The effect of click repetition rate on vestibular evoked myogenic potential

Vestibular evoked myogenic potentials (VEMPs) generated by click stimulation and recorded on the sternocleidomastoid muscle have been used as a test of vestibular reflexes. Various parameters of the stimulus and recording setting have been studied. However, the influence of stimulation repetition rate of VEMPs and the most optimal stimulation rate for clinical use have not yet been defined. Each ear of 12 normal adults was tested at five different click stimulation rates (1 Hz, 5 Hz, 10 Hz, 15 Hz and 20 Hz) in random order. VEMP responses were evident in all 24 ears stimulated with 1 Hz, 5 Hz and 10 Hz. One ear was void of response at 15 Hz stimulation and nine ears at 20 Hz stimulation. The relative amplitude or the rank of amplitude in individual ears was higher at 1 Hz and 5 Hz stimulation, progressively decreasing as the stimulation rate increased. Comparisons of p13 and n23 latencies showed no difference among five stimulation rates, but variance was greatest at 20 Hz stimulation and smallest at 1 Hz. VEMPs generated at lower stimulation repetition rate seemed to be more marked and constant. However, with regard to examination time and patient compliance, a 5 Hz stimulus is advisable if both short examination time and higher signal/noise ratio are required.