Vestibular evoked myogenic potentials in young children: test parameters and normative data.

OBJECTIVE: The vestibular evoked myogenic potential (VEMP) is a test of the vestibulocollic reflex that has been extensively studied in adults. Much is known about the normal values in adults as well as their changes with age. In children, the expected test values and their possible changes in development have not yet been described nor has the feasibility of reliable testing in this group. The aim of this prospective study is to accumulate normative data and to verify the viability of testing in young children. The study focused on optimal test parameters, reproducibility, and subject compliance in a pediatric population. METHODS: Thirty normal-hearing children (60 ears) ages 3 to 11 completed VEMP testing and audiograms for analysis. VEMP testing was performed with alternating clicks at three intensities (80-, 85-, and 90-dB normalized hearing level) using averaged, unrectified electromyograms recorded by surface electrode on the sternocleidomastoid muscle ipsilateral to the stimulus. VEMP latencies, amplitude, compliance, and length of testing were recorded for each patient, as well as their feedback on the testing session. The subjects were divided into four age groups for analysis. RESULTS: All but one of the subjects attempting VEMP testing was able to finish. Of 30 children completing VEMP tests, bilateral reflexes were recorded for all subjects with symmetric responses in 28 of 30 subjects (93%). The mean peak latencies (+/- standard deviation [SD]) of pI and nII were 11.3 msec (1.3 ms) and 17.6 msec (1.4 ms), respectively. The mean pI-nII amplitude (+/- SD) was 122 muV (68 muV). There was a significantly shorter nII mean peak latency of group I (ages 3-5) left ear in comparison to other groups, with an absolute shorter mean latency nII in the right ear of group I (not significant). Average test time was 15 minutes with two researchers testing, and subjects were highly compliant. CONCLUSIONS: VEMP is a well-tolerated test for screening vestibular function in young children, performed with minimal test time and reproducible results. Mean latencies in this study suggested a shorter initial negative peak (nII) than in adult studies, consistent with prolongation seen in previous research on the effects of age. Ninety-decibel normalized hearing level clicks were adequate for uniform response rates. Expected latency and amplitude values in single-channel VEMP-unrectified electromyograms were established. This is the first study describing expected latencies and optimal testing parameters in children.

Partial laryngectomy imaging.

The treatment of early stage laryngeal cancer is radiation therapy in the majority of cases, with surgery reserved for salvage therapy. Some institutions advocate partial laryngectomy procedures as primary treatment due to improved voice preservation with equivalent local control. The partial laryngectomy includes several variations of laryngeal resection to incorporate differing lesion locations and their patterns of oncologic spread. This serves as a challenge to the evaluating radiologist as post-surgical and post-radiation therapy changes distort the anatomy, and may not reflect recurrent or persistent disease. This article discusses the types of partial laryngectomy, as well as the indications and possible complications of the procedures. Additionally, the appearance of expected changes is outlined in contrast to recurrent or persistent disease.