Effects of valproic acid and levetiracetam monotherapy on balance functions in patients with generalized epilepsy.

BACKGROUND: It is reported that antiepileptic drugs have an effect on balance functions. The aim of the study was to evaluate and compare the effects of valproic acid and levetiracetam monotherapy on balance functions in patients with generalized epilepsy using objective test methods. METHODS: The study included 43 generalized epilepsy patients aged 18-60 years, including 20 patients receiving valproic acid monotherapy, 23 patients receiving levetiracetam monotherapy, and 25 healthy individuals as controls, in the Neurology Clinic of a university hospital in eastern Turkey. The demographic data form was filled out and the Video Head Impulse Test and Vestibular Evoked Myogenic Potentials test were performed. RESULTS: Statistically significant differences were obtained between the groups in lateral, posterior, and anterior semicircular canal gains and RALP and LARP asymmetry values in the V-HIT test (p < 0.05). Statistically significant differences were obtained between the groups in P1, N1 latency and asymmetry values in the C-VEMP test and in N1, P1 latency, amplitude, and asymmetry values in the o-VEMP test (p < 0.05). CONCLUSION: Valproic acid and levetiracetam may affect the vestibulocular and vestibulocolic reflex pathways negatively. In this cohort, valproic acid had more pronounced adverse effects on balance functions as compared to levetiracetam.

Predictive nomograms and an algorithm for managing patients with probable Meniere's disease.

PURPOSE: To explore the efficacy of diagnostic tests in accurately reclassifying patients initially diagnosed with probable Meniere's disease (MD) into either definite or non-MD categories. MATERIALS AND METHODS: A retrospective cohort study was conducted at a neurotology clinic between 1/2016 and 5/2022. Patients underwent a battery of tests, from which sensitivity, specificity, positive and negative predictive values, as well as positive and negative likelihood ratios, were calculated. Additionally, prediction nomograms were developed. RESULTS: Of the 69 patients, 25 (36.2 %) were initially classified as definite MD, 21 (30.4 %), probable MD, and 23 (33.4 %) non-MD. The mean follow-up was 3.5 years. The sensitivity of electrocochleography (ECochG) was the highest (92 %), with a negative likelihood ratio of 15 %. Magnetic resonance imaging (MRI) with MD-protocol had the highest specificity (100 %), with a positive likelihood ratio of 100 %. Videonystagmography, video head impulse test, and cervical vestibular-evoked myogenic potentials, had lower sensitivity and specificity. We were able to reclassify 18 (86 %) patients with probable MD: 12 (57 %) were diagnosed with definite MD, and 6 (29 %) were diagnosed with non-MD, consistent with their clinical course. CONCLUSIONS: The combination of ECochG and MRI with MD-protocol provides the most reliable approach to reclassify patients with Probable MD, ensuring a precise and accurate diagnosis. Vestibular tests express the functional status of the labyrinth and may not be reliable. Our findings provide valuable insights into clinical decision-making for patients with Probable MD and raise the consideration of additional diagnostic tests as supplementary to the existing clinical-only diagnosis criteria.

The clinical meaning and significance of OVEMP morphology.

PURPOSE: While some OVEMP recordings are morphologically straightforward, some are poor in appearance, which can create a challenge, as they often require a "second look" by another experienced assessor. Even OVEMPs in normal subjects are sometimes poorly formed, but we wondered if the morphological assessment of the OVEMP response might provide some additional diagnostic information. METHODS: A single experienced assessor evaluated the OVEMP recordings of 60 patients referred sequentially to a tertiary care centre, and categorized them as "easy to assess" (i.e. obvious to a minimally trained assessor) or "difficult to assess", often requiring a second look by another experienced assessor. RESULTS: In 48 patients, the results were easy to assess (regardless of the actual clinical results) while 12 were classified as "difficult". This figure reflected the rate of morphologically poor responses we found in our population of normative data. CONCLUSION: Our clinical concern is that many centres have given up relying on OVEMP assessment because the morphology of the wave may be challenging to interpret. OVEMP assessment often calls for a "second look", requiring a collaboration between two experienced assessors. It seems that this feature may not be diagnostically useful and poor OVEMP morphology may present a challenge in interpretation, but this should not be used as a reason to defer OVEMP testing.

Bone conducted cervical vestibular evoked myogenic potentials: comparison of tone burst stimulus vs chirp stimulus.

PURPOSE: Vestibular evoked myogenic potential (VEMP) is a test used to evaluate the function of otolith organs. In healthy individuals, air-conducted (AC) responses are obtained, whereas, in conductive hearing loss, the inability to transmit the signal well enough with AC stimuli has led to the need for bone-conducted (BC) stimuli. This study aimed to compare 500 Hz Chirp and Tone Burst stimuli in terms of latency and amplitude in BC cVEMP. METHODS: This prospective observational case control study included 35 healthy participants (70 ears) between the age of 20-50. Participants underwent VEMP testing with BC 500 Hz Tone Burst stimulus and 500 Hz narrow band Chirp stimulus without changing the position of the bone conducted vibrator. The intensity of the stimuli was 50 dB nHL. RESULTS: Response rate of 500 Hz TB Stimulus was 51.4% and 95.7% in Chirp stimulus. It was observed that significantly more responses were obtained with Chirp stimulus than TB stimulus (p < 0.001). In terms of p1 latency, n1 latency, both latencies were significantly shorter in Chirp stimulus (p < 0.001). p1n1 amplitude was found significantly larger in Chirp stimulus (p < 0.001). CONCLUSION: Compared to 500 Hz TB stimulus, 500 Hz Chirp stimulus results in a higher response rate, larger p1n1 amplitude, and shorter p1 and n1 latency. A higher response rate may provide a more accurate assessment of otolith organs, reducing false negatives due to signal transmission in patients.

The role of cochlear and vestibular afferents in long-latency cervical vestibular evoked myogenic potentials.

OBJECTIVE: To examine the origin of cervical vestibular evoked myogenic potential (cVEMP) late waves (n34-p44) elicited with air-conducted click stimuli. DESIGN: Using a retrospective design, cVEMPs from normal volunteers were compared to those obtained from patients with vestibular and auditory pathologies. STUDY SAMPLE: (1) Normal volunteers (n = 56); (2) severe-to-profound sensorineural hearing loss (SNHL) with normal vestibular function (n = 21); (3) peripheral vestibular impairment with preserved hearing (n = 16); (4) total vestibulocochlear deficit (n = 23). RESULTS: All normal volunteers had ipsilateral-dominant early p13-n23 peaks. Late peaks were present bilaterally in 78%. The p13-n23 response was present in all patients with SNHL but normal vestibular function, and 43% had late waves. Statistical comparison of these patients to a subset of age-matched controls showed no significant difference in the frequencies, amplitudes or latencies of their ipsilateral early and late peaks. cVEMPs were absent in all patients with vestibular impairment. CONCLUSION: The presence of long-latency cVEMP waves was not dependent on the integrity of sensorineural hearing pathways, but instead correlated with intact vestibular function. This finding conflicts with the view that these late waves are cochlear in origin, and suggests that vestibular afferents may assume a more prominent role in their generation.

[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.

[Update on diagnostic procedures in third window syndromes. German version]. / Update zur Diagnostik der Drittfenstersyndrome.

BACKGROUND: The diagnosis of third window syndromes often poses a challenge in clinical practice. OBJECTIVE: This paper provides an up-to-date overview of diagnostic procedures in third window syndromes, with special emphasis on superior canal dehiscence syndrome (SCDS), large vestibular aqueduct syndrome (LVAS), and X-chromosomal malformation of the cochlea. MATERIALS AND METHODS: A literature search was performed in PubMed up to December 2023. Furthermore, a selection of the authors' own cases is presented. RESULTS: Audiovestibular tests for the diagnosis of third window syndromes are most often reported for patients with SCDS in the literature. In this context, cut-off values with different sensitivities and specificities have been defined for different outcome parameters of vestibular evoked myogenic potentials. Current developments include the application of electrocochleography, broadband tympanometry, video head impulse testing, and vibration-induced nystagmus. Genetic analyses are increasingly applied in LVAS. CONCLUSION: The diagnosis of third window syndromes is always based on the synthesis of patients' symptoms, clinical signs, audiovestibular test results, and imaging.

Investigation of Pathogenesis and Otolithic Organ Responses in Sailors with Seasickness Using cVEMP.

There are different theories cited as the cause of Motion Sickness. Asymmetrical otolithic organ function is one of the etiology theories of motion sickness. In our study, the aim was to reveal whether there is a cause originating from the sacculocolic reflex pathway in the physiopathology of seasickness. The patient group included 15 man sailors with diagnosis of seasickness and the control group included 15 man sailors without seasickness in our study. Cervical evoked myogenic vestibular potential (cVEMP) findings were compared between the groups. In the right and left ears of sailors with seasickness, the mean latencies of the p13 and n23 waves at 100, 95, and 90 dB normal hearing level (nHL) levels were found significantly shorter than in the control group (p < 0.05, for all). In the seasickness group, cVEMP interaural wave amplitude asymmetry ratio at 100 nHL level were found significantly higher than the control group (p = 0.001). The findings of our study indicated that there may be reasons arising rom the sacculocolic reflex pathway in the pathophysiology of seasickness.

Otolithic functions in patients with residual dizziness after successful repositioning manoeuvres for unilateral posterior canal BPPV.

OBJECTIVE: To evaluate otolithic functions in patients with residual dizziness after successful canalith repositioning procedures (CRPs) for unilateral posterior canal benign paroxysmal positional vertigo (BPPV), and to investigate possible risk factors. METHODS: This case-control observational study included healthy controls and patients with residual dizziness after improvement following CRP for BPPV. All participants were subjected to full history taking, otoscopy, audiological basic evaluation, Dix-Hallpike test to search for posterior canal BPPV, residual dizziness screening, and vestibular evoked myogenic potential (VEMP) testing. Between-group differences were assessed and possible factors associated with residual dizziness were identified by univariate analysis. RESULTS: A total of 50 patients with residual dizziness (mean age, 56.53 ± 7.46 years [29 female: 21 male]) and 50 healthy controls (mean age, 58.13 ± 7.57 years [20 female: 30 male]) were included. A significant difference in VEMP latencies was found between the patient and control group (delayed in the patient group), with no significant between-group difference in amplitude in both ears. Aging, female sex, long duration of BPPV, number of CRPs, cervical VEMP and ocular VEMP abnormalities, and winter onset, were significantly associated with the risk of residual dizziness. CONCLUSIONS: Residual dizziness is a frequent sequel of BPPV that may relate to otolithic dysfunction. VEMP changes were revealed in the form of delayed latencies.

Ocular vestibular-evoked myogenic potential assists in differentiation of multiple system atrophy from Parkinson's disease.

Vestibular-evoked myogenic potentials (VEMPs) can help assess otolithic neural pathway in the brainstem that may also participate in cardiovascular autonomic function. Parkinson's disease (PD) is associated with altered VEMP responses; however, the association between VEMP abnormalities and multiple system atrophy (MSA) remains unknown. Therefore, we compared the extent of otolith dysfunction using ocular (oVEMP) and cervical VEMP (cVEMP) between MSA and PD. We analyzed the clinical features and VEMP and head-up tilt table test (HUT) findings using the Finometer in 24 patients with MSA and 52 with de-novo PD, who had undergone neurotologic evaluation in a referral-based university hospital in South Korea from January 2021 to March 2023. MSA was associated with bilateral oVEMP abnormality (odds ratio [95% confidence interval] = 9.19 [1.77-47.76], p=0.008). n1-p1 amplitude was negatively correlated with Unified Multiple System Atrophy Rating Scale I-II scores in patients with MSA (r=-0.571, p=0.033), whereas it did not correlate with Movement Disorder Society-Unified Parkinson's Disease Rating Scale-III scores in patients with PD (r=-0.051, p=0.687). n1 latency was negatively correlated with maximum changes in systolic blood pressure within 15 s during HUT in patients with PD (r=-0.335, p=0.040) but not in those with MSA (r=0.277, p=0.299). In conclusion, bilaterally abnormal oVEMP responses may indicate the extent of brainstem dysfunction in MSA. oVEMP reflects the integrity of otolith-autonomic interplay, reliably assists in differentiating between MSA and PD, and helps infer clinical decline.

Impaired vestibular function associated with orthostatic hypotension in patients with multiple system atrophy.

BACKGROUND: Orthostatic hypotension (OH) is one of the most common symptoms in patients with multiple system atrophy (MSA). Vestibular system plays an important role in blood pressure regulation during orthostatic challenges through vestibular-sympathetic reflex. The current study aimed to investigate the relationship between vestibular function and OH in patients with MSA. METHODS: Participants with MSA, including 20 with OH (mean age, 57.55 ± 8.44 years; 7 females) and 15 without OH (mean age, 59.00 ± 8.12 years; 2 females) and 18 healthy controls (mean age, 59.03 ± 6.44 years; 8 females) were enrolled. Cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) tests were conducted to evaluate vestibular function. RESULTS: Patients with MSA presented with significantly higher rate of absent cVEMPs (57.1% vs 11.1%, p = 0.001) and oVEMPs (25.7% vs 0, p = 0.021) than controls. MSA patients with OH showed more absent cVEMPs (75.0% vs 11.1%, Bonferroni corrected p < 0.001) and oVEMPs (40.0% vs 0, Bonferroni corrected p = 0.003) than controls. Patients with OH also showed higher rate of absent cVEMPs than those without OH (33.3%, Bonferroni corrected p = 0.014). CONCLUSIONS: Our results demonstrated that impairment of vestibular function was associated with MSA, particularly in those with OH. Absent VEMPs may be a potential marker for MSA severity. Our findings suggest that impaired vestibular function is involved in OH development and may serve as an intervention target.

Masseter Vestibular evoked myogenic potentials: A new tool to assess the vestibulomasseteric reflex pathway.

Purpose: This review article provides the readers with an in-depth insight in understanding and interpreting various research literatures on the masseter vestibular evoked myogenic potentials (mVEMP). The article also reviews the contemporary researches involving the clinical applications of the mVEMP. Conclusions: Masseter VEMP is an evolving yet clinically promising neuro-otology test tool that has recently gained more research interest and is considered an additional tool to diagnose various vestibular disorders. Masseter VEMP assesses the functional integrity of the acoustic-masseteric and vestibulo-masseteric reflex pathways. The mVEMP could be used as a complementary test to evaluate the same peripheral generator as the cervical VEMP but a different central pathway i.e., vestibulo-trigeminal pathway. Various research studies that have experimented on parameters such as the effect of different electrode montages (zygomatic vs mandibular configurations), stimulation rates, filter settings and stimuli used to evoke mVEMP have been discussed in this article that could assist in the optimization of a comprehensive clinical protocol. The latency and the amplitude of mVEMP waveforms serve as significant parameters in differentiating normals from those of the clinical populations. Along with the cVEMPs and oVEMPs, mVEMP might help diagnose brainstem lesions in REM Sleep behaviour disorders, Multiple Sclerosis and Parkinson's disease. However, further studies are required to probe in this area of research.

Vestibular function in cases of posterior semicircular canal canalolithiasis and cupulolithiasis.

Objective: To analyze and compare the vestibular function of posterior canal cupulolithiasis and canalolithiasis. Methods: The results of posterior cupulolithiasis in 45 cases, posterior canalolithiasis in 122 cases and 19 healthy controls were analyzed retrospectively. Results: The abnormal rates of vHIT in the canalolithiasis group and the cupulolithiasis group were 42.6 and 37.8%, respectively, both higher than those in the control group (both p < 0.05); there was no statistically significant difference between two BPPV groups (p = 0.573). The abnormal vHIT in 76.9% of the canalolithiasis cases and 82.4% of the cupulolithiasis cases showed normal gain with saccades, with no difference between the groups (p = 0.859). The lesion location of vHIT in the two groups did not show a correlation with the affected side of BPPV (both p > 0.05). 84.4% of canalolithiasis and 65.0% of cupulolithiasis had abnormal VEMP results, with no significant differences in abnormality rates or sides (both p > 0.05). Abnormal results of VEMPs did not show any correlation with side (p > 0.05). The results of pc-ca and pc-cu were both abnormal in 14 cases and 7 cases, and there was no correlation between the site and side of the injury (all p > 0.05). Conclusion: The results of vHIT and VEMP in pc-cu and pc-ca were partially abnormal, but they did not show any correlation with side of BPPV. It can be considered that there are scattered vestibular peripheral organ damage in both groups.

Relationship Between Motion Sickness Susceptibility and Vestibular Test Results.

Objective: There is no test parameter with high sensitivity and specificity for the diagnosis of motion sickness. The aim of this study was to demonstrate a correlation between vestibular function tests and motion sickness. In addition, our secondary aim is to evaluate the sensitivity of the skull vibration-induced nystagmus test (SVINT) in the diagnosis of motion sickness. Methods: A total of 44 young adults aged 19-25 who had no hearing loss, complaints of dizziness/vertigo, or any diagnosed neurological disease were included. According to the motion sickness susceptibility questionnaire-short form (MSSQ-SF), participants were divided into the motion sickness group (21±1.38 years) and control group (20.5±1.18 years). Mean MSSQ-SF score for the motion sickness group is 78.18±12.2 and for control group 19.09±17.08. Ocular and cervical vestibular evoked myogenic potential tests, SVINT, video head impulse test, and oculomotor tests were performed. Results: The only significant difference between the groups was in n1-p1 amplitudes in the left ocular vestibular evoked myogenic potential test (p=0.014). None of the other parameters differed between the two groups (p>0.05). Conclusions: There was no significant relationship between motion sickness susceptibility and the results of any vestibular function test. Performing diagnostic tests for motion sickness in an environment that creates significant sensory conflict may yield different results. This study contributes to the literature in terms of evaluating the vestibular system using a comprehensive test battery and is the first to use the SVINT test in motion sickness.

Diagnostic value of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo.

OBJECTIVES: Vestibular evoked myogenic potentials (VEMPs) are useful for studying the disturbances along nerve pathways implicated in the transmission of neurological information from otolithic organs related to vestibular function. This study aims to determine the differences in VEMPs in patients affected with benign paroxysmal positional vertigo (BPPV). METHODS: We recruited 36 patients, 9 diagnosed with recurrent BPPV (rBPPV), 9 with only one episode of vertigo (iBPPV), and 18 as a control group. We performed cervical and ocular VEMPs (cVEMPs and oVEMPs). RESULTS: We observed differences in asymmetry ratio, which was 41.82% in cVEMPs in iBPPV and 68.27% in oVEMPs in rBPPV, while no asymmetry was found in control cases. Also, there was a lack of both VEMP responses in 22.2% of cases and an absence of cVEMP in 11.1% in iBPPV; in rBPPV, 11.1 % presented no responses in cVEMPs or oVEMPs, 22.2% showed no oVEMP, and 11.1% showed no cVEMP. These values were normal in the control group. CONCLUSION: The value of VEMPs in BPPV demonstrates the implication of vestibular damage, mainly utricle damage. For better sensitivity in detecting otolith abnormalities, we should perform oVEMPs and cVEMPs in recurrent BPPV and early stages of BPPV.

Posterior Semicircular Canal Dehiscence with Vestibulo-Ocular Reflex Reduction for the Affected Canal at the Video-Head Impulse Test: Considerations to Pathomechanisms.

Posterior semicircular canal dehiscence (PSCD) has been demonstrated to result in a third mobile window mechanism (TMWM) in the inner ear similar to superior semicircular canal dehiscence (SSCD). Typical clinical and instrumental features of TMWM, including low-frequency conductive hearing loss (CHL), autophony, pulsatile tinnitus, sound/pressure-induced vertigo and enhanced vestibular-evoked myogenic potentials, have been widely described in cases with PSCD. Nevertheless, video-head impulse test (vHIT) results have been poorly investigated. Here, we present six patients with PSCD presenting with a clinical scenario consistent with a TMWM and an impaired vestibulo-ocular reflex (VOR) for the affected canal on vHIT. In two cases, an additional dehiscence between the facial nerve and the horizontal semicircular canal (HSC) was detected, leading to a concurrent VOR impairment for the HSC. While in SSCD, a VOR gain reduction could be ascribed to a spontaneous "auto-plugging" process due to a dural prolapse into the canal, the same pathomechanism is difficult to conceive in PSCD due to a different anatomical position, making a dural herniation less likely. Alternative putative pathomechanisms are discussed, including an endolymphatic flow dissipation during head impulses as already hypothesized in SSCD. The association of symptoms/signs consistent with TMWM and a reduced VOR gain for the posterior canal might address the diagnosis toward PSCD.

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.

Subjective Visual Vertical and Vestibular Evoked Myogenic Potential in Meniere's disease,

Abstract Objective To evaluate otolith function by comparing the findings of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential tests in patients in the inter-crisis period of unilateral definite Meniere's disease. Methods The sample consisted of an experimental group (n = 22; 10 men and 12 women, mean age 47.32 ± 12.82 years) with definite unilateral Meniere's disease and a control group (n = 14; 5 men and 9 women, with a mean age of 41.64 ± 13.45 years). They all underwent vestibular evaluation by means of Subjective Visual Vertical with the bucket method and, cervical and ocular Vestibular Evoked Myogenic Potential tests. The data were collected and subjected to statistical analysis. Results The results of the comparison of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential, the ocular Vestibular Evoked Myogenic Potential and, the association of cervical Vestibular Evoked Myogenic Potential with the ocular Vestibular Evoked Myogenic Potential showed no significant difference, indicating concordance among the tests. Conclusion The identified abnormalities and the concordance between the combined proportion of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential findings indicate that the association of these three tests contributes to the identification of sustained and transient otolith dysfunction in the inter-crisis of unilateral definite Meniere's disease. Level of evidence 2.

Vestibular System Eletrophysiology: An Analysis of the Relationship between Hearing and Movement

Abstract Introduction Knowledge about the positive effects that music and dance bring, in its various forms, to the healthy human brain, is important not only in the context of basic neuroscience but may also strongly affect practices in neurorehabilitation. Objective To verify the relationship between hearing and movement and, specifically, to analyze the interference of professional dance practice and formal musical training in the magnitude of the vestibule-cervical and vestibular reflexes. Method The sample consisted of 92 subjects, aged between 18 and 35 years old, 31 professional musicians, 31 ballet dancers, and 30 control subjects. Only subjects with normal hearing sensitivity were included. Cervical vestibular evoked myogenic potential (cVEMP) was recorded in the sternocleidomastoid muscle, and ocular vestibular evoked myogenic potential (oVEMP) was recorded in the lower oblique muscle of the eye, using tone-bursts (500Hz). Analysis of variance (ANOVA) or Kruskall-Wallis tests were performed. Results The cVEMP presented earlier and higher amplitude waves when recorded in the group of dancers, with a significant difference between all tested groups for latency and amplitude of the N23 wave; the comparison was restricted between dancers and control groups, with no difference between ballet dancers and musicians. The N1 wave of the oVEMP presented lower latencies in dancers than in musicians and controls (p= 0.001). No significant differences were found between the groups for the P1 wave. Conclusion Greater magnitudes of vestibule-cervical reflex responses and faster vestibule-ocular reflex responses were observed in dancers. Dance practice provides greater development of the vestibular system, but musical training also contributes to the magnitude of these responses.

Vestibular function assessment in sudden hearing loss

Abstract Objectives: To perform vestibular assessment using cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing in patients with sudden hearing loss. Moreover, to evaluate the correlation of dizziness with vestibular tests and the correlation of vestibular tests with hearing prognosis. Methods: This is an observational, longitudinal and prospective study, including participants diagnosed with sudden hearing loss. The participants underwent cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing. The audiometric assessment was performed at the beginning and at the end of the follow-up. A value of p ≤ 0.05 was considered statistically significant. Results: Seventeen patients were included in the study sample, with a mean age of 45.4 ± 11.1 years. Five participants (29.41%) had dizziness and 15 (88.23%) had tinnitus. All participants underwent vestibular evaluation through cervical and ocular vestibular evoked myogenic potential and video head impulse test, and 13 of them were evaluated through caloric testing. The cervical vestibular evoked myogenic potential was considered altered in five (29.41%) participants, while 11 (64.71%) showed alterations at the ocular vestibular evoked myogenic potential. The video head impulse test and the caloric testing were considered altered in seven (41.18%) and five (38.46%) participants, respectively. There was no statistically significant correlation between the clinical data and the results of vestibular tests or hearing recovery, nor between the results of vestibular tests and hearing recovery. Conclusion: The assessment through vestibular evoked myogenic potential, video head impulse test and caloric testing showed vestibular involvement in some participants. However, it cannot be stated that the results of the vestibular tests are related to the hearing prognosis of sudden hearing loss.