[Evaluation of semicircular canal and otolith graviceptive pathway function in patients diagnosed with motion sickness disorder based on the diagnostic criteria of the Bárány society].

Objective: To investigate the altered function of the semicircular canal and otolith graviceptive pathway in patients diagnosed with motion sickness disorder (MSD) based on the diagnostic criteria of the Bárány society, and explore its relevance to the pathogenesis of MSD. Methods: This is a case-control study. Twenty patients with MSD and age-and sex-matched healthy controls without a history of MSD from the Department of Neurology of Aerospace Center Hospital between March and August 2022 were recruited. All subjects completed the motion sickness susceptibility questionnaire-short version (MSSQ-short) and the motion sickness assessment questionnaire (MSAQ). Canal function was evaluated using caloric stimulation test and video head impulse test (vHIT), and subjective visual vertical/horizontal (SVV/SVH) and vestibular evoked myogenic potential (VEMP) were employed to assess otolith graviceptive function. Differences in vestibular function and correlations between the two groups were analyzed. Results: Each group consisted of 20 cases (9 males and 11 females). The mean age of the MSD and control groups was (26.9±3.9) years and (27.0±3.4) years, respectively. The scores of MSSQ-short [27.0 (22.5, 38.8) vs 1.2 (0, 3.2), P<0.001] and MSAQ [70.1 (54.5, 78.1) vs 11.8 (11.1, 13.9), P<0.001] were significantly higher in the MSD group compared with those of the control group. Evaluation of canal function revealed a significantly higher incidence of caloric stimulation intolerance in MSD patients (60.0%, 12/20) compared with that of the control group (20.0%, 4/20) (P=0.010). Evaluation of otolith graviceptive pathway indicated no significant difference in SVV, SVH and cervical VEMP (cVEMP) abnormality rates between the two groups (all P>0.05). The ocular VEMP (oVEMP) abnormality rate was significantly higher in the MSD group (55.0%, 11/20) than that of the control group (10.0%, 2/20) (P=0.002), with a delayed P1-wave latency compared with the control group [(18.4±1.2) ms vs (17.6±0.8) ms, P=0.018]. Further correlation analysis revealed that P1-wave latency in oVEMP was positively correlated with MSSQ-short (r=0.486, P=0.002) and MSAQ (r=0.391, P=0.015) scores, and duration of caloric intolerance symptoms (r=0.377, P=0.004). Conclusion: The presence of hypersensitivity to caloric stimulation and delayed latency of otolith function in patients with MSD suggests a "separation" between semicircular canal and otolithic function, which may be related to sensory conflict.

Efficacy of vestibular rehabilitation program in children with balance disorders and sensorineural hearing loss.

OBJECTIVE: Asses the efficacy of a Vestibular-balance rehabilitation program to minimize or reverse balance disability in children with sensorineural hearing loss. METHOD: Forty-five hearing-impaired children with balance deficits (i.e., variable degrees of sensorineural hearing loss or auditory neuropathy). Thirty-five were rehabilitated with cochlear implants, and ten with hearing aids. Their age ranged from 4 to 10 years old. A Pre-rehab evaluation was done using questionnaires, neuromuscular evaluation, vestibular and balance office testing, and vestibular lab testing (using cVEMP and caloric test). Customized balances, as well as vestibular rehabilitation exercises, have been applied for three months. That was followed by post-rehab assessment, including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test. RESULTS: There was a statistically significant difference in all measured parameters (including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test) after rehabilitation. CONCLUSIONS: Vestibular-balance rehabilitation intervention positively impacts vestibular and balance functions in hearing-impaired children.

The role of vestibular function tests in nontuberculous mycobacterial otomastoiditis: A case report.

BACKGROUND: Nontuberculous mycobacteria (NTM), an extremely rare pathogen causing cervicofacial infections, may result in permanent hearing impairment or intracranial complications. Due to the lack of specific manifestations during the initial onset of NTM otomastoiditis, physicians may misdiagnose it as cholesteatoma or other common bacterial infections. PATIENT CONCERNS: A 44-year-old male who complained of left-sided aural fullness, otalgia, and dizziness for 2 months. DIAGNOSIS: The initial diagnosis was hypothesized to be cholesteatoma based on a whitish mass with mucoid discharge filling the entire outer ear canal on otoscopy and left-sided mixed hearing loss. However, NTM was identified by microbial culture at the 2-month follow-up after surgery. INTERVENTIONS: The patient underwent a left-sided exploratory tympanotomy. Because NTM otomastoiditis was diagnosed, 3 weeks of starting therapies were administered with azithromycin (500 mg/day, oral administration), cefoxitin (3 g/day, intravenous drip), and amikacin (750 mg/day, intravenous drip). The maintenance therapies were azithromycin (500 mg/day, oral administration) and doxycycline (200 mg/day, oral administration) for 7 months. OUTCOMES: The patient's clinical condition improved initially after surgery, but the otomastoiditis gradually worsened, combined with subtle meningitis, 2 months after surgery. The external auditory canal became swollen and obstructed, making it difficult to monitor the treatment efficacy through otoscopy. Thus, we used regular vestibular function tests, including static posturography, cervical vestibular evoked myogenic potentials, and video Head Impulse Test, to assess recovery outcomes. After antibiotic treatment, the infectious symptoms subsided significantly, and there was no evidence of infection recurrence 7 months after treatment. Improvements in static posturography and cervical vestibular evoked myogenic potentials were compatible with the clinical manifestations, but video Head Impulse Test showed an unremarkable correlation. LESSONS: The clinical condition of NTM otomastoiditis may be evaluated using vestibular tests if patients have symptoms of dizziness.

Evaluating Fixed Single-Point Parameters When Applied to Vestibular Evoked Myogenic Potentials: The Effect of Single Point and Signal Window.

OBJECTIVES: Several studies have applied a common objective detection algorithm (fixed single point [ Fsp ]) for detection of the vestibular evoked myogenic potential (VEMP). However, fundamental parameters of Fsp , such as establishing the location and duration of a signal window, have not been examined. In addition, Fsp criterion values used for response detection have not been established for cervical VEMPs (cVEMPs) or ocular VEMPs (oVEMPs). The purpose of this article was to investigate the effect of various single points and signal windows on Fsp , as well as determining Fsp criteria to determine response presence for cVEMP and oVEMP in a group of young healthy participants. DESIGN: Twenty young healthy adults under the age of 30 and with no history of hearing or balance concerns were enrolled in the study protocol. Air-conducted cVEMPs and oVEMPs were evoked using 500 Hz tone bursts at 123 dB pSPL recorded at a fixed electromyography activation of 50 µV for cVEMPs and 35° gaze angle for oVEMPs. Responses were analyzed off-line using visual and objective detection. Fsp was applied to cVEMPs and oVEMPs using a range of single points and signal windows. RESULTS: Noise variance was lowest for cVEMPs at the latency of P1, and for oVEMPs noise variance was not significantly different across the single-point latencies. On average, extending the length of the signal window lowered the Fsp value in cVEMPs and oVEMPs. An Fsp value of 2.0 was chosen as the criterion cutoff associated with the 95th percentile during no-response conditions using group data for cVEMPs and oVEMPs, respectively. Fsp values for cVEMPs and oVEMPs were not significantly different from each other. DISCUSSION: This study established single-point latency and time-window parameters for VEMP-related applications of the Fsp detection algorithm. Fsp criteria values were established for cVEMP and oVEMP. Using these parameters, responses were detected in all participants.

Does Location of Intralabyrinthine Vestibular Schwannoma Determine Objective and Subjective Vestibular Function?

BACKGROUND AND OBJECTIVE: The incidence of intralabyrinthine schwannomas is increasing, and a growing attention is given to the detrimental effects on hearing function. On the contrary, the vestibular profile of intralabyrinthine vestibular schwannomas (VSs) is still not well understood. We aimed to investigate and report the observed relationships between the intralabyrinthine location of the schwannomas and objective and subjective vestibular profile of the patients. METHODS: Retrospective cohort study of 20 consecutive individuals with sporadic intralabyrinthine schwannomas and grouped according to the intralabyrinthine location of the schwannomas. Vestibular testing consisted of the video head impulse test of all three semicircular canals, the caloric test, cervical and ocular vestibular evoked myogenic potentials, and the dizziness handicap inventory. A nonparametric unpaired t test was performed to compare groups, and Fisher's exact test was used for categorical data. RESULTS: The median video head impulse test gains (lateral, anterior, posterior) were 0.40, 0.50, and 0.75 for intravestibular schwannomas and 0.93, 1.52, and 0.91 for intracochlear schwannomas ( p = 0.0001, p = 0.009, p = 0.33), respectively. Caloric unilateral weakness had a median of 100% for intravestibular schwannomas and 14% for intracochlear schwannomas ( p = 0.0001). The mean dizziness handicap inventory was 21 for intravestibular schwannomas and 1 for cochlear schwannomas ( p = 0.02). There were no significant differences in vestibular evoked myogenic potentials according to intralabyrinthine location. CONCLUSION: By both objective and subjective measures, intralabyrinthine schwannomas with an intravestibular component has significantly worse vestibular function than schwannomas with purely cochlear involvement.

Audiovestibular Findings in Patients with Concurrent Superior Canal Dehiscence and Vestibular Schwannoma.

OBJECTIVE: To describe the clinical-instrumental findings in case of concurrent superior canal dehiscence (SCD) and ipsilateral vestibular schwannoma (VS), aiming to highlight the importance of an extensive instrumental assessment to achieve a correct diagnosis. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Five patients with concurrent SCD and VS. INTERVENTION: Clinical-instrumental assessment and imaging. MAIN OUTCOME MEASURE: Clinical presentation, audiovestibular findings, and imaging. RESULTS: The chief complaints were hearing loss (HL) and unsteadiness (80%). Other main symptoms included tinnitus (60%) and pressure-induced vertigo (40%). Mixed-HL was identified in three patients and pure sensorineural-HL in 1, including a roll-over curve in speech-audiometry in two cases. Vibration-induced nystagmus was elicited in all cases, whereas vestibular-evoked myogenic potentials showed reduced thresholds and enhanced amplitudes on the affected side in three patients. Ipsilesional weakness on caloric testing was detected in three patients and a bilateral hyporeflexia in one. A global canal impairment was detected by the video-head impulse test in one case, whereas the rest of the cohort exhibited a reduced function for the affected superior canal, together with ipsilateral posterior canal impairment in two cases. All patients performed both temporal bones HRCT scan and brain-MRI showing unilateral SCD and ipsilateral VS, respectively. All patients were submitted to a wait-and-scan approach, requiring VS removal only in one case. CONCLUSION: Simultaneous SCD and VS might result in subtle clinical presentation with puzzling lesion patterns. When unclear symptoms and signs occur, a complete audiovestibular assessment plays a key role to address imaging and diagnosis.

[The "difficult" patient-pearls and pitfalls of vestibular diagnostic tests: Part 2 : Difficult aspects of vestibular laboratory testing]. / "Schwierige" Patient:innen ­ Vestibularisdiagnostik unter erschwerten Bedingungen: Teil 2 : Schwierige Aspekte der apparativen Vestibularisprüfung.

Patients with the cardinal symptoms "vertigo" or "dizziness" may be a real challenge for the treating otorhinolaryngologist. While the first part of this educational series was focused on history taking and bedside neurotological examination, the present paper is devoted to difficult aspects of vestibular laboratory testing, including getting the indication right, what to do if my patient is not able to fully cooperate during the tests, how to choose the adequate diagnostic procedure depending on the patient's comorbidities, how to interpret discordant results of various tests. Finally the paper addresses which conclusions can be drawn (and cannot be drawn) from normal findings in vestibular testing and how to communicate this result to the dizzy patient.

Characteristics of vestibular-evoked myogenic potentials in children with vestibular malformation and severe sensorineural hearing loss.

BACKGROUND: With the increasing clinical focus on the safety of bilateral cochlear implantation (CI) and the potential risk of bilateral vestibular dysfunction, evaluating vestibular end-organ function in patients with vestibular malformations with accompanying abnormalities has been strongly recommended. OBJECTIVES: To identify the vestibular-evoked myogenic potential (VEMP) values among children with sensorineural hearing loss (SNHL) with vestibular malformation and assess the effectiveness of VEMP testing for inner ear malformations (IEM) diagnosis. METHODS: This study included 96 children (192 ears), including those with vestibular malformations (48 ears), large vestibular aqueduct syndrome (LVAS) (50 ears), and SNHL without IEM (94 ears; control group). All groups underwent ocular and cervical VEMP (oVEMP and cVEMP, respectively) testing. The response rates, VEMP parameters, and wave characteristics were compared. RESULTS: The cVEMP response rates were 37.5 %, 64 %, and 58.51 % and the oVEMP response rates were 42.86 %, 78.95 %, and 77.27 % in the vestibular malformation, LVAS, and control groups, respectively, and significantly differed between groups (cVEMP: X2 = 18.228, P<0.001) (oVEMP: X2 = 7.528, P = 0.023). Significant inter-group differences were observed for the cVEMP and oVEMP latency and amplitude (P < 0.05). The LVAS group's waveform exhibited a prolonged latency and increased amplitude compared with that of the other groups. CONCLUSION: Patients with SNHL were highly susceptible to otolith dysfunction, regardless of comorbid vestibular malformation presence. Measuring VEMPs is an effective and rapid evaluation technique for vestibular function and could provide a basis for vestibular rehabilitation training.

Electrode Montage Induced Changes in Air-Conducted Ocular Vestibular-Evoked Myogenic Potential.

OBJECTIVES: Stimulus and recording parameters are pivotal for shaping the ocular vestibular-evoked myogenic potential (oVEMP). In the last decade, several attempts were made to identify the optimum electrode placement site to improve the oVEMP responses. A vast majority of these found larger response amplitudes for alternate electrode montages like belly-tendon (BT), chin-referenced (CR), and/or sternum-referenced montages than the clinically used infra-orbital montage. However, no study has yet compared all alternate electrode montages in a simultaneous recording paradigm to eliminate other confounding factors. Also, no study has compared all of them for their test-retest reliability, waveform morphology, and signal-to-noise ratio. Therefore, the decision on which among these electrode montages is best suited for oVEMP acquisition remains opaque. The present study aimed to investigate the effects of various electrode montages on oVEMP's response parameters and to determine the test-retest reliability of each of these in clinically healthy individuals using a simultaneous recording paradigm. DESIGN: This study had a within-subject experimental design. Fifty-five young healthy adults (age range: 20-30 years) underwent contralateral oVEMP recording using infra-orbital, BT, chin-referenced, and sternum-referenced electrode montages simultaneously using a four-channel evoked potential system. RESULTS: BT montage had a significantly shorter latency, larger amplitude, higher signal-to-noise ratio, and better morphology than other alternate montages ( p < 0.008). Further, all electrode montages of the current study showed fair/moderate to excellent test-retest reliability. CONCLUSIONS: By virtue of producing significantly better response parameters than the other electrode montages, BT montage seems better suited to the recording of oVEMP than the known electrode montages thus far.

Chirp-Evoked VEMPs: A Test-Retest Reliability Study.

OBJECTIVES: To determine the test-retest reliability of cervical and ocular vestibular-evoked myogenic potentials (c&oVEMP) evoked by 500 Hz narrowband (NB) CE-Chirp and broadband (BB) CE-Chirp stimuli. DESIGN: Twenty healthy participants (10 female) were tested twice on the same day to determine the within-session reliability and 1 week later to determine the between-session reliability. The latency, amplitude, and asymmetry ratio of c&oVEMPs elicited by 95 dB nHL air-conducted (AC) 500 Hz NB CE-Chirp and BB CE-Chirp were recorded bilaterally. RESULTS: A moderate to good between-session reliability with intraclass correlation coefficient (ICC) values ranging from 0.52 to 0.82 was observed for cVEMP latency, amplitude, and asymmetry ratio evoked by 500 Hz NB CE-Chirp, as well as for the BB CE-Chirp cVEMP amplitude (ICC of 0.70 and 0.84). In contrast, an overall poor reliability ICC values between 0.30 and 0.42 for cVEMP latency and asymmetry ratio were observed for BB CE-Chirp. For the oVEMP, overall poor between-session reliability for all response parameters evoked by the 500 Hz NB CE-Chirp and the BB CE-Chirp was observed. CONCLUSIONS: The 500 Hz NB CE-Chirp was more reliable than the BB CE-Chirp in terms of cVEMP latency, amplitude, and asymmetry ratio. Further investigation using the standard electrode montage is necessary to assess the test-retest reliability of the chirp-evoked oVEMP.

Evidence of Vestibular and Balance Dysfunction in Patients With Mild Cognitive Impairment and Alzheimer's Disease.

OBJECTIVES: Given the expected rise in dementia prevalence, early diagnosis is vital. As a growing body of literature has identified a potential association between vestibular function and cognition, vestibular assessment may aid in early screening. The aim of the study was to better comprehend the proposed association between vestibular function and Alzheimer's disease (AD) by comparing vestibular parameters (vestibular function testing and clinical balance measures) between a group with mild cognitive impairment (MCI), AD, and healthy controls with age-normal cognition. DESIGN: Cross-sectional analysis of the GECkO study, an ongoing prospective single-center longitudinal cohort study. This study included 100 older adults (55 to 84 years). A total of 33 participants with MCI, 17 participants with AD, and 50 participants of age, sex, and hearing-matched healthy controls were included. RESULTS: Participants with AD demonstrated a delayed latency of the p13 component measured by cervical vestibular-evoked myogenic potentials (cVEMP) compared with healthy controls and participants with MCI. Other measures including n23 latency, presence of intact responses, rectified amplitude, mean rectified voltage (measured by cVEMP) and lateral vestibulo-ocular reflex gain (measured by video Head Impulse Test [vHIT]) did not differ between groups. The Timed Up and Go (TUG), Performance-Oriented Mobility Assessment-Balance subscale (POMA-B), and Functional Gait Assessment (FGA) differed significantly between the three groups. Here, more cognitively impaired groups were associated with worse clinical balance scores. CONCLUSIONS: Vestibular and balance deficits were more prevalent in groups with increasing cognitive decline. Regarding vestibular function testing, p13 latency as measured by cVEMP was delayed in participants with AD. Other cVEMP or vHIT measures did not differ between groups. All three clinical balance assessments (TUG, POMA-B, and FGA) resulted in worse scores along the AD continuum. Future research integrating vestibular parameters that add value (including otolith function testing, balance, and spatial navigation) is recommended to validate the association between vestibular function and cognition while avoiding redundant testing.

Vestibular evoked myogenic potential (VEMP) test-retest reliability in adults.

BACKGROUND: The technique of measuring ocular vestibular evoked myogenic potentials (oVEMP) in response to Mini-shaker vibration is relatively new, there is a limited normative data to define the presence or absence of a response in the literature. OBJECTIVE: To determine the test-retest reliability of cervical and ocular VEMPs (cVEMP and oVEMP, respectively) to air-conducted sound (ACS) and bone-conducted vibration (BCV) stimulation and to determine normative ranges for the responses. METHODS: Twenty normal-hearing individuals (40 ears) and 20 hearing impaired volunteers with normal balance function (40 ears) were examined in this study. ACS cVEMP and BCV oVEMP (using a Mini-shaker) were recorded from both groups to assess the test-retest reliability and to collect normative VEMP data for P1/N1 latencies and amplitudes from 20 normal hearing individuals. To test reliability, VEMP recordings were repeated within the same session. RESULTS: The test-retest reliability for all the cVEMP parameters showed excellent reliability whereas oVEMP parameters showed between fair and excellent reliability depending on the parameter tested. Normative data for VEMP P1/N1 latencies and amplitudes were established. CONCLUSIONS: Normative data and test-retest reliability for BCV oVEMP using the Mini-shaker at 100 Hz were established in our study for the first time in the literature. Responses appear reliable.

Measurement of Ocular Vestibular Evoked Myogenic Potentials: Nasion Reference Montage as an Alternative to the Clinical Standard Montage.

OBJECTIVE: To compare two novel electrode montages for ocular, vestibular evoked myogenic potential using single-nasion reference electrodes with the clinical standard montage. STUDY DESIGN: Randomized crossover experiment. SETTING: Tertiary referral center. PARTICIPANTS: Sixty healthy participants. INTERVENTION: Normal hearing and vestibular function were confirmed with an extensive test-battery. All ocular, vestibular evoked myogenic potential settings were measured with air-conducted tone bursts at 100-dB normal hearing level and a frequency of 500 Hz. Three electrode montages were measured in randomized order: the clinical standard montage ("S"), the nasion reference montage ("N"), and the nasion reference montage with a more lateral active electrode ("L"). Upgaze was standardized to 35 degrees. MAIN OUTCOME MEASURES: Detection rate, latency of N1 and P1, peak-to-peak amplitude of N1 and P1, signal-to-noise ratio (SNR), asymmetry ratio (AR), concordance of expert assessment, and reliability. RESULTS: All electrode montages showed detection rates greater than 90%. Latencies for "L" were shorter than for "S" and "N." Amplitudes and SNR for "S" and "N" were higher than for "L," whereas the values for "S" and "N" did not differ significantly. For AR, no significant differences between the montages were assessed. Concordance of experts ranged from 78% for "L" and 89.8% for "N." All montages provided excellent day-to-day reliability (intraclass correlation coefficient ≥0.9) for amplitudes and SNR. CONCLUSIONS: Montage N could be a useful alternative to the clinical standard montage: although results are roughly equivalent, montage N requires one less electrode to do so.

Relationship between clinical measures of hearing and clinical measures of vestibular function.

PURPOSE: Patients often have basic audiometry (BA) but not objective diagnostic tests of the vestibular system (VNG) when complaining of symptoms of a vestibular disorder. The relationship of BA results to VNG results is unknown. This study sought to determine if BA scores are related to impaired VNG scores. MATERIALS AND METHODS: We reviewed electronic medical records at a tertiary care center, for patients seen between 2015 and 2021 who had had both a BA and a VNG (n = 651). BA subtests were pure tone averages, word recognition, and tympanogram. VNG subtests were cervical vestibular evoked myogenic potentials, Dix-Hallpike maneuvers, and bi-thermal caloric tests. All tests were summarized as normal/abnormal. RESULTS: More subjects had abnormal BA than abnormal VNG scores. Age but not sex was significantly related to abnormal scores. High BP was a significant comorbidity in 15 % of the sample, more in patients with abnormal than normal VNG scores. Although the abnormal BA and abnormal VNG were significantly related, pure tone averages and tympanogram scores were not related to VNG subtests. Abnormal word recognition with both ears combined was significantly related to normal and abnormal bi-thermal caloric tests. CONCLUSIONS: If the clinician needs to know of any VNG impairment, in general, then performing a BA without a VNG might suffice. If the clinician needs information about the details of possible vestibular impairment, then a VNG should be performed.

Vestibular function in children with vestibulocochlear nerve aplasia/hypoplasia.

BACKGROUND: Infants and young children with vestibulocochlear nerve (VCN) hypoplasia/aplasia present with severe hearing loss and are candidates for cochlear implantation (CI). It is unknown whether vestibular function is related to CI outcome and if vestibular tests can guide the operation decision. AIMS/OBJECTIVES: Our aim was to describe the vestibular function in patients with VCN hypoplasia/aplasia before a possible CI. MATERIALS AND METHODS: Forty-two ears in 23 patients were tested between 2019 and 2022 with bone-conducted cervical vestibular evoked myogenic potentials (BCcVEMP), video head impulse test (vHIT) and miniice-water caloric test (mIWC). RESULTS: All ears could be tested with at least one vestibular test and 83% could be tested with more than one method. Twenty-nine ears (61%) showed normal function with at least one method. The presence of a normal response to any test doubled the likelihood of a measured hearing threshold after CI, the best predictors being the BCcVEMP and vHIT (p < 0.05). CONCLUSION: Canal function may represent a predictor of auditive pathway integrity with a possible favourable audiological outcome after CI operation. SIGNIFICANCE: Our results demonstrate high vestibular response rates suggesting a functioning pathway despite the radiological diagnosis.

Vestibular evoked myogenic and auditory brainstem evoked potentials in a female migraine population.

Background and purpose:

The purpose of the present study was to evaluate ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), and brainstem auditory evoked potential (BAEP) response characteristics and to understand the pathophy­siology of vestibular dysfunction in female migraineurs with vertigo symptoms. We also aimed to assess the electrophysiological di­­agnostic significance of the VEMP respon­ses in vestibular migraine (VM). 

23 patients with migraine without aura (MoA), 23 patients with VM, and 20 sex-and age-matched healthy controls, a total of 66 female participants were enrolled in this study. The outcome parameters were asymmetry ratios (ARs), amplitudes of oVEMP, cVEMP, N1P1, P13N23, and the respective latencies (mean ± SD). From the BAEP graphs, absolute and interpeak interval latencies of waves were analyzed. 

30.4% of the MoA group and 21.7% of the VM group had uni- or bilaterally absent cVEMP responses which were statistically significant only in the MoA group (p=0.035) in comparison to control group. Both groups displayed statistically insignificant absent or asymmetrical responses for oVEMP (13.1%). Cervical VEMP P13 and N23 latency, peak-to-peak amplitude, interaural latencies, and amplitude ARs did not show any significant difference between MoA and VM patients and healthy controls. No significant difference was detected among the three groups in the oVEMP and BAEP parameters.

Although absent cVEMP responses were more common in MoA and VM patients than in healthy individuals, the VEMP and BAEP test results should not be used in the differential diagnosis of VM and MoA. 

The Need for Vestibular Implants in a Tertiary Referral Ear, Nose, and Throat Center and Its Relation to Hearing Status.

BACKGROUND: Patients with bilateral vestibulopathy (BVP) are at increased risk of falling and have poor quality of life. Several research groups are currently developing and investigating vestibular implants to treat BVP. The goal was to identify how many patients can be considered eligible for vestibular implantation. METHODS: The objective vestibular implantation criteria for research were applied to the results of the caloric irrigation test, the sinusoidal harmonic acceleration test, the video head impulse test, and the cervical and ocular vestibular evoked myogenic potential tests. RESULTS: Vestibular implant eligibility was situated between 3.6% and 15.7% (semicircular canal implant: 3.6%; otolith implant: 15.7%; combined implant: 4.8%). Only 16 out of the 29 patients (55%) eligible for a vestibular implant had bilateral severe-to-profound hearing loss. The remaining 45% (13/29) thus have better hearing in at least 1 ear. CONCLUSION: Vestibular implant eligibility in an ear, nose, and throat department was situated between 3.6% and 15.7%, depending on the type of implant that was considered. In addition, the data showed that 45% of the eligible patients had normal-to-moderate hearing in at least 1 ear. In other words, only recruiting patients with (bilateral) severe-to-profound hearing loss for vestibular implantation leads to the systematic exclusion of about half of the candidates. Structure-preserving surgical techniques are thus a major future challenge in the field of vestibular implantation.

Cervical vestibular evoked myogenic potential (cVEMP) findings in adults with sensorineural hearing loss (SNHL): comparisons between 500 Hz tone burst and narrowband CE-Chirp stimuli.

There has been a growing interest in studying the usefulness of chirp stimuli in recording cervical vestibular evoked myogenic potential (cVEMP) waveforms. Nevertheless, the study outcomes are debatable and require verification. In view of this, the aim of the present study was to compare cVEMP results when elicited by 500 Hz tone burst and narrowband (NB) CE-Chirp stimuli in adults with sensorineural hearing loss (SNHL). Fifty adults with bilateral SNHL (aged 20-65 years) underwent the cVEMP testing based on the established protocol. The 500 Hz tone burst and NB CE-Chirp (centred at 500 Hz) stimuli were presented to each ear at an intensity level of 120.5 dB peSPL. P1 latency, N1 latency, and P1-N1 amplitude values were analysed accordingly. The NB CE-Chirp stimulus produced significantly shorter P1 and N1 latencies (p < 0.001) with large effect sizes (d > 0.80). In contrast, both stimuli elicited cVEMP responses with P1-N1 amplitude values that were not statistically different from one another (p = 0.157, d = 0.15). Additionally, age and hearing level were found to be significantly correlated (r = 0.56, p < 0.001), as were age and cVEMP amplitude for each stimulus (p < 0.001). To conclude, since both stimuli were presented at an equivalent intensity level (in dB peSPL), the shorter P1 and N1 latencies of cVEMP produced by the NB CE-Chirp stimulus (centred at 500 Hz) were unlikely due to enhanced saccular stimulation. Another more sensible reason is the temporal adjustment of the chirp stimulus.

The impact of vestibular dysfunction on falls and postural instability in individuals with type 2 diabetes with and without diabetic polyneuropathy.

Aim: This study aimed to determine the association between vestibular dysfunction, falls, and postural instability in individuals with type 2 diabetes (T2D) compared to healthy control individuals and to examine the impact of diabetic polyneuropathy (DPN). Methods: This cross-sectional study included individuals with T2D with DPN (n = 43), without DPN (n = 32), and healthy controls (n = 32). Cervical and ocular vestibular evoked myogenic potentials (VEMP) were recorded, and latencies and amplitudes were determined. DPN was diagnosed based on nerve conduction studies and clinical scores. Postural instability was examined using a static posturographic balance system and calculated as an instability index (ST). Falls were recorded retrospectively during the past year. Group comparisons were conducted by using univariate and bivariate statistics. Results: Individuals with T2D experienced more falls than healthy controls (T2D with DPN n = 12[38%], T2D without DPN n = 15[35%], controls n = 5[16%], p = 0.04). Individuals with T2D had decreased postural stability, T2D with DPN, ST (median of 52[iqi = 33; 77]), T2D without DPN, ST (median of 31[iqi = 24; 39]), controls ST (median of 26[iqi = 19; 33], p = 0.01), when comparing all three groups. Individuals with T2D had a greater number of no-responses in oVEMP compared to controls (T2D with DPN, n = 15[46.9%] T2D without DPN n = 25[58.1%], controls n = 9[28.1%], p = 0.04). No difference was found in cVEMP and oVEMP amplitudes in any of the groups. Irrespectively of DPN, fallers with T2D had decreased oVEMP and cVEMP latencies on the right ears, when comparing to non-fallers, respectively, n10 (fallers [median of 16, iqi=15;19 ms.] vs. non-fallers [median of 25 iqi=16;35 ms]); p13 (fallers [median of 16, iqi=15;17 ms.] vs. non-fallers [median of 15, iqi=8;16 ms.], p < 0.05). Conclusion: Falls and postural instability were more frequent in individuals with T2D compared to healthy controls. Fallers with T2D had vestibular end-organ impairments based on the oVEMP and cVEMP latencies on the right but not the left ears, irrespective of DPN. Individuals with T2D had more frequent no-response of the oVEMP, indicating impaired vestibular nerve function.