Usefulness of vestibular evoked myogenic potentials in diagnosis of peripheral vestibular disorders
Keywords:VEMP, Vestibular disorders, Vertigo, Meniere’s disease, Vestibular neuritis
Background: Vestibular evoked myogenic potentials (VEMP) are electromyographic responses to high-intensity acoustic stimuli to test vestibular system, otolith function and integrity of inferior vestibular nerve. These are easy to perform and non-invasive. In this study, we aimed at clinical application of VEMP to evaluate common peripheral vestibular disorders.
Methods: Prospective observational study carried in ENT department during January 2015-November 2016 over 40 patients in age group between 30-70 years with history of vertigo who underwent regular neuro-otological examination and VEMP.
Results: Of these, 25 diagnosed with BPPV, 11 with Meniere’s disease, and four with vestibular neuritis. Eight patients showed delayed VEMP responses. 28 (70%) patients had normal VEMP, 12 (30%) had abnormal VEMP responses. Out of 25 patients suffering from benign paroxysmal positional vertigo (BPPV) posterior semi-circular canal was involved in 20 (80%) patients and lateral semi-circular canal in 5 (20%) patients. Abnormal VEMP was found in 5 (20%) patients involving posterior semi-circular canal and in 1 (20%) patient involving lateral semi-circular canal. In patients with Meniere’s disease stage I, Meniere’s disease was observed in 7 (63.6%), stage II in 2 (18.1%), and stage IV disease in 1 (9.09%) patient. In these patients, abnormal VEMP was found in 3 (42.8%) of 7 stage I, 1 (50%) of 2 stage II and 1 (100%) of stage IV patients. One (20%) patient had abnormal VEMP responses during study.
Conclusions: VEMP are short-latency EMG that evaluates saccule and inferior vestibular nerve in peripheral vestibular nervous system. VEMP should be considered as complementary test along with conventional vestibular function tests in patients with peripheral vertigo.
Sheykholeslami K, Kaga K. The otolithic organ as a receptor of vestibular hearing revealed by vestibular-evoked myogenic potentials in patients with inner ear anomalies. Hearing Res. 2002;165(1-2):62-7.
Ferber-Viart C, Dubreuil C, Duclaux R. Vestibular evoked myogenic potentials in humans: a review. Acta oto-laryngol. 1999;119(1):6-15.
Hughes CA, Proctor L. Benign paroxysmal positional vertigo. Laryngoscope. 1997;107(5):607-13.
Ochi K, Ohashi T, Nishino H. Variance of vestibular‐evoked myogenic potentials. Laryngoscope. 2001;111(3):522-7.
Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngology--head and neck surgery. 2008;139(5):47-81.
Shepard NT, Telian SA. Programmatic vestibular rehabilitation. Otolaryngol Head Neck Surg. 1995;112(1):173-82.
Kanumuri S, Chaitanya KV, Nara J, Reddy KV. Role of cervical vestibular-evoked myogenic potentials in evaluating vestibular dysfunction in patients with Type II diabetes mellitus: A prospective institutional study. Indian J Otol. 2018;24(2):105.
Lee SH, Song DG, Kim S, Lee JH, Kang DG. Results of auditory brainstem response monitoring of microvascular decompression: a prospective study of 22 patients with hemifacial spasm. Laryngoscope. 2009;119(10):1887-92.
Wang BC, Liang Y, Liu XL, Zhao J, Liu YL, Li YF et al. Comparison of chirp versus click and tone pip stimulation for cervical vestibular evoked myogenic potentials. Eur Arch Oto-Rhino-Laryngol. 2014;271(12):3139-46.
Akin FW, Murnane OD, Panus PC, Caruthers SK, Wilkinson AE, Profiitt TM. The influence of voluntary tonic EMG level on the vestibular-evoked myogenic potential. J Rehabilitation Res Develop. 2004;41.
Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). Cmaj. 2003;169(7):681-93.
Rauch SD. Vestibular evoked myogenic potentials. Curr opinion otolaryngol head neck surg. 2006;14(5):299-304.
Nandi R, Luxon LM. Development and assessment of the vestibular system. Int J Audiol. 2008;47(9):566-77.
Egami N, Ushio M, Yamasoba T, Yamaguchi T, Murofushi T, Iwasaki S. The diagnostic value of vestibular evoked myogenic potentials in patients with Meniere's disease. J Vestibular Res. 2013;23(4,5):249-57.
Paparella MM. The cause (multifactorial inheritance) and pathogenesis (endolymphatic malabsorption) of Meniere's disease and its symptoms (mechanical and chemical). Acta oto-laryngologica. 1985;99(3-4):445-51.
Zapala DA, Brey RH. Clinical experience with the vestibular evoked myogenic potential. J Am Academy Audiol. 2004;15(3):198-215.
Fife TD, Colebatch JG, Kerber KA, Brantberg K, Strupp M, Lee H et al. Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2017;89(22):2288-96.