No abstract

Highlights History and nystagmus profile paramount to diagnosis of benign positional vertigo. Randomised controlled trials demonstrate effectiveness of repositioning manoeuvres. Atypical positional nystagmus warrants vestibular function assessment and imaging.

Objectives: Small, excitatory surface potentials can sometimes be recorded from the contralateral sternocleidomastoid muscle (SCM) following monaural acoustic stimulation. Little is known about the physiological properties of these crossed reflexes. In this study, we sought the properties of crossed SCM responses and through comparison with other cochlear and vestibular myogenic potentials, their likely receptor origin. Design: Surface potentials were recorded from the ipsilateral and contralateral SCM and postauricular (PAM) muscles of 11 healthy volunteers, 4 patients with superior canal dehiscence and 1 with profound hearing loss. Air-conducted clicks of 105 dB nHL and tone bursts (250 to 4000 Hz) of 100 dB nHL were presented monaurally through TDH 49 headphones during head elevation. Click-evoked responses were recorded under two conditions of gaze in random order: gaze straight ahead and rotated hard toward the contralateral recording electrodes. Amplitudes (corrected and uncorrected) and latencies for crossed SCM responses were compared with vestibular (ipsilateral SCM) and cochlear (PAM) responses between groups and across the different recording conditions. Results: Surface waveforms were biphasic; positive-negative for the ipsilateral SCM, and negative-positive for the contralateral SCM and PAM. There were significant differences in the amplitudes and latencies (p = 0.004) for click responses of healthy controls across recording sites. PAM responses had the largest mean-corrected amplitudes (2.3 ± 2.8) and longest latencies (13.0 ± 1.2 msec), compared with ipsilateral (1.6 ± 0.5; 12.0 ± 0.7 msec) and contralateral (0.8 ± 0.3; 10.4 ± 1.0 msec) SCM responses. Uncorrected amplitudes and muscle activation for PAM increased by 104.4% and 46.8% with lateral gaze respectively, whereas SCM responses were not significantly affected. Click responses of patients with superior canal dehiscence followed a similar latency, amplitude, and gaze modulation trend as controls. SCM responses were preserved in the patient with profound hearing loss, yet all PAM were absent. There were significant differences in the frequency tuning of the three reflexes (p < 0.001). Tuning curves of healthy controls were flat for PAM and down sloping for ipsilateral and contralateral SCM responses. For superior canal dehiscence, they were rising for PAM and slightly down sloping for SCM responses. Conclusions: Properties of crossed SCM responses were similar, though not identical, to those of ipsilateral SCM responses and are likely to be predominantly vestibular in origin. They are unlikely to represent volume conduction from the PAM as they were unaffected by lateral gaze, were shorter in latency, and had different tuning properties. The influence of crossed vestibulo-collic pathways should be considered when interpreting cervical vestibular-evoked myogenic potentials recorded under conditions of binaural stimulation.