Objectives To determine whether cervical vestibular evoked myogenic potential (cVEMP) thresholds or ocular VEMP amplitudes are more sensitive and specific in the diagnosis of superior semicircular canal dehiscence syndrome (SCDS). Study design Prospective case-control study Setting Tertiary referral center Subjects and Methods 29 patients with SCDS (mean age 48y; range 31–66y) and 25 age-matched controls (mean age 48y; range 30–66y). Intervention(s) cVEMP and oVEMP in response to air-conducted sound (ACS). All patients underwent surgery for repair of SCDS. Main outcome measure(s) cVEMP thresholds; oVEMP n10 and peak-to-peak amplitudes. Results cVEMP threshold results showed sensitivity and specificity ranging from 80–100% for the diagnosis of SCDS. In contrast, oVEMP amplitudes demonstrated sensitivity and specificity >90%. Conclusions oVEMP amplitudes are superior to cVEMP thresholds in the diagnosis of SCDS.

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Background-Vestibular Evoked Myogenic Potential (VEMP) testing has gained increased interest in the diagnosis of a variety of vestibular etiologies. Comparisons of 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.

Objectives To characterize both cervical and ocular vestibular-evoked myogenic potential (cVEMP, oVEMP) responses to air-conducted sound (ACS) and midline taps in Ménière disease (MD), vestibular migraine (VM), and controls, as well as to determine if cVEMP or oVEMP responses can differentiate MD from VM. Study Design Prospective cohort study. Setting Tertiary referral center. Subjects and Methods Unilateral definite MD patients (n = 20), VM patients (n = 21) by modified Neuhauser criteria, and age-matched controls (n = 28). cVEMP testing used ACS (clicks), and oVEMP testing used ACS (clicks and 500-Hz tone bursts) and midline tap stimuli (reflex hammer and Mini-Shaker). Outcome parameters were cVEMP peak-to-peak amplitudes and oVEMP n10 amplitudes. Results Relative to controls, MD and VM groups both showed reduced click-evoked cVEMP (P < .001) and oVEMP (P < .001) amplitudes. Only the MD group showed reduction in tone-evoked amplitudes for oVEMP. Tone-evoked oVEMPs differentiated MD from controls (P = .001) and from VM (P = .007). The oVEMPs in response to the reflex hammer and Mini-Shaker midline taps showed no differences between groups (P > .210). Conclusions Using these techniques, VM and MD behaved similarly on most of the VEMP test battery. A link in their pathophysiology may be responsible for these responses. The data suggest a difference in 500-Hz tone burst–evoked oVEMP responses between MD and MV as a group. However, no VEMP test that was investigated segregated individuals with MD from those with VM.

There is a high incidence of vestibular loss in children with cochlear implants (CCI). However, the relationship between vestibular loss and various outcomes is unknown in children. Objectives 1) determine if age-related changes in peripheral vestibular tests occur; 2) quantify peripheral vestibular function in children with normal hearing (CNH) and CCI; 3) determine if amount of vestibular loss predicts visual acuity and balance performance. Design Eleven CCI and 12 CNH completed the following tests of vestibular function: ocular and cervical vestibular evoked myogenic potential (VEMP) to assess utricle and saccule function, and the video head impulse test (vHIT) to assess semicircular canal function. The relationship between amount of vestibular loss and the following balance and visual acuity outcomes was assessed: dynamic gait index, single leg stance, the sensory organization test, and tests of visual acuity, including dynamic visual acuity and the gaze stabilization test. Results 1) There were no significant age-related changes in peripheral vestibular testing with the exception of the n23 cervical VEMP latency, which was moderately correlated with age; 2) CCI had significantly higher rates of vestibular loss for each test of canal and otolith function; 3) Amount of vestibular loss predicted performance on single leg stance, the dynamic gait index, some conditions of the sensory organization test, and the dynamic visual acuity test. Age was also a contributing factor for predicting the performance of almost all outcomes. Conclusions Preliminarily, children with vestibular loss do not recover naturally to levels of their healthy peers, particularly with activities that utilize vestibular input; they have poorer visual acuity and balance function.

Along with gain, incorporating CS frequency in interpreting vHIT improves diagnostic accuracy. A repeatable CS (>81.89%) and/or low gain (<0.78) indicate vestibular loss.

Objective This study was designed to examine the age and gender distribution and the effect of menopause in a large cohort of participants diagnosed with benign paroxysmal positional vertigo (BPPV). Methods We analyzed 1,377 BPPV patients and surveyed 935 women from this group, all diagnosed at Boys Town National Research Hospital (BTNRH) over the last decade. Results A detailed age- and gender- distribution analysis of BPPV onset showed that aging had a profound impact on BPPV occurrence in both genders, and that peri-menopausal women were especially susceptible to BPPV (3.2:1 female to male). The latter is a novel finding and was confirmed by a direct survey of female BPPV patients (168 participated). In addition, there was a pronounced female preponderance (6.8:1) for BPPV in the teenage group despite the low prevalence in this age group. Conclusions The data suggest that hormonal fluctuations (especially during menopause) may increase the tendency to develop BPPV.

Numerous video head impulse test (vHIT) devices are available commercially; however, gain is not calculated uniformly. An evaluation of these devices/algorithms in healthy controls and patients with vestibular loss is necessary for comparing and synthesizing work that utilizes different devices and gain calculations.Using three commercially available vHIT devices/algorithms, the purpose of the present study was to compare: (1) horizontal canal vHIT gain among devices/algorithms in normal control subjects; (2) the effects of age on vHIT gain for each device/algorithm in normal control subjects; and (3) the clinical performance of horizontal canal vHIT gain between devices/algorithms for differentiating normal versus abnormal vestibular function.Prospective.Sixty-one normal control adult subjects (range 20–78) and eleven adults with unilateral or bilateral vestibular loss (range 32–79).vHIT was administered using three different devices/algorithms, randomized in order, for each subject on the same day: (1) Impulse (Otometrics, Schaumberg, IL; monocular eye recording, right eye only; using area under the curve gain), (2) EyeSeeCam (Interacoustics, Denmark; monocular eye recording, left eye only; using instantaneous gain), and (3) VisualEyes (MicroMedical, Chatham, IL, binocular eye recording; using position gain).There was a significant mean difference in vHIT gain among devices/algorithms for both the normal control and vestibular loss groups. vHIT gain was significantly larger in the ipsilateral direction of the eye used to measure gain; however, in spite of the significant mean differences in vHIT gain among devices/algorithms and the significant directional bias, classification of “normal” versus “abnormal” gain is consistent across all compared devices/algorithms, with the exception of instantaneous gain at 40 msec. There was not an effect of age on vHIT gain up to 78 years regardless of the device/algorithm.These findings support that vHIT gain is significantly different between devices/algorithms, suggesting that care should be taken when making direct comparisons of absolute gain values between devices/algorithms.