Effects of Age on the Bone-Conduction Amplitude-Modulated cVEMP Temporal Modulation Transfer Function.

Objectives: Cervical vestibular evoked myogenic potentials (cVEMPs) reflect saccular stimulation that results in an inhibitory muscle reflex recorded over the sternocleidomastoid muscle. These responses are utilized to study basic vestibular functions and are also applied clinically. Traditionally, cVEMPs have utilized transient stimuli such as clicks and tonebursts to evoke onset responses.

Effects of Age on the Frequency Amplitude Ratio of Cervical and Ocular Vestibular Evoked Myogenic Potentials.

Purpose: An increase in the 1000/500 Hz frequency amplitude ratio (FAR) of the cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP, respectively) may serve as a potential biomarker for diagnosing Meniere's disease (MD). However, the aging process can also result in an increased FAR for VEMPs. In older patients, distinguishing whether changes in VEMP FAR are due to MD or aging processes becomes difficult.

Effects of Age and Middle Ear on the Frequency Tuning of the cVEMP and oVEMP.

Background: Upward shift in the air conducted (AC) frequency tuning of vestibular evoked myogenic potentials (VEMPs) as an effect of aging is hypothesized to be due to the microstructural stiffening changes in the inner ear. However, with an AC stimulus, it may be possible that the shift in the frequency tuning of VEMPs as an effect of aging may also be due to contributions from the middle ear.

Purpose: The main aim of this study was to examine the effects of age on the frequency tuning of the cervical VEMP (cVEMP) and ocular VEMP (oVEMP) and determine the role of middle ear transmission characteristics in shaping these effects.

Inter-trial coherence as a measure of synchrony in cervical vestibular evoked myogenic potentials.

Background: Cervical vestibular evoked myogenic potentials (cVEMPs) are surface-recorded responses that reflect saccular function. Analysis of cVEMPs has focused, nearly exclusively, on time-domain waveform measurements such as amplitude and latency of response peaks, but synchrony-based measures have not been previously reported.

New Method: Time-frequency analyses were used to apply an objective response-detection algorithm and to quantify response synchrony.

Temporal Modulation Transfer Functions of Amplitude-Modulated Cervical Vestibular-Evoked Myogenic Potentials in Young Adults.

Objectives: Cervical vestibular-evoked myogenic potentials (cVEMPs) are widely used to evaluate saccular function in clinical and research applications. Typically, transient tonebursts are used to elicit cVEMPs. In this study, we used bone-conducted amplitude-modulated (AM) tones to elicit AMcVEMPs.

Agreement Between Caloric and Horizontal Video Head Impulse Testing in School-Aged Children Presenting With Dizziness.

Objective: The purpose of this investigation was to determine the relationship between the horizontal semicircular canal video head impulse test (hvHIT) and the caloric test in a sample of school-age children evaluated due to complaints of dizziness or imbalance. In adults, these two tests provide different but complementary information regarding vestibular function and/or pathology. However, the most common causes of vestibular loss in children are different than those in adults, and it is not clear how these two tests of horizontal semicircular canal function are related in a pediatric population.

Effects of Stimulus Polarity on Amplitude-Modulated Cervical Vestibular-Evoked Myogenic Potentials.

Background: Traditional approaches to cervical vestibular-evoked myogenic potentials use a transient stimulus to elicit an onset response. However, alternate approaches with long duration stimuli may allow the development of new methodologies to better understand basic function of the vestibular system, as well as potentially developing new clinical applications.

Purpose: The objective of this study was to examine the effects of stimulus polarity on response properties of amplitude-modulated cervical vestibular-evoked myogenic potentials (AMcVEMPs).

Nonlinearity in bone-conducted amplitude-modulated cervical vestibular-evoked myogenic potentials: harmonic distortion products.

Otolith organs of the balance system, the saccule and utricle, encode linear acceleration. Integrity of the saccule is commonly assessed using cervical vestibular-evoked myogenic potentials (cVEMPs) arising from an inhibitory reflex along the vestibulospinal pathway. Conventional approaches to eliciting these responses use brief, transient sounds to elicit onset responses.

Comparison of Bone-Conducted Cervical VEMPs Elicited by B71 and B81 Bone Vibrators.

Objective: A variety of stimulus delivery methods can elicit vestibular evoked myogenic potentials (VEMPs). The current study compared bone conduction (BC) cervical VEMPs (cVEMPs) across two different clinical bone vibrators. It was hypothesized that the B81 transducer would be more effective for producing larger BC-cVEMP peak to peak amplitudes due to its low-frequency advantages in pure-tone audiometry applications.

Effects of Tonic Muscle Activation on Amplitude-Modulated Cervical Vestibular Evoked Myogenic Potentials (AMcVEMPs) in Young Females: Preliminary Findings.

Cervical vestibular evoked myogenic potentials (cVEMPs) are usually elicited by transient tonebursts, but when elicited by amplitude-modulated (AM) tones, they can provide new information about cVEMPs. Previous reports of cVEMPs elicited by AM tones, or AMcVEMPs, have not systematically examined the effects of tonic EMG activation on their response properties. Fourteen young, healthy female adults (ages 20-24) with clinically normal audiograms participated in this study.

Test-Retest Reliability of the Dizziness Symptom Profile.

Objectives: This investigation was conducted to measure the test-retest reliability of the Dizziness Symptom Profile (DSP). The DSP was developed to assist primary care providers, general otolaryngologists, and other health care providers in the development of a differential diagnosis for patients who present with dizziness, vertigo, or unsteadiness. The DSP yields a score ranging from 0 to 100% for each of 7 subscales.

Vestibular function after cochlear implantation: A test battery and case-by-case approach.

Objectives: The purpose of this study was to assess the effects of cochlear implantation on the functional integrity of the horizontal semicircular canal using multiple methodologies, and to discuss and highlight the limitations of using isolated vestibular tests to assess vestibular function in surgical ears.

Methods: Ten cochlear implant patients were consented to undergo a preoperative and 3-month postoperative vestibular assessment. The horizontal semicircular canal (SCC) was assessed using three different vestibular test measures that assess function using different stimuli and at different frequencies ranges: caloric testing, sinusoidal harmonic acceleration testing in the rotary chair, and video head impulse testing in the plane of the horizontal SCC.

A factor analytic assessment of the English translation of the neuropsychological vertigo inventory (NVI).

Purpose: Vestibular impairments have been associated with a variety of cognitive deficits, most notably deficits in visuo-spatial memory. The Neuropsychological Vertigo Inventory (NVI) was developed to measure self-reported cognitive deficits in patients with dizziness and/or vertigo. The original French language version of the NVI includes 28 items and 7 subscales.

The Clinical Significance of the Failure to Perceive Vertigo in the Postcaloric Period Despite a Robust Caloric Response.

Purpose The purpose of this project was to explore the association between the perception of motion during caloric testing and two tasks associated with central vestibular processing: postural stability and visuospatial memory. Method This was a prospective study of 25 patients who were found to have nonvestibular etiologies of their symptoms and normal vestibular function test results and who underwent caloric testing with a mean maximum slow phase eye velocity for each irrigation of 15° or greater. Following each caloric irrigation, patients were asked whether they had any sensation of movement.

Maximum Output and Low-Frequency Limitations of B71 and B81 Clinical Bone Vibrators: Implications for Vestibular Evoked Potentials.

Objectives: Bone-conducted vestibular evoked myogenic potentials (VEMPs) are tuned to have their maximum amplitude in response to tone bursts at or below 250 Hz. The low-frequency limitations of clinical bone vibrators have not been established for transient, tone burst stimuli at frequencies that are optimal for eliciting VEMPs.

Design: Tone bursts with frequencies of 250 to 2000 Hz were delivered to B71 and B81 bone vibrators and their output was examined using an artificial mastoid.

Diabetes and the Vestibular System.

Falls are among the most injurious, costly, and feared conditions affecting older adults. Patients with diabetes have a significantly greater risk for falling due to complications affecting the sensory systems required for balance: vision, proprioception, and vestibular. The effects of diabetes mellitus on the vestibular system are perhaps the least understood of these systems.

The Medial Canthus Reference Electrode Is not Electrically Indifferent to the Ocular Vestibular Evoked Myogenic Potential.

Objective: To determine whether a reference electrode placed over the contralateral medical canthus is electrically indifferent to the ocular vestibular evoked myogenic potential (oVEMP).

Study Design: Prospective observational study.

Setting: Tertiary academic center.

Development and Preliminary Findings of the Dizziness Symptom Profile.

Objectives: Dizziness, vertigo, and unsteadiness are common complaints of patients who present to primary care providers. These patients often are referred to otology for assessment and management. Unfortunately, there are a small number of specialists to manage these patients.

Age predicts the absence of caloric-induced vertigo.

Introduction: The absence of vertigo during the caloric test, despite a robust response, has been suggested to represent a central vestibular system phenomenon. The purpose of this investigation was to determine the prevalence of absent caloric-induced vertigo perception in an unselected group of patients and to assess possible predicting variables.

Methods: Prospective investigation of 92 unselected patients who underwent caloric testing.

Temporal bone anatomy characteristics in superior semicircular canal dehiscence.

Introduction: Superior semicircular canal dehiscence (SCD) remains difficult to diagnose despite advances in high-resolution computed tomography (HRCT) imaging. We hypothesize possible associations between gross temporal bone anatomy and sub-millimeter pathology of the semicircular canals, which may supplement imaging and clinical suspicion. This pilot study investigates differences in gross temporal bone anatomic parameters between temporal bones with and without SCD.

Ocular and Cervical Vestibular Evoked Myogenic Potentials in Patients With Vestibular Migraine.

Objective: To evaluate the relationship between normal and abnormal ocular vestibular evoked myogenic potentials (oVEMP) and cervical vestibular evoked myogenic potentials (cVEMP) in patients with and without vestibular migraine (VM).

Study Design: Retrospective review of oVEMP and cVEMP results in patients with vestibular disorders who were assessed clinically and completed vestibular function studies. Data were extracted from a deidentified RedCap Repository.

Reevaluating Order Effects in the Binaural Bithermal Caloric Test.

Purpose: The purpose of this study was to determine whether a significant order effect exists in the binaural bithermal caloric test.

Method: Fifteen volunteers (mean age = 24.3 years, range = 18-38 years) with no history of vestibular disorder, hearing loss, concussion, or neurological disease underwent caloric testing on 3 occasions.

Anatomic Variations in Temporal Bones Affect the Intensity of Nystagmus During Warm Caloric Irrigation.

Hypothesis: Anatomic variables within the mastoid will correlate with intensity of caloric responses.

Background: During caloric irrigation, heat is transferred from the external auditory canal to the lateral semicircular canal (LSCC) through aerated mastoid bone. Temporal bone airspace volume and bone volume vary widely but the effect of this variation on caloric irrigation testing is not well characterized.

Variation in the Use of Vestibular Diagnostic Testing for Patients Presenting to Otolaryngology Clinics with Dizziness.

Objective: We used a national otolaryngology practice-based research network database to characterize the utilization of vestibular function testing in patients diagnosed with dizziness and/or a vestibular disorder.

Study Design: Database review.

Setting: The Creating Healthcare Excellence through Education and Research (CHEER) practice-based research network of academic and community providers

Subjects And Methods: Dizzy patients in the CHEER retrospective database were identified through ICD-9 codes; vestibular testing procedures were identified with CPT codes.

Hospital Anxiety and Depression Scale: Factor Structure, Internal Consistency and Convergent Validity in Patients with Dizziness.

Psychiatric comorbidities, particularly anxiety-related pathologies, are often observed in dizzy patients. The Hospital Anxiety and Depression Scale (HADS) is a widely used self-report instrument used to screen for anxiety and depression in medical outpatient settings. The purpose of this study was to assess the factor structure, internal consistency and convergent validity of the HADS in an unselected group of patients with dizziness.