Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes

Taylor, Rachael L.; Magnussen, John; Kwok, Belinda Y C; Young, Allison S.; Ihtijarevic, Berina; Argaet, Emma C; Reid, Nicole; Rivas, Cheryl; Pogson, Jacob M.; Rosengren, Sally M.; Hálmagyi, G. Michael; Welgampola, Miriam S.

doi:10.3389/fneur.2020.580184

Cited by 5 publications

(5 citation statements)

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“…Several studies have shown that symptomatic patients with near dehiscence have audiometric and vestibular testing results similar to normal non-dehiscent ears and significantly different from ears with frank dehiscence, suggesting that near dehiscence does not have the same effect on inner ear biomechanics (three studies with a total of 223 SCDS ears, 90 near dehiscence syndrome ears and 83 normal ears; only one study assessed SCDS ears vs. normal ears) ( 65 , 94 , 153 ). By contrast, there are reports of patients with near dehiscence demonstrating supranormal bone conduction thresholds, reduced cVEMP thresholds and increased oVEMP amplitudes, suggesting that these findings may be inconsistent in this patient population (11 and 86 ears) ( 152 , 154 ). ECochG has also been shown to be produce an increased SP to AP ratio among patients with near dehiscence ( 153 ).…”

Section: Challenges In Scds Managementmentioning

confidence: 77%

Current Trends, Controversies, and Future Directions in the Evaluation and Management of Superior Canal Dehiscence Syndrome

et al. 2021

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Patients with superior canal dehiscence syndrome (SCDS) can present with a range of auditory and/or vestibular signs and symptoms that are associated with a bony defect of the superior semicircular canal (SSC). Over the past two decades, advances in diagnostic techniques have raised the awareness of SCDS and treatment approaches have been refined to improve patient outcomes. However, a number of challenges remain. First, there is currently no standardized clinical testing algorithm for quantifying the effects of superior canal dehiscence (SCD). SCDS mimics a number of common otologic disorders and established metrics such as supranormal bone conduction thresholds and vestibular evoked myogenic potential (VEMP) measurements; although useful in certain cases, have diagnostic limitations. Second, while high-resolution computed tomography (CT) is the gold standard for the detection of SCD, a bony defect does not always result in signs and symptoms. Third, even when SCD repair is indicated, there is a lack of consensus about nomenclature to describe the SCD, ideal surgical approach, specific repair techniques, and type of materials used. Finally, there is no established algorithm in evaluation of SCDS patients who fail primary repair and may be candidates for revision surgery. Herein, we will discuss both contemporary and emerging diagnostic approaches for patients with SCDS and highlight challenges and controversies in the management of this unique patient cohort.

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Section: Challenges In Scds Managementmentioning

confidence: 77%

Current Trends, Controversies, and Future Directions in the Evaluation and Management of Superior Canal Dehiscence Syndrome

et al. 2021

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“…A possible contribution of the horizontal canal through the spread of regional mobilization of endolymphatic fluid has also been suggested in animals by Carey et al [41]. The implication of an asymmetric concomitant stimulation of otolith structures in SCD patients is otherwise corroborated in the clinical setting by abnormal otolithic test results (ipsilateral hyperexcitability of cVEMPs and oVEMPs) not only with sounds (air-conducted stimulations) but also after bone-conducted vibration stimulations [14,15,38,42].…”

Section: Characteristics Of the Nystagmus Obtained In Scd (Direction ...mentioning

confidence: 87%

“…Otolith tests (oVEMP, cVEMP) are currently described as the most efficient in SCD diagnosis; they are positive in 80-90% of cases with ACS stimulations [11,14] but also after BC stimulations [42].…”

Section: Svin As a Bone-conducted Tullio Phenomenon (Bctp)mentioning

confidence: 99%

Skull Vibration-Induced Nystagmus in Superior Semicircular Canal Dehiscence: A New Insight into Vestibular Exploration—A Review

Dumas,

Curthoys,

Castellucci

et al. 2024

Audiology Research

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The third window syndrome, often associated with the Tullio phenomenon, is currently most often observed in patients with a superior semicircular-canal dehiscence (SCD) but is not specific to this pathology. Clinical and vestibular tests suggestive of this pathology are not always concomitantly observed and have been recently complemented by the skull-vibration-induced nystagmus test, which constitutes a bone-conducted Tullio phenomenon (BCTP). The aim of this work was to collect from the literature the insights given by this bedside test performed with bone-conducted stimulations in SCD. The PRISMA guidelines were used, and 10 publications were included and analyzed. Skull vibration-induced nystagmus (SVIN), as observed in 55 to 100% of SCD patients, usually signals SCD with greater sensitivity than the air-conducted Tullio phenomenon (ACTP) or the Hennebert sign. The SVIN direction when the test is performed on the vertex location at 100 Hz is most often ipsilaterally beating in 82% of cases for the horizontal and torsional components and down-beating for the vertical component. Vertex stimulations are more efficient than mastoid stimulations at 100 Hz but are equivalent at higher frequencies. SVIN efficiency may depend on stimulus location, order, and duration. In SCD, SVIN frequency sensitivity is extended toward high frequencies, with around 400 Hz being optimal. SVIN direction may depend in 25% on stimulus frequency and in 50% on stimulus location. Mastoid stimulations show frequently diverging results following the side of stimulation. An after-nystagmus observed in 25% of cases can be interpreted in light of recent physiological data showing two modes of activation: (1) cycle-by-cycle phase-locked activation of action potentials in SCC afferents with irregular resting discharge; (2) cupula deflection by fluid streaming caused by the travelling waves of fluid displacement initiated by sound or vibration at the point of the dehiscence. The SVIN direction and intensity may result from these two mechanisms’ competition. This instability explains the SVIN variability following stimulus location and frequency observed in some patients but also discrepancies between investigators. SVIN is a recent useful insight among other bedside examination tests for the diagnosis of SCD in clinical practice.

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“…After excluding 607 duplicate articles, 408 articles were excluded due to the lack of a relevant of title and abstract. The full text of the remaining 27 articles was evaluated, and 18 studies were excluded due to the inclusion of other interventions or a lack of outcomes (1,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). Consequently, nine studies with 721 participants were finally included in the metaanalysis.…”

Section: Study Selectionmentioning

confidence: 99%

Usefulness of Cervical Vestibular-Evoked Myogenic Potentials for Diagnosing Patients With Superior Canal Dehiscence Syndrome: A Meta-Analysis

Kim

et al. 2021

Otology &Amp; Neurotology

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Objectives: To compare the diagnostic accuracy of cervical vestibular-evoked myogenic potential (cVEMP) for detecting superior canal dehiscence (SCD) syndrome to that of computed tomography (CT) and surgical findings. Databases Reviewed: PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database. Methods: Databases were searched up to July 2021. True positives, true negatives, false positives, and false negatives were extracted. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: Our search yielded nine studies with 721 patients. Including all cVEMP thresholds, the diagnostic odds ratio (DOR) was 32.8483 (95% confidence interval [CI]: 19.6577, 54.8900; I 2 ¼ 49.9%). The area under the summary receiver operating characteristic curve (AUC) was 0.879. Sensitivity and specificity were 0.8278 (95% CI: 0.7517, 0.8842; I 2 ¼ 76.4%) and 0.8824 (95% CI: 0.7859, 0.9387; I 2 ¼ 92.8%), respectively. However, there was a high degree of heterogeneity (I 2 ! 70%) due to the different VEMP threshold values used among the studies. In subgroup analysis, higher cVEMP threshold values showed higher sensitivity (threshold 85: 0.9568; threshold 65: 0.7691) but lower specificity (threshold 85: 0.5879; threshold 65: 0.8913). The threshold 75 subgroup showed moderate sensitivity of 0.7455, high specificity of 0.9526, and the highest DOR of 38.9062. The AUC of this subgroup was 0.894. Conclusions: cVEMP is a reliable adjunctive tool for the clinical diagnosis of SCD. Taking the balance between sensitivity and specificity into consideration, a cVEMP threshold value of 75 showed good diagnostic accuracy.

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Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes

Abstract: Conclusions: A two-step protocol of click AC oVEMP amplitudes and 125 Hz BC oVEMP latency measures optimizes the specificity of VEMP testing in SCD.

Cited by 5 publications

References 45 publications

Current Trends, Controversies, and Future Directions in the Evaluation and Management of Superior Canal Dehiscence Syndrome

Current Trends, Controversies, and Future Directions in the Evaluation and Management of Superior Canal Dehiscence Syndrome

Skull Vibration-Induced Nystagmus in Superior Semicircular Canal Dehiscence: A New Insight into Vestibular Exploration—A Review

Usefulness of Cervical Vestibular-Evoked Myogenic Potentials for Diagnosing Patients With Superior Canal Dehiscence Syndrome: A Meta-Analysis

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