Role of the Frontal Sinus in Mediating Ocular Vestibular-Evoked Myogenic Potentials by Bone Vibration Stimuli Applied to the Forehead

Abstract

This study investigated ocular vestibular-evoked myogenic potential (oVEMP) tests via Fpz and Fz taps to assess the role of the frontal sinus in mediating oVEMP elicitation. Forty healthy subjects and 80 patients with Ménière disease (MD) underwent a series of oVEMP tests via a minishaker tapping at the Fpz and Fz sites in a randomized order. Response rates of oVEMP test via various tapping sites were compared. Dimensions of the frontal sinus were measured via CT scan. A significantly negative correlation between the age and height of the frontal sinus was noted, and the cutoff age for discriminating present and absent Fpz oVEMPs in MD patients was 52 years. Additionally, oVEMPs by Fpz tapping were more efficiently presented in males than females, likely because of the greater resonance by the larger height of the frontal sinus in males (3.88 ± 0.68 cm) than females (3.42 ± 0.67 cm). In conclusion, the height of the frontal sinus plays a role in mediating the elicitation of oVEMPs. The oVEMPs could be easily elicited by the first-order bone vibration (Fpz/Fz tapping) coupled with the second-order resonance effect (with a high extent of the frontal sinus). Thus, initial tapping at the Fpz site is suggested. If it fails, try the Fz site for screening the oVEMPs.

Inner Ear Damage by Firecracker Trauma

“…The operator held the vibrator by hand and tapped on the forehead. If no oVEMP was elicited, alternatively, tapping at the ipsilateral mastoid site (2 cm behind the opening of the external ear canal) was subsequently performed [Lin et al, 2017].…”

“…The norm for the asymmetry ratio was 16 ±12%, and those with an asymmetry ratio > 40% were interpreted as reduced response. In addition, those ears with absent oVEMP by forehead tapping but present oVEMPs by mastoid tapping were interpreted as reduced responses [Lin et al, 2017].…”

Resonance Effect of the Frontal Sinus on Ocular Vestibular-Evoked Myogenic Potential Recordings

“…During measurement, the inferior boundary was the top of nasion in sagittal view (Fig. 1B) and the most pneumatization in superior, anterior, posterior, right and left direction were all identified (Lin et al 2017). After marking process was completed, 3D images of bilateral frontal sinuses were automatically created with simultaneous volume calculation.…”

“…Restated, with frontal sinus volume >1.91 mL, oVEMP recordings via Fpz tapping may benefit from the resonance effect of the frontal sinus. Additionally, a previous study also suggested a relationship between larger frontal sinus volume and enhanced resonance effect in the skull (Lin et al 2017). Hence, healthy adults having both present Fpz-oVEMP and present Fz-oVEMP were compared.…”

“…A recent study has reported that elicitation of oVEMP depends on the first-order bone vibration coupled with the second-order resonance effect of the frontal sinus (Lin et al 2017). Restated, the importance of resonance in skull vibration means that oVEMPs elicited by bone vibration on the skull would vary depending on whether the resonance effect of the frontal sinus occurs (Wang et al 2012).…”