogenic potentials may help to identify the location of the tumour regarding the involved nerve parts. Conclusion. In order to preserve audiovestibular function in VS, it is important to stop the growth of the tumour and to avoid degenerative changes in the inner ear. A detailed neurotological workup helps to diagnose VS of all sizes and can also provide useful prognostic information.
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Affiliation(s)
- Constantin von Kirschbaum
- Department of Otorhinolaryngology and Head and Neck Surgery, Grosshadern Medical Center, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Gürkov
- Department of Otorhinolaryngology and Head and Neck Surgery, Grosshadern Medical Center, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
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Colebatch JG, Rosengren SM, Welgampola MS. Vestibular-evoked myogenic potentials. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:133-155. [PMID: 27638068 DOI: 10.1016/b978-0-444-63437-5.00010-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The vestibular-evoked myogenic potential (VEMP) is a short-latency potential evoked through activation of vestibular receptors using sound or vibration. It is generated by modulated electromyographic signals either from the sternocleidomastoid muscle for the cervical VEMP (cVEMP) or the inferior oblique muscle for the ocular VEMP (oVEMP). These reflexes appear to originate from the otolith organs and thus complement existing methods of vestibular assessment, which are mainly based upon canal function. This review considers the basis, methodology, and current applications of the cVEMP and oVEMP in the assessment and diagnosis of vestibular disorders, both peripheral and central.
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Affiliation(s)
- J G Colebatch
- Neuroscience Research Australia and Department of Neurology, Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, Australia.
| | - S M Rosengren
- Neurology Department, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney, Australia
| | - M S Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney Australia
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Weber KP, Rosengren SM. Clinical utility of ocular vestibular-evoked myogenic potentials (oVEMPs). Curr Neurol Neurosci Rep 2015; 15:22. [PMID: 25773001 DOI: 10.1007/s11910-015-0548-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the last years, vestibular-evoked myogenic potentials (VEMPs) have been established as clinical tests of otolith function. Complementary to the cervical VEMPs, which assess mainly saccular function, ocular VEMPs (oVEMPs) test predominantly utricular otolith function. oVEMPs are elicited either with air-conducted (AC) sound or bone-conducted (BC) skull vibration and are recorded from beneath the eyes during up-gaze. They assess the vestibulo-ocular reflex and are a crossed excitatory response originating from the inferior oblique eye muscle. Enlarged oVEMPs have proven to be sensitive for screening of superior canal dehiscence, while absent oVEMPs indicate a loss of superior vestibular nerve otolith function, often seen in vestibular neuritis (VN) or vestibular Schwannoma.
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Affiliation(s)
- Konrad P Weber
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland,
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Taylor RL, Kong J, Flanagan S, Pogson J, Croxson G, Pohl D, Welgampola MS. Prevalence of vestibular dysfunction in patients with vestibular schwannoma using video head-impulses and vestibular-evoked potentials. J Neurol 2015; 262:1228-37. [PMID: 25794859 DOI: 10.1007/s00415-015-7697-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/27/2015] [Accepted: 03/01/2015] [Indexed: 11/30/2022]
Abstract
We sought to investigate the utility of new non-invasive tests of semicircular-canal and otolith function that are usable in the neuro-otology office practice in patients with vestibular schwannoma. Fifty patients with vestibular schwannoma were assessed using a 5-item battery consisting of air-conducted cervical- and bone conducted ocular-vestibular-evoked myogenic potentials (AC cVEMPs and BC oVEMPs) and video head impulse testing (vHIT) in all three canal planes. VEMP asymmetry ratios, latencies, and vHIT gains were used to determine the test sensitivity, relationship with tumour size and the pattern of vestibular nerve involvement. The percentage of abnormalities for each of the five tests for the entire sample ranged between 36.2-61.7%. In 58.3 % of patients, test abnormalities were referable to both superior and inferior vestibular nerve divisions. Selective inferior nerve dysfunction was identified in 10.4% and superior nerve dysfunction in 12.5%. The remaining 18.8% of patients demonstrated a normal test profile. The sensitivity of the 5-item battery increased with tumour size and all patients with medium to large (>14 mm) schwannoma had at least two abnormal vestibular test result. Our results indicate that dysfunction of the superior and inferior vestibular nerve evolves in parallel for most patients with schwannoma. Unexplained vHIT and VEMP asymmetry should alert otologists and neurologists to undertake imaging in patients presenting with non-specific disequilibrium or vertigo.
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Affiliation(s)
- Rachael L Taylor
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, Australia
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Venhovens J, Meulstee J, Verhagen WIM. Vestibular evoked myogenic potentials (VEMPs) in central neurological disorders. Clin Neurophysiol 2015; 127:40-49. [PMID: 25649969 DOI: 10.1016/j.clinph.2014.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 11/28/2022]
Abstract
Several types of acoustic stimulation (i.e. tone bursts or clicks), bone-conducted vibration, forehead taps, and galvanic stimulation elicit myogenic potentials. These can be recorded in cervical and ocular muscles, the so called vestibular evoked myogenic potentials (VEMPs). The cervical VEMP (cVEMP) resembles the vestibulo-collic reflex and the responses can be recorded from the ipsilateral sternocleidomastoid muscle. The ocular VEMP resembles the vestibulo-ocular reflex and can be recorded from extra-ocular muscles by a surface electrode beneath the contralateral infraorbital margin. Initially, the literature concerning VEMPs was limited to peripheral vestibular disorders, however, the field of VEMP testing is rapidly expanding, with an increasing focus on central neurological disorders. The current literature concerning VEMP abnormalities in central neurological disorders is critically reviewed, especially regarding the methodological aspects in relation to quality as well as the clinical interpretation of the VEMP results. Suggestions for further research are proposed as well as some clinically useful indications.
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Affiliation(s)
- J Venhovens
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands.
| | - J Meulstee
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
| | - W I M Verhagen
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
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Pötter-Nerger M, Govender S, Deuschl G, Volkmann J, Colebatch JG. Selective changes of ocular vestibular myogenic potentials in Parkinson's disease. Mov Disord 2014; 30:584-9. [PMID: 25545048 DOI: 10.1002/mds.26114] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/15/2014] [Accepted: 10/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vestibular evoked myogenic potentials represent electrophysiological tools to measure vestibular reflex actions at different levels of the brainstem in Parkinson's disease. OBJECTIVE To investigate cervical and ocular vestibular myogenic potentials in Parkinsonian patients with mild disability. METHODS In 13 Parkinsonian patients and 13 age-matched healthy controls, cervical and ocular vestibular myogenic potentials were recorded after unilateral air-conducted tone bursts and bone-conducted stimuli delivered at the forehead or mastoids. RESULTS In contrast to relatively preserved cervical vestibular evoked myogenic potentials, ocular vestibular evoked myogenic potentials were significantly delayed and of reduced amplitude, particularly after impulsive stimulation in Parkinsonian patients. Levodopa had no significant effect on either type of response. CONCLUSION In mild to moderate Parkinson's disease, altered ocular vestibular myogenic potentials may indicate early functional involvement of the upper brainstem, in contrast to preserved lower brainstem function as reflected by normal cervical vestibular myogenic potentials.
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Affiliation(s)
- Monika Pötter-Nerger
- Department of Neurology, Christian-Albrecht-University, Kiel, Germany; Department of Neurology, University Hamburg-Eppendorf, Hamburg, Germany; Prince of Wales Clinical School and Neuroscience Research Australia, University New South Wales, Sydney, NSW 2052, Australia
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Chiarovano E, Darlington C, Vidal PP, Lamas G, de Waele C. The role of cervical and ocular vestibular evoked myogenic potentials in the assessment of patients with vestibular schwannomas. PLoS One 2014; 9:e105026. [PMID: 25137289 PMCID: PMC4138161 DOI: 10.1371/journal.pone.0105026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 07/18/2014] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To investigate the clinical utility of VEMPs in patients suffering from unilateral vestibular schwannoma (VS) and to determine the optimal stimulation parameter (air conducted sound, bone conducted vibration) for evaluating the function of the vestibular nerve. METHODS Data were obtained in 63 patients with non-operated VS, and 20 patients operated on VS. Vestibular function was assessed by caloric, cervical and ocular VEMP testing. 37/63 patients with conclusive ACS ocular VEMPs responses were studied separately. RESULTS In the 63 non-operated VS patients, cVEMPs were abnormal in 65.1% of patients in response to AC STB and in 49.2% of patients to AC clicks. In the 37/63 patients with positive responses from the unaffected side, oVEMPs were abnormal in 75.7% of patients with ACS, in 67.6% with AFz and in 56.8% with mastoid BCV stimulation. In 16% of the patients, VEMPs were the only abnormal test (normal caloric and normal hearing). Among the 26 patients who did not show oVEMP responses on either side with ACS, oVEMPs responses could be obtained with AFz (50%) and with mastoid stimulation (89%). CONCLUSIONS The VEMP test demonstrated significant clinical value as it yielded the only abnormal test results in some patients suffering from a unilateral vestibular schwannoma. For oVEMPs, we suggest that ACS stimulation should be the initial test. In patients who responded to ACS and who had normal responses, BCV was not required. In patients with abnormal responses on the affected side using ACS, BCV at AFz should be used to confirm abnormal function of the superior vestibular nerve. In patients who exhibited no responses on either side to ACS, BCV was the only approach allowing assessment of the function of the superior vestibular nerve. We favor using AFz stimulation first because it is easier to perform in clinical practice than mastoid stimulation.
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Affiliation(s)
- Elodie Chiarovano
- CESEM – CNRS UMR 8194 – Université Paris Descartes, Centre Universitaire des Saints-Pères, Paris, France
| | - Cynthia Darlington
- Department of Pharmacology and Toxicology, University of Otago Medical School, Dunedin, New Zealand
| | - Pierre-Paul Vidal
- CESEM – CNRS UMR 8194 – Université Paris Descartes, Centre Universitaire des Saints-Pères, Paris, France
| | - Georges Lamas
- ENT Department – Salpêtrière Hospital, Paris, France
| | - Catherine de Waele
- CESEM – CNRS UMR 8194 – Université Paris Descartes, Centre Universitaire des Saints-Pères, Paris, France
- ENT Department – Salpêtrière Hospital, Paris, France
- * E-mail:
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A Step Further in Vestibular Testing for Patients with Vestibular Schwannoma. Otol Neurotol 2014; 35:934-5. [DOI: 10.1097/mao.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Murofushi T. Vestibular evoked myogenic potential. World J Otorhinolaryngol 2014; 4:6-11. [DOI: 10.5319/wjo.v4.i2.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 01/25/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
Vestibular evoked myogenic potential (VEMP), is an electromyographic response of vestibular origin evoked by sound, vibration or electrical stimulation. VEMP is widely used as a clinical test of the otolith organs. Nowadays, two kinds of VEMP, cervical VEMP (cVEMP) and ocular VEMP (oVEMP) are clinically used. cVEMP is a test of sacculo-collic reflex while oVEMP is a test of utriculo-ocular reflex. Absence of responses, large interaural asymmetry of amplitudes, prolonged peak latencies, and abnormal thresholds of responses are regarded as abnormal responses. Clinical application to various diseases of the vestibular system was performed. Using VEMP, a new type of vestibular neuritis, inferior vestibular neuritis was established. A prominent feature of VEMP in Meniere’s disease is a shift of a preferred frequency in cVEMP. The whole aspects of VEMP findings in patients with benign paroxysmal positional vertigo are not clarified yet. Sensitivity of cVEMP to vestibular schwannoma was 80.0%, while specificity was 52.7%. Concerning diagnosis of superior canal dehiscence syndrome (SCDS), oVEMP to air-conducted sound is the most helpful. Augmentation of oVEMP responses is a prominent feature in SCDS. I also presented “idiopathic otolithic vertigo”, which I proposed as a new clinical entity based on VEMP findings. Some patients complained of lateral tilting sensation in the roll plane, or tilting or translational sensation in the pitch plane without rotatory vertigo. Majority of patients with these symptoms had absent or decreased responses of oVEMP and/or cVEMP. I proposed that these patients could be diagnosed as having “idiopathic otolithic vertigo”.
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