Bone Conduction Vibration Vestibular Evoked Myogenic Potential (VEMP) Testing: Reliability in Children, Adolescents, and Young Adults

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.

Cervical vestibular evoked myogenic potentials in healthy children: Normative values for bone and air conduction

“…Note that although the mean of the amplitude ratio is higher for males than females, but this difference falls within the 95% confidence limits. (12,13,22,23). In addition, the present study with a larger population provides more reliable values and better suited methods to the pediatric population.…”

“…In another study conducted in a population including children older than 5 years (n = 21) and adults (n = 9) c-VEMP amplitude was observed to decrease with age for BC but not AC (22). One study of 30 healthy children aged 3-11 years reported shorter AC c-VEMP latencies only in participants aged from 3 through 5 years (23).…”

Preoperative Evaluation of Otosclerosis: A National Survey of Otologists

“…VEMP test results can be confounded by even modest air-bone gaps (37,38). However, the recent introduction of VEMP testing delivered from bone conduction transducers can provide reliable results in such cases (39). Although routine utilization was low in this study (4.7%), we did find that 15.4% of practitioners with less than 5 years of experience used VEMP for preoperative assessment.…”

Cervical vestibular evoked myogenic potentials in 3-month-old infants: Comparative characteristics and feasibility for infant vestibular screening

“…On one hand, this may contribute to the different stimulus modality. Studies have reported that the mechanisms of ACS and BCV to activate otolith organs are different ( 57 ). It seems that ACS predominantly activates saccular afferents, while BCV stimulates both saccular and utricular afferent ( 58 ).…”