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Vestibular evoked myogenic potentials in practice: Methods, pitfalls and clinical applications
Sally M Rosengren1,2, James G Colebatch3, Allison S Young1,2
1Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, Australia.
Clinical Neurophysiology Practice
|April 6, 2019
Summary
Vestibular evoked myogenic potentials (VEMPs) offer valuable insights into otolith function. This review details VEMP methods, applications, and potential pitfalls for accurate neuro-otology diagnosis.
Area of Science:
- Neuroscience
- Otolaryngology
- Audiology
Background:
- Vestibular evoked myogenic potentials (VEMPs) are increasingly utilized in neuro-otology assessments.
- These otolith-dependent reflexes are crucial for evaluating vestibular and auditory pathway integrity.
- VEMPs aid in diagnosing conditions like superior semicircular canal dehiscence.
Purpose of the Study:
- To review and standardize Vestibular evoked myogenic potentials (VEMPs) methodology.
- To provide a theoretical background for commonly used VEMP techniques.
- To discuss common pitfalls and clinical applications of VEMPs.
Main Methods:
- Review of current Vestibular evoked myogenic potentials (VEMPs) stimulation and recording techniques.
- Analysis of air-conducted sound and bone-conducted vibration methods.
- Discussion of surface electrode placement for cervical and ocular VEMPs.
Main Results:
- Significant variability exists in current VEMP methodologies.
- Understanding VEMP methodology is crucial for accurate interpretation.
- VEMPs demonstrate clear diagnostic utility in specific vestibular disorders.
Conclusions:
- Standardized VEMP protocols are needed to reduce variability.
- VEMPs are a valuable tool for diagnosing otolith and vestibular system disorders.
- Further research into VEMP techniques will enhance clinical applications.
Keywords:
AC, air-conductedAR, asymmetry ratioAVS, acute vestibular syndromeBAER, brainstem auditory evoked potentialBC, bone-conductedBPV, benign positioning vertigoBVP, bilateral vestibulopathyCANVAS, cerebellar ataxia, neuropathy and vestibular areflexia syndromeDeg, degreesECG, electrocardiographicEEG, electroencephalographicEMG, electromyographic activity/electromyogramFL, force levelHL, hearing levelIO, inferior obliqueMD, Meniere’s diseaseMethodNIOSH, National Institutes of Occupational Safety and HealthOtolithPCS, posterior circulation strokePICA, posterior inferior cerebellar arteryPP, peak-to-peakRMS, root mean squareSCC, semicircular canalSCD, superior canal dehiscenceSCM, sternocleidomastoidSL, sensation levelSPL, sound pressure level, being the RMS value for a sinusoidSVH, subjective visual horizontalSoundUW, unilateral weaknessVEMPVEMP, vestibular evoked myogenic potentialVM, vestibular migraineVN, vestibular neuritisVS, vestibular schwannomaVestibularVibrationcVEMP, cervical vestibular evoked myogenic potentialdB, decibels, the logarithm of the relative power versus a referencedBA, decibels, measured using an “A” weightingnHL, normal hearing leveloVEMP, ocular vestibular evoked myogenic potentialpkFL, peak force levelpkSPL, peak sound pressure level (3 dB higher than RMS for a sinusoid)vHIT, video head impulse test
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