Ocular and cervical VEMPs: A study of 74 patients suffering from peripheral vestibular disorders

Chiarovano, Elodie; Zamith, F.; Vidal, Pierre‐Paul; Waele, Catherine de

doi:10.1016/j.clinph.2011.01.006

Cited by 42 publications

(48 citation statements)

References 43 publications

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“…51 Nevertheless, our results in MD patients are comparable with the results of other studies in patients with MD. 24–26,52,53 (3) In both MD and VM, there may be central changes in the otolith-ocular and otolith-cervical reflexes that decrease the gain of the reflexes to reduce the symptoms of vertigo that result during attacks of either disorder. The result in VEMP testing would therefore be similar between the groups, regardless of labyrinthine pathology.…”

Section: Discussionmentioning

confidence: 99%

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Can Vestibular‐Evoked Myogenic Potentials Help Differentiate Ménière Disease from Vestibular Migraine?

Zúñiga

Janky²,

Schubert³

et al. 2012

Otolaryngol.--head neck surg.

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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.

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Section: Discussionmentioning

confidence: 99%

“…24,26,27 The oVEMP, in response to taps on the midline forehead, putatively examines the utricle by measuring an excitatory potential from the inferior oblique muscle of the contralateral eye. 28–32 The exact vestibular endorgan(s) responsible for the sound-evoked oVEMP remains a subject of controversy.…”

mentioning

confidence: 99%

Can Vestibular‐Evoked Myogenic Potentials Help Differentiate Ménière Disease from Vestibular Migraine?

Zúñiga

Janky²,

Schubert³

et al. 2012

Otolaryngol.--head neck surg.

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“…VEMPs were recorded with a Nicolet Viking 4 apparatus (Nicolet Biomedical Inc., Madison, WI) with a 4-channel averaging capacity, as previously described [9]–[11].…”

Section: Methodsmentioning

confidence: 99%

The Role of Cervical and Ocular Vestibular Evoked Myogenic Potentials in the Assessment of Patients with Vestibular Schwannomas

et al. 2014

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ObjectivesTo investigate the clinical utility of VEMPs in patients suffering from unilateral vestibular schwannoma (VS) and to determine the optimal stimulation parameter (air conducted sound, bone conducted vibration) for evaluating the function of the vestibular nerve.MethodsData were obtained in 63 patients with non-operated VS, and 20 patients operated on VS. Vestibular function was assessed by caloric, cervical and ocular VEMP testing. 37/63 patients with conclusive ACS ocular VEMPs responses were studied separately.ResultsIn the 63 non-operated VS patients, cVEMPs were abnormal in 65.1% of patients in response to AC STB and in 49.2% of patients to AC clicks. In the 37/63 patients with positive responses from the unaffected side, oVEMPs were abnormal in 75.7% of patients with ACS, in 67.6% with AFz and in 56.8% with mastoid BCV stimulation. In 16% of the patients, VEMPs were the only abnormal test (normal caloric and normal hearing). Among the 26 patients who did not show oVEMP responses on either side with ACS, oVEMPs responses could be obtained with AFz (50%) and with mastoid stimulation (89%).ConclusionsThe VEMP test demonstrated significant clinical value as it yielded the only abnormal test results in some patients suffering from a unilateral vestibular schwannoma. For oVEMPs, we suggest that ACS stimulation should be the initial test. In patients who responded to ACS and who had normal responses, BCV was not required. In patients with abnormal responses on the affected side using ACS, BCV at AFz should be used to confirm abnormal function of the superior vestibular nerve. In patients who exhibited no responses on either side to ACS, BCV was the only approach allowing assessment of the function of the superior vestibular nerve. We favor using AFz stimulation first because it is easier to perform in clinical practice than mastoid stimulation.

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“…The data from studies of the OCR of patients after vestibular neuritis also show great variability, but here it is not known conclusively whether otolith function may have returned after the neuritis (96, 97). On the other hand, VEMPs do show a clear asymmetry after unilateral vestibular loss acutely and chronically after surgical unilateral loss (98, 99) and after neuritis (100). The asymmetrical VEMPs are preserved for many years and probably permanently after the vestibular loss (92, 101–103).…”

Section: Sustained and Transient Aspects Of Behavioral Responsesmentioning

confidence: 97%

Sustained and Transient Vestibular Systems: A Physiological Basis for Interpreting Vestibular Function

et al. 2017

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Otolithic afferents with regular resting discharge respond to gravity or low-frequency linear accelerations, and we term these the static or sustained otolithic system. However, in the otolithic sense organs, there is anatomical differentiation across the maculae and corresponding physiological differentiation. A specialized band of receptors called the striola consists of mainly type I receptors whose hair bundles are weakly tethered to the overlying otolithic membrane. The afferent neurons, which form calyx synapses on type I striolar receptors, have irregular resting discharge and have low thresholds to high frequency (e.g., 500 Hz) bone-conducted vibration and air-conducted sound. High-frequency sound and vibration likely causes fluid displacement which deflects the weakly tethered hair bundles of the very fast type I receptors. Irregular vestibular afferents show phase locking, similar to cochlear afferents, up to stimulus frequencies of kilohertz. We term these irregular afferents the transient system signaling dynamic otolithic stimulation. A 500-Hz vibration preferentially activates the otolith irregular afferents, since regular afferents are not activated at intensities used in clinical testing, whereas irregular afferents have low thresholds. We show how this sustained and transient distinction applies at the vestibular nuclei. The two systems have differential responses to vibration and sound, to ototoxic antibiotics, to galvanic stimulation, and to natural linear acceleration, and such differential sensitivity allows probing of the two systems. A 500-Hz vibration that selectively activates irregular otolithic afferents results in stimulus-locked eye movements in animals and humans. The preparatory myogenic potentials for these eye movements are measured in the new clinical test of otolith function—ocular vestibular-evoked myogenic potentials. We suggest 500-Hz vibration may identify the contribution of the transient system to vestibular controlled responses, such as vestibulo-ocular, vestibulo-spinal, and vestibulo-sympathetic responses. The prospect of particular treatments targeting one or the other of the transient or sustained systems is now being realized in the clinic by the use of intratympanic gentamicin which preferentially attacks type I receptors. We suggest that it is valuable to view vestibular responses by this sustained-transient distinction.

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Ocular and cervical VEMPs: A study of 74 patients suffering from peripheral vestibular disorders

Cited by 42 publications

References 43 publications

Can Vestibular‐Evoked Myogenic Potentials Help Differentiate Ménière Disease from Vestibular Migraine?

Can Vestibular‐Evoked Myogenic Potentials Help Differentiate Ménière Disease from Vestibular Migraine?

The Role of Cervical and Ocular Vestibular Evoked Myogenic Potentials in the Assessment of Patients with Vestibular Schwannomas

Sustained and Transient Vestibular Systems: A Physiological Basis for Interpreting Vestibular Function

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