Dataset Information

Optimization of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing Using an Impulse Hammer in Adults, Adolescents, and Children.

ABSTRACT:

Objective

To characterize cervical and ocular vestibular evoked myogenic potential (c- and oVEMP) responses using an impulse hammer (IH) in adults and pediatrics at standardized force levels and evaluate: the relationship of force level on VEMP amplitude, sternocleidomastoid (SCM) contraction on cVEMP amplitude, required number of tap stimuli, and subject comfort. Using these data, optimal testing parameters were selected.

Study design

Prospective study.

Setting

Tertiary referral center.

Patients

Seventy-eight healthy adults, adolescents, and children with no hearing or vestibular deficits.

Interventions

All subjects received c- and oVEMP testing using IH and 500 Hz tone burst air conduction stimuli. Adults received hard, medium, and soft force levels. Adolescents and children received medium and soft force levels. A comfort questionnaire was administered pre- and post-testing.

Main outcome measures

IH VEMP response parameters (response rates, latency, cVEMP pre-stimulus SCM Electromyography [EMG], and peak-to-peak amplitude) were assessed per force level. Subjective reporting for patient comfort was also assessed.

Results

VEMP response rates ranged from 92 to 100%. Force had a linear relationship with VEMP amplitude. SCM contraction had a linear relationship with raw cVEMP amplitude; however, dissipated with amplitude normalization. Force level did not impact the number of taps needed. A minimum peak force of 15 to 20 N, accounting for SCM contraction, and using a lower EMG monitoring limit for cVEMP is recommended to elicit reliable responses.

Conclusions

Overall, IH VEMP is appropriate and comfortable to use in adults and pediatrics and can be useful when an air conduction stimulus is contraindicated or not preferred.

SUBMITTER: Rodriguez AI

PROVIDER: S-EPMC7311239 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVES:Pediatric vestibular evaluations incorporate cervical and ocular vestibular evoked myogenic potential (c- and oVEMP, respectively) testing; however, in children, c- and oVEMP thresholds have been minimally investigated and frequency tuning is unknown. Children are also at risk for unsafe sound exposure secondary to VEMP. While it is unknown if VEMP threshold testing leads to cochlear changes, it is possible that this risk increases due to the increased number of trials needed to obtain a threshold. Obtaining VEMP thresholds at various frequencies in children provides further information for pediatric normative VEMP data. Assessing for cochlear changes after VEMP threshold testing would provide information on the safety of threshold VEMP testing in children. The objectives of this study were to (1) characterize c- and oVEMP thresholds in children, adolescents, and young adults with normal hearing using 500 and 750 Hz tone burst (TB) stimuli, (2) compare frequency tuning of 500 and 750 Hz TB, and (3) assess whether cochlear changes exist after VEMP threshold testing. It is hypothesized that children, adolescents, and young adults would not show age-related changes to the vestibular system. Therefore, reliable VEMP thresholds would be seen below maximum acoustical stimulation levels (e.g., <125 dB SPL) and frequency tuning will be similar for 500 and 750 Hz TB stimuli. DESIGN:Ten children (age 4-9), 10 adolescents (age 10-19), and 10 young adults (age 20-29) with normal hearing and tympanometry participated. All subjects received c- and oVEMP testing at maximum stimulation and threshold. To address frequency tuning, but not exceed recommended sound exposure allowance, subjects received a 500 Hz TB stimulus in one ear and a 750 Hz TB stimulus in the other ear. Subjects completed tympanometry pre-VEMP, and audiometric threshold testing, distortion product otoacoustic emission testing, and subjective questionnaire pre- and post-VEMP to study the effect of VEMP exposure on cochlear function for each stimulus frequency. RESULTS:(1) cVEMP thresholds were determined for both stimulus frequencies for children (500 Hz = 106 dB SPL; 750 Hz = 106 dB SPL), adolescents (500 Hz = 107.5 dB SPL; 750 Hz = 109.5 dB SPL), and young adults (500 Hz = 111.5 dB SPL; 750 Hz = 112 dB SPL). oVEMP thresholds were also obtained in response to both stimulus frequencies for children (500 Hz = 111.1 dB SPL; 750 Hz = 112.2 dB SPL), adolescents (500 Hz = 112.5 dB SPL; 750 Hz = 114.5 dB SPL), and young adults (500 Hz = 116 dB SPL; 750 Hz = 117 dB SPL). Similar thresholds were found between groups except for children who had significantly lower thresholds compared with adults for cVEMP (500 Hz: p = 0.002; 750 Hz: p = 0.004) and oVEMP (500 Hz: p = 0.01; 750 Hz: p = 0.02). In addition, equivalent ear-canal volume and VEMP thresholds were linearly correlated. (2) There was no significant effect of stimulus frequency on VEMP response rates, latencies, peak to peak amplitudes, or thresholds, suggesting similar frequency tuning for 500 and 750 Hz. (3) There were no significant effects of VEMP threshold testing on cochlear function for either stimulus frequency. CONCLUSIONS:Children, adolescents, and young adults show VEMP thresholds below high stimulation levels and had similar frequency tuning between 500 and 750 Hz. Use of 750 Hz could be regarded as the safer stimuli due to its shorter duration and thus reduced sound exposure. Children with smaller ear-canal volume had present responses at maximum stimulation and lower thresholds, suggesting that VEMP testing could be initiated at lower acoustic levels to minimize sound exposure and optimize testing.

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