Vestibular evoked myogenic potential (VEMP) testing: normative threshold response curves and effects of age

Vestibular evoked myogenic potential (VEMP) testing has gained increased interest in the diagnosis of a variety of vestibular etiologies. P13/N23 latency, amplitude and threshold response curves have been used to compare pathologic groups to normal controls. Appropriate characterization of these etiologies requires normative data across the frequency spectrum and age range.

The objective of the current study was to test the hypothesis that significant changes in VEMP responses occur as a function of increased age across all test stimuli as well as characterize the VEMP threshold response curve across age.

This project incorporated a prospective study design using a sample of convenience. Openly recruited subjects were assigned to groups according to age.

Forty-six normal controls ranging between 20 and 76 years of age participated in the study. Participants were separated by decade into five age categories from 20 to 60 plus years. Normal participants were characterized by having normal hearing sensitivity, no history of neurologic or balance/dizziness involvement, and negative results on a direct office vestibular examination.

VEMP responses were measured at threshold to click and 250, 500, 750, and 1000 Hz tone burst stimuli and at a suprathreshold level to 500 Hz toneburst stimuli at123 dB SPL.

A mixed group factorial ANOVA (analysis of variance) and linear regression were performed to examine the effects of VEMP characteristics on age.

There were no significant differences between ears for any of the test parameters. There were no significant differences between age groups for n23 latency or amplitude in response to any of the stimuli. Significant mean differences did exist between age groups for p13 latency (250, 750, and 1000 Hz) and threshold (500 and 750 Hz). Age was significantly correlated with VEMP parameters. VEMP threshold was positively correlated (250, 500, 750, 1000 Hz); and amplitude was negatively correlated (500 Hz maximum). The threshold response curves revealed best frequency tuning at 500 Hz with the highest thresholds in response to click stimuli. However, this best frequency tuning dissipated with increased age. VEMP response rates also decreased with increased age.

We have demonstrated that minor differences in VEMP responses occur with age. Given the reduced response rates and flattened frequency tuning curve for individuals over the age of 60, frequency tuning curves may not be a good diagnostic indicator for this age group.