scholarly journals A Comparison of Two Recording Montages for Ocular Vestibular Evoked Myogenic Potentials in Patients with Superior Canal Dehiscence Syndrome

2019 ◽  
Vol 30 (04) ◽  
pp. 293-301
Author(s):  
Kathryn Makowiec ◽  
Devin McCaslin ◽  
Kelsey Hatton
Keyword(s):  
Normal Control ◽  
Tertiary Care ◽  
Tone Burst ◽  
Vestibular Evoked Myogenic Potentials ◽  
Vestibular Evoked Myogenic Potential ◽  
Superior Semicircular Canal Dehiscence ◽  
Response Characteristics ◽  
Large Tertiary Care ◽  
Age Range ◽  
Canal Dehiscence

AbstractThe purpose of this investigation was to evaluate the sensitivity and specificity of the ocular vestibular evoked myogenic potential (oVEMP) using two electrode montages in patients with confirmed unilateral superior semicircular canal dehiscence syndrome (SCDS).This study evaluated oVEMP response characteristics measured using two different electrode montages from 12 unilateral SCDS ears and 36 age-matched control ears (age range = 23–66). The oVEMP responses were elicited using 500 Hz tone-burst air conduction stimuli presented at an intensity of 95 dB nHL and a rate of 5.1/sec. The two electrode montages used are described as an “infraorbital” montage and a “belly-tendon” montage.Balance function laboratory embedded in a large, tertiary care otology clinic.The belly-tendon electrode montage resulted in significantly larger amplitude responses than the infraorbital electrode montage for the ears with SCDS and the normal control ears. For both electrode montages the ear with SCDS exhibited a significantly larger amplitude response, ∼50% larger than the response amplitude from the normal control ear. The belly-tendon montage additionally produced larger median increases in amplitude compared with the infraorbital montage. Specifically, the median increase in oVEMP N1-P1 amplitudes using the belly-tendon montage was 39% greater in control ears, 76% greater in the SCDS ears, and 17% greater in the contralateral SCDS ears.The belly-tendon electrode montage yields significantly larger oVEMP amplitude responses for participants with SCDS and normal control participants.

scholarly journals Toward Optimizing cVEMP: 2,000-Hz Tone Bursts Improve the Detection of Superior Canal Dehiscence

2018 ◽  
Vol 23 (6) ◽  
pp. 335-344 ◽  
Author(s):  
Kimberley S. Noij ◽  
Barbara S. Herrmann ◽  
John J. Guinan Jr. ◽  
Steven D. Rauch
Keyword(s):  
Roc Analysis ◽  
Matched Control ◽  
Tone Burst ◽  
Sound Level ◽  
Vestibular Evoked Myogenic Potential ◽  
Superior Semicircular Canal Dehiscence ◽  
Myogenic Potential ◽  
Superior Canal Dehiscence ◽  
Inferior Vestibular Nerve ◽  
Canal Dehiscence

Background: The cervical vestibular evoked myogenic potential (cVEMP) test measures saccular and inferior vestibular nerve function. The cVEMP can be elicited with different frequency stimuli and interpreted using a variety of metrics. Patients with superior semicircular canal dehiscence (SCD) syndrome generally have lower cVEMP thresholds and larger amplitudes, although there is overlap with healthy subjects. The aim of this study was to evaluate which metric and frequency best differentiate healthy ears from SCD ears using cVEMP. Methods: Twenty-one patients with SCD and 23 age-matched controls were prospectively included and underwent cVEMP testing at 500, 750, 1,000 and 2,000 Hz. Sound level functions were obtained at all frequencies to acquire threshold and to calculate normalized peak-to-peak amplitude (VEMPn) and VEMP inhibition depth (VEMPid). Third window indicator (TWI) metrics were calculated by subtracting the 250-Hz air-bone gap from the ipsilateral cVEMP threshold at each frequency. Ears of SCD patients were divided into three groups based on CT imaging: dehiscent, thin or unaffected. The ears of healthy age-matched control subjects constituted a fourth group. Results: Comparing metrics at all frequencies revealed that 2,000-Hz stimuli were most effective in differentiating SCD from normal ears. ROC analysis indicated that for both 2,000-Hz cVEMP threshold and for 2,000-Hz TWI, 100% specificity could be achieved with a sensitivity of 92.0%. With 2,000-Hz VEMPn and VEMPid at the highest sound level, 100% specificity could be achieved with a sensitivity of 96.0%. Conclusion: The best diagnostic accuracy of cVEMP in SCD patients can be achieved with 2,000-Hz tone burst stimuli, regardless of which metric is used.

Superior semicircular canal dehiscence simulating otosclerosis

2003 ◽  
Vol 117 (7) ◽  
pp. 553-557 ◽  
Author(s):  
G. Michael Halmagyi ◽  
Swee T. Aw ◽  
Leigh A. McGarvie ◽  
Michael J. Todd ◽  
Andrew Bradshaw ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Vestibular Evoked Myogenic Potentials ◽  
Patient Needs ◽  
Vestibular Evoked Myogenic Potential ◽  
Superior Semicircular Canal Dehiscence ◽  
Superior Semicircular Canal ◽  
Acoustic Reflexes ◽  
Temporal Bones ◽  
Conductive Hearing ◽  
Canal Dehiscence

This is a report of a patient with an air-bone gap, thought 10 years ago to be a conductive hearing loss due to otosclerosis and treated with a stapedectomy. It now transpires that the patient actually had a conductive hearing gain due to superior semicircular canal dehiscence. In retrospect for as long as he could remember the patient had experienced cochlear hypersensitivity to bone-conducted sounds so that he could hear his own heart beat and joints move, as well as a tuning fork placed at his ankle. He also had vestibular hypersensitivity to air-conducted sounds with sound-induced eye movements (Tullio phenomenon), pressure-induced nystagmus and low-threshold, high-amplitude vestibular-evoked myogenic potentials. Furthermore some of his acoustic reflexes were preserved even after stapedectomy and two revisions. This case shows that if acoustic reflexes are preserved in a patient with an air-bone gap then the patient needs to be checked for sound- and pressure-induced nystagmus and needs to have vestibular-evoked myogenic potential testing. If there is sound- or pressure-induced nystagmus and if the vestibular-evoked myogenic potentials are also preserved, the problem is most likely in the floor of the middle fossa and not in the middle ear, and the patient needs a high-resolution spiral computed tomography (CT) of the temporal bones to show this.

Bilateral superior semicircular canal dehiscence: bilateral conductive hearing loss with subtle vestibular symptoms

2020 ◽  
Vol 13 (3) ◽  
pp. e233042
Author(s):  
Diogo Pereira ◽  
Abílio Leonardo ◽  
Delfim Duarte ◽  
Nuno Oliveira
Keyword(s):  
Hearing Loss ◽  
Semicircular Canal ◽  
Conductive Hearing Loss ◽  
Vestibular Evoked Myogenic Potentials ◽  
Caucasian Woman ◽  
Superior Semicircular Canal Dehiscence ◽  
Superior Semicircular Canal ◽  
Vestibular Symptoms ◽  
Conductive Hearing ◽  
Canal Dehiscence

Superior semicircular canal dehiscence is caused by a bone defect on the roof of the superior semicircular canal. The estimated prevalence when unilateral varies between 0.4% and 0.7% and is still unknown when bilateral. Patients may present with audiologic and vestibular symptoms that may vary from asymptomatic to disabling. We report a case of a 72-year-old Caucasian woman presented to otolaryngology department reporting imbalance, bilateral pulsatile tinnitus, hypoacusis while being very sensitive to certain sounds. Physical examination was unremarkable, except for the Rinne test that was negative in both sides. The patient underwent an audiometry revealing a mild bilateral conductive hearing loss. A temporal bone CT scan was performed which evidenced bilateral superior semicircular canal dehiscence. Cervical vestibular evoked myogenic potentials and electrocochleography confirmed diagnosis. Although rare, superior semicircular canal dehiscence shall be considered in conductive hearing loss with vestibular symptoms.

Comparison of vestibular evoked myogenic potentials elicited by click and short duration tone burst stimuli

2010 ◽  
Vol 125 (4) ◽  
pp. 343-347 ◽  
Author(s):  
K Kumar ◽  
S Kumar Sinha ◽  
A Kumar Bharti ◽  
A Barman
Keyword(s):  
Short Duration ◽  
Clinical Assessment ◽  
Low Frequency ◽  
Tone Burst ◽  
Normal Hearing ◽  
Vestibular Evoked Myogenic Potentials ◽  
Vestibular Evoked Myogenic Potential ◽  
Acoustic Stimuli ◽  
Myogenic Potential ◽  
Electrical Impulses

AbstractIntroduction:Vestibular evoked myogenic potentials are short latency electrical impulses that are produced in response to higher level acoustic stimuli. They are used clinically to diagnose sacculocollic pathway dysfunction.Aim:This study aimed to compare the vestibular evoked myogenic potential responses elicited by click stimuli and short duration tone burst stimuli, in normal hearing individuals.Method:Seventeen subjects participated. In all subjects, we assessed vestibular evoked myogenic potentials elicited by click and short duration tone burst stimuli.Results and conclusion:The latency of the vestibular evoked myogenic potential responses (i.e. the p13 and n23 peaks) was longer for tone burst stimuli compared with click stimuli. The amplitude of the p13–n23 waveform was greater for tone burst stimuli than click stimuli. Thus, the click stimulus may be preferable for clinical assessment and identification of abnormalities as this stimulus has less variability, while a low frequency tone burst stimulus may be preferable when assessing the presence or absence of vestibular evoked myogenic potential responses.

scholarly journals Vestibular evoked myogenic potential

2014 ◽  
Vol 67 (suppl. 1) ◽  
pp. 38-45
Author(s):  
Slobodanka Lemajic-Komazec ◽  
Zoran Komazec ◽  
Ljiljana Vlaski ◽  
Slobodan Savovic ◽  
Maja Buljcik-Cupic ◽  
...  
Keyword(s):  
Tone Burst ◽  
Acoustic Stimulation ◽  
Vestibular Evoked Myogenic Potentials ◽  
Vestibular Evoked Myogenic Potential ◽  
Average Value ◽  
Myogenic Potential ◽  
The Difference ◽  
Interaural Differences ◽  
The Right ◽  
A Prospective Study

Introduction. Vestibular evoked myogenic potentials are neurophysiological method for examining of saccular function, the bottom of the vestibular nerve that in nervates the sacculus and central vestibular pathways. Those are inhibitory potentials of the sternocleido mastoid musclein response to ipsilateral acoustic stimulation of the sacculus. Parameters of vestibular evoked myogenic potential testing include threshold, latencies of p1 and n1 wave and interamplitude p13-n23, interaural difference of p13 and n23 latency and interaural amplitude difference ratio. The aim of this study was to compire parameters standardization of vestibular evoked myogenic potentials responses, latency p13 and n23 of waves, the amplitude of responses and interaural differences in the amplitude andto determinewhether there is a difference in values between the sexes. Material and methods. This research was meant to be a prospective study which included 30 normal audiovestibular volunteers of both sexes. The group consisted of 53.3% women and 46.7% men. The saccular function testing by vestibular evoked myogenic potentials was performed monoaurally using air-conductive 500 Hz tone burst auditory stimulation. Results. The average value of the p13 wave latency in healthy subjects of this study was 15.18 ms (?1.24) while the mean latency of n23 waves in the same subjects was 25.00 ms (?2.23). The average value of the amplitude of the p13-n23 waves was 80.28 (34. ?04) microvolts. Conclusion. The difference in the values of the basic parameters of vestibular evoked myogenic potential responses between men and women does not exist. No differences between the right and the left ear in the values of latency and amplitude were observed.

scholarly journals Superior Semicircular Canal Dehiscence Syndrome: Review of Clinical Manifestations in Adults and Children

2009 ◽  
Vol 24 (2) ◽  
pp. 6-13
Author(s):  
Scheherazade C. Ibrahim ◽  
Charlotte M. Chiong ◽  
Nathaniel W. Yang
Keyword(s):  
Semicircular Canal ◽  
Clinical Manifestations ◽  
Case Series ◽  
Vestibular Evoked Myogenic Potential ◽  
Superior Semicircular Canal Dehiscence ◽  
Computed Tomographic ◽  
Myogenic Potential ◽  
Superior Semicircular Canal ◽  
Computed Tomographic Scan ◽  
Canal Dehiscence

Objective: This report aims to determine the clinical manifestations and management of patients with superior semicircular canal dehiscence syndrome (SSCDS). Methods: Study Design: Case series. Setting: Tertiary hospitals and private clinics Participants: Out of 30 patients with vestibular vertigo or otologic symptom, 14 patients were diagnosed with SSCDS based on high resolution computed tomographic scan (HRCT).  The demographic features, incidence of specific signs and symptoms and management of these patients were described, including the audiograms, vestibular evoked myogenic potential (VEMP) responses and ancillary tests. Results: Vertigo was the most common vestibular symptom of SSCDS. Tullio phenomenon was elicited in 50% of patients with confirmed dehiscence on HRCT scan. Low frequency (250 Hz and 500 Hz) air-bone gap was noted in 21.4% of patients. Lowered VEMP responses were also noted in 66.7% of patients with confirmed SSCDS. Severity of symptoms may determine its management. Conclusion: The diagnosis of SSCDS does not conform to a specific clinical presentation or audiologic result thus good clinical correlation is needed in order to raise suspicion of the disease and prompt the clinician to order confirmatory imaging by computed tomographic scan or magnetic resonance imaging. The presence of this syndrome in a proportion of children that is greater than previously reported needs further study as these children may be genetically predisposed to have thinned out superior semicircular canals that eventually become dehisced albeit at an earlier age. Key words: Superior semicircular canal dehiscence, pure tone audiometry, vestibular evoked myogenic potential

scholarly journals Case Report: Local Anesthesia Round Window Plugging and Simultaneous Vibrant Soundbridge Implant for Superior Semicircular Canal Dehiscence

2020 ◽  
Vol 11 ◽  
Author(s):  
Giulia Mignacco ◽  
Lorenzo Salerni ◽  
Ilaria Bindi ◽  
Giovanni Monciatti ◽  
Alfonso Cerase ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Round Window ◽  
Bone Conduction ◽  
Hearing Threshold ◽  
Vestibular Evoked Myogenic Potentials ◽  
Vibrant Soundbridge ◽  
Superior Semicircular Canal Dehiscence ◽  
Superior Semicircular Canal ◽  
The Right ◽  
Canal Dehiscence

The aim of the present study is to report the outcomes of round window reinforcement surgery performed with the application of a Vibrant Soundbridge middle ear implant (VSB; MED-EL) in a patient with superior semicircular canal dehiscence (SSCD) who presented with recurrent vertigo, Tullio phenomenon, Hennebert's sign, bone conduction hypersensitivity, and bilateral moderate to severe mixed hearing loss. Vestibular evoked myogenic potentials (VEMPs) and high-resolution computed tomography (HRCT) confirmed bilateral superior semicircular canal dehiscence while this was not seen in magnetic resonance imaging. The surgical procedure was performed in the right ear as it had worse vestibular and auditory symptoms, a poorer hearing threshold, and greatly altered HRCT and VEMPs findings. With local-assisted anesthesia, round window reinforcement surgery (plugging) with perichondrium was performed with simultaneous positioning of a VSB on the round window niche. At the one and 3 months follow-up after surgery, VSB-aided hearing threshold in the right ear improved to mild, and loud sounds did not elicit either dizziness or pain in the patient.

Vestibular-Evoked Myogenic Potential Testing in Vestibular Localization and Diagnosis

2020 ◽  
Vol 40 (01) ◽  
pp. 018-032 ◽  
Author(s):  
Rachael L. Taylor ◽  
Miriam S. Welgampola ◽  
Benjamin Nham ◽  
Sally M. Rosengren
Keyword(s):  
Vestibular System ◽  
Vestibular Evoked Myogenic Potentials ◽  
Vestibular Disorders ◽  
Complementary Information ◽  
Vestibular Evoked Myogenic Potential ◽  
Myogenic Potential ◽  
Superior Canal Dehiscence ◽  
Otolith Function ◽  
Utricular Function ◽  
Canal Dehiscence

AbstractVestibular-evoked myogenic potentials (VEMPs) are short-latency, otolith-dependent reflexes recorded from the neck and eye muscles. They are widely used in neuro-otology clinics as tests of otolith function. Cervical VEMPs are recorded from the neck muscles and reflect predominantly saccular function, while ocular VEMPs are reflexes of the extraocular muscles and reflect utricular function. They have an important role in the diagnosis of superior canal dehiscence syndrome and provide complementary information about otolith function that is useful in the diagnosis of other vestibular disorders. Like other evoked potentials, they can provide important localizing information about lesions that may occur along the VEMP pathway. This review will describe the VEMP abnormalities seen in common disorders of the vestibular system and its pathways.

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