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

Kimberley S Noij, Barbara S Herrmann, John J Guinan, Steven D Rauch
Author Information
  1. Kimberley S Noij: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
  2. Barbara S Herrmann: Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
  3. John J Guinan: Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
  4. Steven D Rauch: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA, steven_rauch@meei.harvard.edu.

Abstract

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.

Keywords

References

  1. J Neurol Neurosurg Psychiatry. 1994 Feb;57(2):190-7 [PMID: 8126503]
  2. AJNR Am J Neuroradiol. 2017 Jan;38(1):2-9 [PMID: 27561833]
  3. Ear Hear. 2015 Sep-Oct;36(5):591-604 [PMID: 25811931]
  4. Otolaryngol Head Neck Surg. 2013 Jul;149(1):142-5 [PMID: 23674567]
  5. Arch Otolaryngol Head Neck Surg. 1998 Mar;124(3):249-58 [PMID: 9525507]
  6. Otolaryngol Head Neck Surg. 2017 May;156(5):917-923 [PMID: 28168887]
  7. Audiol Neurootol. 2012;17(4):207-18 [PMID: 22472299]
  8. Otolaryngol Head Neck Surg. 2009 Jul;141(1):24-8 [PMID: 19559953]
  9. Otol Neurotol. 2013 Feb;34(2):360-7 [PMID: 23444482]
  10. Neurology. 2017 Nov 28;89(22):2288-2296 [PMID: 29093067]
  11. Clin Neurophysiol. 2011 Nov;122(11):2282-9 [PMID: 21550301]
  12. Otol Neurotol. 2007 Oct;28(7):920-6 [PMID: 17955609]
  13. Audiol Neurootol. 2017;22(4-5):282-291 [PMID: 29324449]
  14. Semin Neurol. 2009 Nov;29(5):541-7 [PMID: 19834866]
  15. Audiol Neurootol. 2009;14(1):54-8 [PMID: 18781064]
  16. Otol Neurotol. 2013 Jan;34(1):127-34 [PMID: 23151775]
  17. Otol Neurotol. 2014 Sep;35(8):e222-7 [PMID: 24836595]
  18. Acta Otolaryngol. 1999;119(6):633-40 [PMID: 10586994]
  19. Clin Neurophysiol. 2016 Jun;127(6):2522-31 [PMID: 27105578]
  20. Otol Neurotol. 2004 May;25(3):323-32 [PMID: 15129113]
  21. Acta Otolaryngol Suppl. 2001;545:41-9 [PMID: 11677740]
  22. Otol Neurotol. 2018 Feb;39(2):212-220 [PMID: 29210947]
  23. Neurology. 2008 Feb 5;70(6):464-72 [PMID: 18250291]
  24. Otol Neurotol. 2004 May;25(3):333-8 [PMID: 15129114]
  25. Clin Neurophysiol. 2001 Nov;112(11):1971-9 [PMID: 11682335]
  26. Otol Neurotol. 2013 Jan;34(1):121-6 [PMID: 23183641]
  27. Otol Neurotol. 2014 Feb;35(2):338-43 [PMID: 24448294]
  28. Ear Hear. 2018 Nov/Dec;39(6):1199-1206 [PMID: 29624541]

Grants

  1. UL1 TR002541/NCATS NIH HHS

MeSH Term

Acoustic Stimulation
Adult
Aged
Audiometry, Pure-Tone
Female
Humans
Labyrinth Diseases
Male
Middle Aged
Neural Inhibition
Prospective Studies
Reference Values
Saccule and Utricle
Semicircular Canals
Sound Spectrography
Vestibular Evoked Myogenic Potentials
Vestibular Nerve
Vestibule, Labyrinth

Word Cloud

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