Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Archives of Oto-Rhino-Laryngology
Published in: European Archives of Oto-Rhino-Laryngology 9/2016

01-09-2016 | Otology

Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal

Authors: Niraj Kumar Singh, Kumari Apeksha

Published in: European Archives of Oto-Rhino-Laryngology | Issue 9/2016

Login to get access

Abstract

Benign paroxysmal positional vertigo (BPPV) constitutes a major proportion of the population with peripheral vestibulopathies. Although the freely floating otoconia within the semicircular canals is responsible for the symptoms of BPPV, the source of the otoconia debris is mainly believed to be the otolith organs. Therefore, the pathology in either or both the otolith organs appears a logical proposition. Cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), being the tests for functional integrity of the otolith organs, appear promising for investigating otolith involvement in BPPV. While recent evidences are suggestive of equivocal findings for cVEMP, there are only a few studies on oVEMP. Additionally, both these potentials have never been explored in the same set of individuals with BPPV. Therefore, the present study aimed to evaluate the functional integrity of the otolith organs through cVEMP and oVEMP in individuals with posterior canal BPPV. Thirty-one individuals with unilateral posterior canal BPPV and 31 age- and gender-matched healthy controls underwent 500 Hz tone-burst-evoked cVEMP and oVEMP. The results demonstrated no significant group difference on any of the cVEMP parameters (p > 0.05). A similar trend was noticed for the latency-related parameters of oVEMP. However, the peak-to-peak amplitude was significantly smaller in the affected ears of individuals with BPPV than their unaffected ears and the ears of healthy controls (p < 0.05). The BPPV group showed significantly higher inter-aural amplitude difference ratio than the healthy controls (p < 0.05). Further, the sensitivity and specificity of oVEMP were also found to be far superior to those of cVEMP. Thus, the outcome of the present study revealed involvement of utricle rather than saccule in posterior canal BPPV, and therefore, oVEMP appears to be better suited to clinical investigation than cVEMP in individuals with posterior canal BPPV.
Literature
1.
Herdman SJ, Tusa RJ (2000) Assessment and treatment of patients with benign paroxysmal positional vertigo. In: Herdman S (ed) Vestibular Rehabilitation. F.A. Davis Company, Phyladelphia, pp 451–475
2.
von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H (2007) Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 78:710–715CrossRef
3.
4.
Hall SF, Ruby RF, McClure JA (1979) The mechanics of benign paroxysmal positional vertigo. J Otolaryngol 8:151–158PubMed
5.
Korres SG, Balatsouras DG (2004) Diagnostic, pathophysiologic and therapeutic aspects of benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 131:438–444CrossRef
6.
Dix MR, Hallpike CS (1952) The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 45:341–354PubMedPubMedCentral
7.
Gacek RR (2003) Pathology of benign paroxysmal positional vertigo revisited. Ann Otol Rhinol Laryngol 112:574–582CrossRefPubMed
8.
Gacek RR, Gacek MD (1998) Updates on pathology and management of benign paroxysmal vertigo. Otorhinolaryngol Nova 8:235–244CrossRef
9.
Murofushi T, Halmagyi GM, Yavor RA, Colebatch JG (1996) Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis: an indication of inferior vestibular nerve involvement? Arch Otolaryngol Head Neck Surg 122:845–848CrossRefPubMed
10.
Todd NP, Rosengren SM, Aw ST, Colebatch JG (2007) Ocular vestibular evoked myogenic potentials (OVEMPs) produced by air- and bone-conducted sound. Clin Neurophysiol 118:381–390CrossRefPubMed
11.
Singh NK, Barman A (2013) Characterizing the frequency tuning properties of air-conduction ocular vestibular evoked myogenic potentials in healthy individuals. Int J Audiol 52(12):849–854CrossRefPubMed
12.
Singh NK, Singh P, Usha M, Akshay M (2013) Audio-vestibular finding in vestibular paroxysmia. Indian J Otol 19(2):82–84CrossRef
13.
Colebatch JG, Halmagyi GM, Skuse NF (1994) Myogenic potentials generated by a click-evoked vestibulocollic reflex. J Neurol Neurosurg Psychiatry 57(2):190–197CrossRefPubMedPubMedCentral
14.
Chiarovano E, Zamith F, Vidal P, Waele C (2011) Ocular and cervical VEMPs: a study of 74 patients suffering from peripheral vestibular disorders. Clin Neurophysiol 122:1650–1659CrossRefPubMed
15.
Rosengren SM, Todd NPM, Colebatch JG (2005) Vestibular-evoked extraocular potentials produced by stimulation with bone-conducted sound. Clin Neurophysiol 116(8):1938–1948CrossRefPubMed
16.
Todd MN, Rosengren S, Colebatch J (2009) A utricular origin of frequency tuning to low-frequency vibration in the human vestibular system. Neurosci Lett 451(3):175–180CrossRefPubMed
17.
Welgampola MS, Carey JP (2010) Waiting for the evidence: VEMP testing and the ability to differentiate utricular versus saccular function. Otolaryngol Head Neck Surg 143:281–283CrossRefPubMedPubMedCentral
18.
Curthoys V, Vulovic L, Manzari L (2012) Ocular vestibular-evoked myogenic potential (oVEMP) to test utricular function: neural and oculomotor evidence. Acta Otolaryngol Ital 32:41–45
19.
Weber KP, Rosengren SM, Michels R, Sturm V, Straumann D, Landau K (2012) Single motor unit activity in human extraocular muscles during the vestibulo-ocular reflex. J Physiol 590(13):3091–3101CrossRefPubMedPubMedCentral
20.
Yetiser S, Ince D, Gul M (2014) An analysis of vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 123(10):686–695CrossRefPubMed
21.
Yang WS, Kim SH, Lee JD, Lee WS (2008) Clinical significance of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo. Otol Neurotol 29:1162–1166CrossRefPubMed
22.
Hong SM, Park DC, Yeo SG, Cha CI (2008) Vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo involving each semicircular canal. Am J Otolaryngol 29(3):184–187CrossRefPubMed
23.
Heide G, Freitag S, Wollenberg I, Ror H, Schimrigk K, Dillmann U (1999) Click evoked myogenic potentials in the differential diagnosis of acute vertigo. J Neurol Neurosurg Psychiatry 66:787–790CrossRefPubMedPubMedCentral
24.
Longo G, Onofri M, Pellicciari T, Quaranta N (2012) Benign paroxysmal positional vertigo: is vestibular evoked myogenic potential testing useful? Acta Otolaryngol 132(1):39–43CrossRefPubMed
25.
Singh NK, Sinha SK, Govindaswamy R, Apeksha K (2014) Are cervical vestibular evoked myogenic potentials sensitive to changes in the vestibular system associated with benign paroxysmal positional vertigo? Hear Balance Commun 12:20–26CrossRef
26.
Lee JD, Park MK, Lee BD, Lee TK, Sung KB, Park JY (2013) Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with benign paroxysmal positional vertigo. Acta Otolaryngol 133:150–153CrossRefPubMed
27.
Nakahara H, Yoshimura E, Tsuda Y, Murofushi T (2013) Damaged utricular function clarified by oVEMP in patients with benign paroxysmal positional vertigo. Acta Otolaryngol 133(2):144–149CrossRefPubMed
28.
Seo T, Saka N, Ohta S, Sakagami M (2013) Detection of utricular dysfunction using ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo. Neurosci Lett 29(550):12–16CrossRef
29.
30.
Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ et al (2008) Clinical practice guideline: benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 139:S47–S81CrossRef
31.
32.
Chihara Y, Iwasaki S, Ushio M, Murofushi T (2007) Vestibular-evoked extraocular potentials by air-conducted sound: another clinical test for vestibular function. Clin Neurophysiol 118(12):2745–2751CrossRefPubMed
33.
Murnane OD, Akin FW, Kelly JK, Byrd S (2011) Effects of stimulus and recording parameters on the air conduction ocular vestibular evoked myogenic potential. J Am Acad Audiol 22:469–480CrossRefPubMed
34.
Wang SJ, Jaw FS, Young YH (2009) Ocular vestibular evoked myogenic potentials elicited from monaural versus binaural acoustic stimulations. Clin Neurophysiol 120(2):420–423CrossRefPubMed
35.
Govender S, Rosengren SM, Colebatch JG (2009) The effect of gaze direction on the ocular vestibular evoked myogenic potential produced by air-conducted sound. Clin Neurophysiol 120(7):1386–1391CrossRefPubMed
36.
Singh NK, Kadisonga P, Ashitha P (2014) Optimizing stimulus repetition rate for recording ocular vestibular evoked myogenic potential elicited by air-conduction tone bursts of 500 Hz. Audiol Res 4(88):14–20
37.
Li MW, Houlden D, Tomlinson RD (1999) Click evoked EMG responses in sternocleidomastoid muscles: characteristics in normal subjects. J Vestib Res 9(5):327–334PubMed
38.
Ozgur A, Erdivanli OC, Coskun ZO, Terzi S, Yigit E, Demirci M, Dursun E (2015) Comparison of tone burst, click and chirp stimulation in vestibular evoked myogenic potential testing in healthy people. Int Adv Otol 11(1):33–35CrossRef
39.
Isaradisaikul S, Navacharoen N, Hanprasertpong C, Kangsanarak KJ (2012) Cervical vestibular evoked myogenic potentials: norms and protocols. Int J Otolaryngol:1–7
40.
Welgampola MS, Colebatch JG (2001) Vestibulocollic reflexes; normal values and the effect of age. Clin Neurophysiol 112:1971–1979CrossRefPubMed
41.
Su HC, Huang TW, Young YH, Cheng PW (2004) Aging effect on vestibular evoked myogenic potential. Otol Neurotol 25:977–980CrossRefPubMed
42.
Kumar K, Bhat JS, Sinha SK (2010) Effect of aging on Vestibular evoked myogenic potential. J Indian Speech Hear Assoc 24:25–28
43.
Singh NK, Kashyap RS, Supreetha L, Sahana V (2013) Characterization of age-related changes in sacculocolic response parameters assessed by cervical vestibular evoked myogenic potentials. Europ Arch Otorhinolaryngol. doi:10.​1007/​s00405-013-2672-0
44.
45.
46.
Wu Z, Zhang S, Zhou N, Yi F, Chen A, Xie S et al (2006) Significance of some otologic function tests in diagnosis of Meniere’s disease. Lin Chuang Er Bi Yan Hou Ke Za Zhi 20(10):433–435PubMed
47.
Honrubia V, Baloh RW, Harris MR, Jacobson KM (1999) Paroxysmal positional vertigo syndrome. Am J Otol 20(4):465–470PubMed
48.
Schratzenstaller B, Wagner-Manslau Strasser G, Arnold W (2005) Canalithiasis of the superior semicircular canal: an anomaly in benign paroxysmal vertigo. Acta Otolaryngol 125:1055–1062CrossRefPubMed
49.
Escher A, Ruffieux C, Maire R (2007) Efficacy of the barbecue manoeuvre in benign paroxysmal vertigo of the horizontal canal. Eur Arch Otorhinolaryngol 264:1239–1241CrossRefPubMed
50.
Colebatch J, Halmagyi GM (1992) Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation. Neurology 42:1635–1636CrossRefPubMed
51.
Parnes LS, McClure JA (1992) Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 102(9):988–992CrossRefPubMed
52.
Buckingham RA (1999) Anatomical and theoretical observations on otolith repositioning for benign paroxysmal positional vertigo. Laryngoscope 109(5):717–722CrossRefPubMed
53.
von Brevern M, Schmidt T, Schönfeld U, Lempert T, Clarke AH (2006) Utricular dysfunction in patients with benign paroxysmal positional vertigo. Otol Neurotol 27(1):92–96CrossRef
54.
Markham CH, Diamond SG, Ito J (1987) Utricular dysfunction in benign paroxysmal positional vertigo. In: Graham MD, Kemink J (eds) The vestibular system: neurophysiologic and clinical research. Raven Press, New York, pp 255–262
55.
Takeda N, Nishiike S, Kitahara T, Kubo T, Ogino H, Koizuka I (1997) Clinical featuresand utricular dysfunction with benign paroxysmal positional vertigo. J Otolaryngol Jpn 100:449–456
56.
Sugita-Kitajima A, Azuma M, Hattori K, Koizuka I (2007) Evaluation of otolith function using off-vertical axis rotation in patient with benign paroxysmal vertigo. Neurosci Lett 422(1):81–86CrossRefPubMed
57.
Faralli M, Ricci G, Ibba MC, Crognoletti M, Longari F, Frenguelli A (2009) Dizziness in patients with recent episodes of benign paroxysmal positional vertigo: real otolithic dysfunction or mental stress? J Otolaryngol Head Neck Surg 38:375–380PubMed
58.
Murofushi T, Nakahara H, Yoshimura E, Tsuda Y (2011) Association of air-conducted sound oVEMP findings with cVEMP and caloric test findings in patients with unilateral peripheral vestibular disorders. Acta Otolaryngol 131:945–950CrossRefPubMed
59.
Taylor RL, Wijewardene A, Gibson WP, Black DA, Halmagyi GM, Welgampola MS (2011) The vestibular evoked-potential profile of Meniere’s disease. Clin Neurophysiol 122(6):1256–1263CrossRefPubMed
60.
Moon IH, Lee CG, Park MK, Lee JD (2012) Acute viral labyrinthitis. Res Vestib Sci 11(3):92–96
61.
Zuniga MG, Janky KL, Schubert MC, Carey JP (2012) Can vestibular-evoked myogenic potentials help differentiate Meniere’s disease from vestibular migraine? Otolaryngol Head Neck Surg 146(5):788–796CrossRefPubMedPubMedCentral
62.
Gabelic T, Krbot M, Sefer AB, Isgum V, Adamec I, Habek M (2013) Ocular and cervical vestibular evoked myogenic potentials in patients with multiple sclerosis. J Clin Neurophysiol 30(1):86–91CrossRefPubMed
63.
Nguyen KD, Welgampola MS, Carey JP (2010) Test-retest reliability and age-related characteristics of the ocular and cervical vestibular evoked myogenic potential tests. Otol Neurotol 31(5):793–802CrossRefPubMedPubMedCentral
64.
Tseng CL, Chou CH, Young YH (2010) Aging effect on the ocular vestibular evoked myogenic potentials. Otol Neurotol 31:959–963CrossRefPubMed
Metadata
Title
Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal
Authors
Niraj Kumar Singh
Kumari Apeksha
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 9/2016
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-015-3867-3

Other articles of this Issue 9/2016

European Archives of Oto-Rhino-Laryngology 9/2016 Go to the issue

Head and Neck

The importance of early diagnosis in patients with maxillary sinus carcinoma

Letter to the Editor

In response to: Hyaluronic acid fat graft myringoplasty vs. fat patch fat graft myringoplasty

Rhinology

Engraftment and regenerative effects of bone marrow stromal cell transplantation on damaged rat olfactory mucosa

Head and Neck

Cervical necrotizing fasciitis: management challenges in poor resource environment

Head and Neck

Cardiac comorbidity in head and neck cancer patients and its influence on cancer treatment selection and mortality: a prospective cohort study

Laryngology

Efficacy and tolerability of an ectoine mouth and throat spray compared with those of saline lozenges in the treatment of acute pharyngitis and/or laryngitis: a prospective, controlled, observational clinical trial