Effects of High Sound Exposure During Air-Conducted Vestibular Evoked Myogenic Potential Testing in Children and Young Adults

Abstract

peSPL sound recordings in children's ears are significantly higher (~3 dB) than that in adults in response to high-intensity VEMP stimuli that are commonly practiced. Equivalent ECV contributes to peSPL delivered to the ear during VEMP testing and should be considered to determine safe acoustic VEMP stimulus parameters; children with smaller ECVs are at risk for unsafe sound exposure during routine VEMP testing, and stimuli should not exceed 120 dB SPL. Using 120 dB SPL stimulus level for children during VEMP testing yields no change to cochlear function and reliable VEMP responses.

Quantitative Vestibular Function Testing in the Pediatric Population

“…Normative oVEMP amplitude ranges for children are approximately 7.0 to 15.8 mV. 27,35,36 For children, oVEMP thresholds are approximately 110 to 115 dB SPL and similar to that of young adults, 38 which is consistent with findings from our laboratory. 29 Similar to cVEMP, oVEMPs are considered abnormal if responses are absent or low in amplitude; however, with third window disorders, large amplitudes and low thresholds are considered abnormal.…”

“…Pediatric normative amplitude ranges are approximately 208. 5 to 285.00 mV and do not differ significantly from young adults; 26,27 however, more variability in amplitude may be observed. 24 In children, normative cVEMP threshold responses have been reported at approximately 105 to 110 dB SPL, 26,28 which is consistent with data from our laboratory.…”

“…On average, children receive an additive approximately 3 dB (or more) in the ear compared with adults when presented with a 500-Hz tone burst at 125 dB SPL; therefore, children are exposed to 128 dB SPL (or as high as 132 dB SPL). 27 Equivalent ECV (as measured by diagnostic tympanometry) predicts the amount of SPL delivered to the ear. When using the European Union standards, children with ECVs less than or equal to 0.8 mL are at risk for unsafe sound energy exposure from VEMP testing.…”

“…When using the European Union standards, children with ECVs less than or equal to 0.8 mL are at risk for unsafe sound energy exposure from VEMP testing. 27,50,51 However, there are a few ways to reduce sound exposure for VEMP and thereby reduce adverse changes in cochlear function for children. First, clinicians can initiate testing at a lower presentation level.…”

Air-Conducted Vestibular Evoked Myogenic Potential Testing in Children, Adolescents, and Young Adults: Thresholds, Frequency Tuning, and Effects of Sound Exposure

“…Compared to the adult literature, less is known about normative c- and oVEMP thresholds and frequency tuning; additionally, the impact of sound exposure during threshold testing is undetermined in children. While the VEMP response is influenced by stimulus intensity, frequency, and duration, these parameters also impact the total sound pressure level (SPL) delivered to a child’s ear during testing when delivered via air- conduction (Thomas et al 2017; Rodriguez et al 2018). Further normative VEMP data and safety acoustic testing would guide pediatric VEMP testing practices so that they are both diagnostically and acoustically appropriate.…”