Research in Vestibular Science

Original Articles

Comparison of vestibular evoked myogenic potentials between low and high tone idiopathic sudden sensorineural hearing loss: Sang-Wook Park, Sang Yun Lee, Somi Ryu, Jung Woo Lee, Chae Dong Yim, Dong Gu Hur, Seong-Ki Ahn; Res Vestib Sci. 2024;23(1):11-15. Published online March 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.001

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Abstract PDF: Objectives
Vestibular evoked myogenic potentials (VEMP) have been reported to be useful in evaluating not only vestibular function but also the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL) patients. Even though low frequency, high frequency, and all frequency-involved ISSNHL groups tend to show varied clinical characteristics, there is a lack of data using VEMP results to analyze these subgroups. We investigated if the VEMP test is a valuable tool to predict recovery from hearing loss in association with different frequencies.
Methods
A total of 26 ISSNHL patients were divided into three different groups impaired with low tone (ascending type), high tone (descending type), and all tones (flat type) based on the initial audiograms. Each group included five, 10, and 11 patents, respectively, and their VEMP results were compared between the three subgroups.
Results
Abnormal VEMP results were found in five of the total 26 ISSNHL patients (19.2%). Two (40.0%), one (10.0%), and two (18.1%) patients of low tone, high tone, and all tone hearing loss groups, respectively, showed abnormal VEMP results. However, there was no statistically significant difference between the three groups.
Conclusions
Even though VEMP is known as a valuable tool for predicting the prognosis of ISSNHL patients, it does not seem to reflect frequency-sensitive aspects of ISSNHL.

Difference of Cervical Vestibular Evoked Myogenic Potentials between Bone-Conduction and Air-Conduction in Patients with Nonspecific Dizziness: Yong-Hwi An, Jung Ho Choi, Seung Yeon Jeon, Hyun Joon Shim; Res Vestib Sci. 2022;21(4):93-98. Published online December 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.4.93

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Abstract PDF: Objectives
This study was performed to evaluate the difference of the cervical vestibular evoked myogenic potentials (cVEMP) stimulated by bone-conduction (BC) and air-conduction (AC) in patients with nonspecific dizziness.
Methods
Twenty-eight dizzy patients (56 ears) and 15 subjects (30 ears) as normal control was enrolled. Responses of BC- and AC-cVEMP were recorded sequentially in both groups. cVEMP parameters including latencies, inter-latencies intervals, amplitudes, and interaural amplitude asymmetry were analyzed and compared.
Results
Among the patients with nonspecific dizziness, AC-cVEMP responses were clearly detected in all 56 ears while BC-cVEMP responses were detected in 32 ears (57.1%). Amplitudes of BC-cVEMP were significantly smaller than those of AC-cVEMP in all patients with BC-cVEMP response. There was no difference in latencies, inter-latencies intervals, and interaural amplitude asymmetry ratios between BC- and AC-cVEMP. There was no significant difference in BCand AC-cVEMP between the dizzy and control groups.
Conclusions
BC-cVEMP is not clinically useful in comparison to AC-cVEMP for the evaluation of nonspecific dizziness. An effective stimulation tool for BC is necessary to provoke more reliable responses of BC-cVEMP.

Review

Clinical Application and Updates on Vestibular Evoked Myogenic Potential: Proposal for Future Development in Vestibulopathy: Myung-Whan Suh, Jinil Kim; Res Vestib Sci. 2018;17(3):71-78. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.71

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Abstract PDF

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

Citations

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Difference of Cervical Vestibular Evoked Myogenic Potentials between Bone-Conduction and Air-Conduction in Patients with Nonspecific Dizziness
Yong-Hwi An, Jung Ho Choi, Seung Yeon Jeon, Hyun Joon Shim
Research in Vestibular Science.2022; 21(4): 93. CrossRef
A Case of Patient with Acute Peripheral Vestibulopathy Involving Isolated Posterior Semicircular Canal
Sang Kwon Im, Mee Hyun Song, Ja Won Gu, Dae Bo Shim
Research in Vestibular Science.2019; 18(4): 128. CrossRef

Original Articles

Cervical Vestibular Evoked Myogenic Potential as a Prognostic Indicator of Benign Paroxysmal Positional Vertigo Recurrence: Min Su Kang, Hyun Ju Han, Min Young Lee, Jae Yung Jung; Res Vestib Sci. 2017;16(2):53-56. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.53

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

Comparison of Video Head Impulse Test with Posterior Semicircular Canal Plane and Cervical Vestibular Evoked Myogenic Potential: Jin Su Park, Yong Woo Lee, Jung Yup Lee, Jae Ho Ban, Sun O Chang, Min-Beom Kim; Res Vestib Sci. 2016;15(3):74-79. Published online September 15, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.3.74

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Abstract PDF

Objective: Cervical vestibular evoked myogenic potential (cVEMP) is thought to be assessing the function of the saccule and inferior vestibular nerve. Therefore, cVEMP indirectly reflects the function of the posterior semicircular canal. Recently, the video head impulse test (vHIT) is considered as useful clinical tool to detect each semicircular canal dysfunction. Goal of this study was to evaluate and compare the results of cVEMP with posterior canal plane of vHIT (p-vHIT).
Methods
Retrospectively, we compared the results of cVEMP with p-vHIT in 43 patients who visited with dizziness. We analyzed the inter-test agreement of cVEMP with p-vHIT.
Results
Positive asymmetry of cVEMP was present in 37.2% (16/43), and no responses of both ears were identified in 16.3% (7/43). In p-vHIT analysis, unilateral positive was 27.9% (12/43), bilateral positive was 11.6% (5/43) and negative in both sides was 60.5% (26/43). The inter-test agreement between cVEMP and p-vHIT was 75.8% (25/33) as we considered even in lesion side. And, Fleiss’s kappa value showed a fair to good agreement (kappa value=0.559). In bilateral no response group (7 patients) in cVEMP, variable additional information could be obtained using p-vHIT.
Conclusion
cVEMP and p-vHIT showed relatively lower inter-test agreement than expected. But, p-vHIT could be easily performed, and give additional information for differential diagnosis.

Citations

Citations to this article as recorded by

Clinical Characteristics of the Patients with Dizziness after Car Accidents
Young Min Hah, Chul Won Yang, Sang Hoon Kim, Seung Geun Yeo, Moon Suh Park, Jae Yong Byun
Korean Journal of Otorhinolaryngology-Head and Nec.2017; 60(8): 390. CrossRef

Case Report

Preserved Ocular Vestibular Evoked Myogenic Potential to Head Tap in a Patient with Positive Head-Heave: Seong Hae Jeong, Carol A Foster, Darcy Strong; Res Vestib Sci. 2015;14(4):152-154.

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Abstract PDF: Vestibular function can be evaluated using various clinical and laboratory findings. Among these, head heave and vestibular evoked myogenic potential (VEMP) represent the otolith-ocular response, which is dynamic rather than static. There have been no reports of tap-evoked VEMP and head-heave in dizzy patients. Here, we report dissociation between ocular VEMP to head tap and the head heave test in acute vestibulopathy.

Review

Clinical Applications of Vestibular Evoked Myogenic Potentials: Jeong Yoon Choi; Res Vestib Sci. 2015;14(2):37-41.

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Abstract PDF: Cervical and ocular vestibular evoked myogenic potential (VEMP) may be one of the important clinical tools for evaluation of vestibular function. Cervical VEMP evaluates saccule and reflects the functional status of inferior vestibular nerve combining with vertical head impulse test. Ocular VEMP assesses utricle function and provides superior vestibular nerve function in addition to horizontal head impulse test and caloric test. Currently, the clinical implications of VEMP have been expanded to estimate disease severity and location, differentiate diverse vestibular disorders, and predict the prognosis. In present review, we discuss the findings of VEMP according to the lesion location from peripheral vestibular dysfunction to central vestibulopathy and disease characteristics from monophasic transient disorders to chronic progressive disorders.

Original Article

Otolith Function Tests in Patients with Orthostatic Dizziness: Su Hyun Ahn, Eun Ju Jeon, Yong Soo Park, Dong Hyun Kim, Inn Chul Nam; Res Vestib Sci. 2015;14(1):15-20.

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Abstract PDF: Background
and Objectives: Orthostatic dizziness (OD) is defined as when dizziness is provoked by standing up from a supine or sitting position. It is usually considered as being associated with orthostatic hypotension (OH). On the other hand, it is recently suggested that otolith organ dysfunction and impaired vestibulosympathetic reflex may account for development of OH and OD. Vestibular evoked myogenic potential (VEMP) and subjective visual vertical and horizontal tests (SVV/SVH) are tools for detecting otolith organ dysfunction. We assessed cervical VEMP (cVEMP) and SVV/SVH test results in the patients with OD to evaluate the relationship between OD and otolith organ function. Materials and Methods: Three hundred-eighty-seven patients who visited dizziness clinic were enrolled in this study. Seventy-three patients presented with OD (i.e., group O), while 314 patients did not present OD (i.e., group N). Vestibular function tests including cVEMP and SVV/SVH were performed. Results: cVEMP showed abnormal response in 47.9% of group O and 60.2% of group N. Abnormal SVV was found in 35.6% of group O and 31.5% of group N. Abnormal SVH was highly found in both group O and group N (30.1%, 27.1%). Conclusion: The values of SVV/SVH and cVEMP abnormality from both groups were not significantly different between the groups O and N. This finding suggests that otolithic function may not be related with OD.

Review

The Principle and Methodology of Vestibular Evoked Myogenic Potential: Min Young Lee, Myung Whan Suh; Res Vestib Sci. 2015;14(1):9-14.

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Abstract PDF: Vestibular evoked myogenic potential (VEMP) has developed as a broadly applied vestibular function test in clinics from its introduction in 1992. In the past, there was only one well known VEMP protocol, which is cervical VEMP, however recently ocular VEMP is also popular. Therefore, clarifying the VEMP recording protocol (cervical VEMP or ocular VEMP) before discussing the VEMP
result
has become essential. There is considerable difference regarding this VEMP test from other vestibular function tests. VEMP is thought to be assessing the functions of the otolith organs (utricle and saccule) which are evoked by acoustic stimulus. Cervical VEMP is valuable since this is the only available test method which could speculate the function of the saccule and inferior vestibular nerve. Still, there’s less clearly understood part regarding the central pathway of VEMP. However, many clinicians and researchers participating in vestibular research speculate that this functional test will have a more dominant role in the near future. Here we describe the basic principles and methodological considerations regarding VEMP recording.

Original Articles

Ocular Vestibular Evoked Myogenic Potential in Vestibular Neuritis Patients: Comparative Study with Cervical Vestibular Evoked Myogenic Potential and Subjective Visual Vertical: Su Il Kim, Young Min Ha, Sang Hoon Kim, Ji Hyun Chung, Moon Suh Park, Jae Yong Byun; Res Vestib Sci. 2014;13(4):102-107.

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Abstract PDF: Background
and Objectives: Subjective visual vertical (SVV) reflects utricle and superior vestibular neural functions, and cervical vestibular evoked myogenic potentials (cVEMP) reflect saccule and inferior vestibular neural functions. But, origin and characteristics of ocular VEMP (oVEMP) remain controversial, especially in case of evoked by air conducted sound (ACS). Thus, the aim of this study was to identify the origin and characteristics of oVEMP by comparing with various otolith function tests. Materials and Methods: Forty vestibular neuritis patients were enrolled from September 2012 to January 2013 in this study. We examined cVEMP, oVEMP using 500 Hz air-counducted sounds. And, we measured static and dynamic SVV. Results: Abnormal cVEMP responses were observed in 6 (15%) patients, and abnormal oVEMP responses were observed in 28 (70%) patients. Abnormal static and dynamic SVV were observed in 18 (45%), 35 (87.5%) patients, respectively. There was strong correlation between oVEMP and dynamic SVV (p=0.009). Conclusion: ACS oVEMP responses showed different tendency from cVEMP responses in vestibular neuritis patients, but similar tendency with results of dynamic SVV. The results suggest that origin of oVEMP is different from that of cVEMP and maybe utricle and superior vestibular neuron.

Predictive Value of Rectified Vestibular Evoked Myogenic Potential in Determining Lesion Side in Unilateral Vestibulopathy Patients: Hye Ran Son, Bong Jik Kim, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2013;12(4):121-126.

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Abstract: Background and Objectives: Rectified vestibular evoked myogenic potential (rVEMP) is a relatively new method that simultaneously measures the muscle contraction power during VEMP recording and corrects the difference of contraction power afterwards. Several studies showed rVEMP is more reliable than non-rectified VEMP (nVEMP). However, those studies evaluated usefulness of rVEMP in patients with normal vestibular function. Thus, we evaluate the effect of rectification to predict lesion side in unilateral vestibulopathy patients. Materials and Methods: One-hundred nine acute unilateral vestibulopathy patients whom VEMP were performed in were included retrospectively. We regarded hearing loss side as lesion side in sudden hearing loss (n=33), meniere’s disease (n=29) and in vestibular neuritis (n=45), the side of positive head thrust test with canal paresis >30% was regarded as a lesion side. We excluded bilateral vestibulopathy. The inter-aural amplitude difference (IAD) ratio was calculated by the nVEMP and rVEMP. Results: Mismatch rate between nVEMP and rVEMP was 36.61%, match rate was 49.54%, opposition rate was 13.76%. rVEMP predicted lesion side on 15 patients of mismatch group correctly, while nVEMP predicted lesion side on 25 patients of mismatch group. There was no significant difference in IAD ratio between nVEMP and rVEMP in patients who showed lesion side weakness on both nVEMP and rVEMP. But, the younger the patient was, the more chance of mismatch was significantly (p=0.03). Conclusion: There was no more corrective role in determining lesion side by rectification in unilateral vestibulopathy. Thus rVEMP might not be helpful for predicting lesion side in unilateral vestibulopathy.

Ocular Vestibular Evoked Myogenic Potentials Produced by Stimulation With Bone-conducted Vibration in Healthy Subjects: Tae Ho Yang, Sun Young Oh, Tae Woo Kim, Byoung Soo Shin, Jun Young Lee, Seul Ki Jeong, Man Wook Seo; Res Vestib Sci. 2012;11(3):97-104.

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Abstract: Background and Objectives: To provide the empirical basis for using ocular vestibular evoked myogenic potentials (oVEMPs) in response to bone-conducted vibration (BCV) stimulation to indicate vestibular function in normal subjects. Materials and Methods: In response to bone-conducted tone burst (90 dB nHL and 100 dB nHL with frequencies 500 Hz and 1,000 Hz, the oVEMPs were measured in 45 healthy controls. The early negative component (n10) of the oVEMP to brief BCV of the forehead and at each mastoid process is recorded by surface electromyography electrodes just beneath the eyes. We used a hand-held vibrator (Bruel and Kjaer 4810 Mini-Shaker) placed on the forehead, in the midline at the hairline (Fz) and at each mastoid process and quantified the individual differences in n10 magnitude, latency and symmetry to Fz and mastoid BCV at each frequency. Results: In normal subjects, n10 responses were symmetrical in the two eyes during Fz and both mastoid stimuli and the latencies of the onset were consistent among subjects. Response rate is similar between Fz and mastoid stimuli. However, at each stimulation site, response rate is higher on 500 Hz than on 1,000 Hz stimulation. During the mastoid stimuli, the onset latency is slightly shorter and amplitude is larger than the Fz stimuli. The average amplitudes decreased with age and average latency (to peak) increased slightly with increasing age. Conclusion: Clear oVEMP responses to bone-conducted Fz and mastoid stimuli were evoked from normal subjects. It is concluded that bone-conducted stimuli as well as air conduction can evoke myogenic potentials from the ocular muscles.

Cervical Vestibular Evoked Myogenic Potential and Ocular Vestibular Evoked Myogenic Potential in Patients With Vestibular Neuritis and Acute Viral Labyrinthitis: Il Ha Moon, Chan Goo Lee, Moo Kyun Park, Jong Dae Lee; Res Vestib Sci. 2012;11(3):92-96.

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Abstract: Background and Objectives: Vestibular neuritis predominantly affects the superior branch of the vestibular nerve, resulting in vertigo. Acute viral labyrinthitis occurs when an infection affects both vestibulo-cochlear nerve and labyrinth, resulting in hearing changes as well as vertigo. The purpose of study is to identify there is a difference of cervical vestibular evoked myogenic potentials (cVEMP) and ocular VEMP (oVEMP) in patients with vestibular neuritis and acute viral labyrinthitis. Materials and Methods: cVEMP and oVEMP tests using 500-Hz tone-burst stimuli were performed on patients with vestibular neuritis and acute viral labyrinthitis. Pure tone audiometry, caloric test and subjective visual vertical (SVV) were performed in all patients. We compared the VEMP results, SVV, caloric test in patients with vestibular neuritis and acute viral labyrinthitis. Results: Abnormal cVEMP responses were detected in 2 (20%) patients with vestibular neuritis and 5 (100%) patients with labyrinthitis. Abnormal oVEMP responses were detected in 9 patients (90%) with vestibular neuritis and 5 (100%) patients with labyrinthitis. oVEMP abnormalities is correlated with caloric test and subjective visual vertical in patients with vestibular neuritis and labyrinthits. Conclusion: Our results shows that the response of cVEMP and oVEMP between patients with vestibular neuritis and acute viral labyrinthitis is different. We can infer that oVEMP response to air-conducted sound is different vestibular origin compared to cVEMP and may originate from utricle.

The Relations of Otholith Function Tests and Risk Factors of Benign Paroxysmal Positional Vertigo: Jae Hoon Joung, Ji Yun Park, Hyeon Mi Park, Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2012;11(1):23-28.

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Abstract PDF: Background and Objectives: Since the liberated otoconia from the degenerated utricle has been postulated as the cause of the benign paroxysmal positional vertigo (BPPV), the relationship of the utricular function and the generation of BPPV have been studied. In addition, abnormal bone metabolism and vascular risk factors resulting insufficient circulation to utricle has been reported to be related to the utricular degeneration in BPPV. We investigated the relationship between the vascular risk factors, bone mineral density (BMD) and recurrence for the BPPV and otholith function tests of BPPV. Materials and Methods: Consecutive patients 84 with BPPV were recruited in a dizziness clinic. Caloric test, ocular vestibular evoked myogenic potentials (oVEMPs) were tested in all the patients in acute phase of BPPV. At the same time, vascular risk factors and BMD were performed. Vascular risk factors were history of hypertension, diabetes mellitus, hyperlipidemia and ischemic heart disease. All the data were analyzed for the relationship between abnormal results of vestibular function tests and the risk factors. Results: Patients 58 (69%) showed abnormal cervical VEMPs that were related to decreased bone density, having more than one vascular risk factor, and older age (>55 years). Abnormal oVEMPs were showed in 53 patients (63%) that were related to older age and vascular risk factors, but not statistically related to bone mineral density. Caloric tests failed to show any statistically significant results. Conclusion: We found abnormal results of cVEMPs and oVEMPs is related to the BMD, vascular risk factors and age. VEMPs could be used for the demonstration of presumptive otolith degeneration in BPPV.

Clinical Significance of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo: Won Sun Yang, Dae Bo Shim, Won Sang Lee; J Korean Bal Soc. 2008;7(1):38-42.

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Abstract PDF: Objectives: To investigate the vestibular evoked myogenic potentials (VEMP) results in benign paroxysmal positional vertigo (BPPV) patients and to verify its clinical applications in BPPV. Subjects and Methods: Forty-one patients with diagnosis of BPPV and 92 healthy volunteers who underwent VEMP testing. Patients were treated by canalith repositioning maneuvers according to the affected canal, and testing of VEMP was performed at diagnosis and after treatment. Results: VEMP results of BPPV patients showed prolonged p13 and n23 latencies compared with those of the control group, and we could not find any significant difference in VEMP latencies between patients with posterior and horizontal canal type of BPPV. The number of times that the maneuver was repeated did not correlate with the degree of latency prolongation, but in the “no response” group, the number of times was considerably greater than those in the “response” group. Conclusions: We found that VEMP latencies are increased in BPPV patients, which may signify neuronal degenerative changes in the macula of the saccule. When an extensive neuronal damage was suspected by VEMP results such as “no response” in VEMP, the disease progress showed a chronic and resistive course. Therefore, we propose that VEMP could be a useful method to determine a clinical prognosis of patients with BPPV.

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