Danielle L. Dennis

Vestibular evoked myogenic potentials (VEMPs) evoked by air- and bone-conducted stimuli in vestibular neuritis.

OBJECTIVE To compare and characterise abnormalities for short latency vestibular evoked myogenic potentials (VEMPs) elicited by air- (AC) and two differing types of bone-conducted (BC) stimuli during vestibular neuritis (VN). METHODS AC (500Hz short tone bursts) and two BC stimuli (500Hz at the forehead and impulses at the mastoids) were used to evoke cervical and ocular potentials (cVEMPs and oVEMPs) in VN patients (n=22) and healthy subjects. RESULTS More abnormalities were observed for the oVEMP than the cVEMP when using either AC 500Hz or BC 500Hz. The AC stimulus showed slightly more abnormalities than the BC 500Hz stimulus. In contrast, BC impulses produced frequent abnormalities for both oVEMPs and cVEMPs. The findings were modelled, based upon presumed selective lesions of the superior nerve. CONCLUSIONS AC 500Hz stimulation was slightly better than BC 500Hz in demonstrating abnormalities in patients with VN. BC impulses behave as expected for a predominantly utricular stimulus. The relative contributions of saccular and utricular fibres differ for stimulus type and target reflex. SIGNIFICANCE AC 500Hz is as effective as BC 500Hz for investigating VN. BC impulses act most strongly on utricular afferents.

Differing response properties of cervical and ocular vestibular evoked myogenic potentials evoked by air-conducted stimulation

Highlights • cVEMPs and oVEMPS were recorded simultaneously from 15 healthy volunteers and 1 patient with superior canal dehiscence (SCD) using air conducted (AC) sound over a 30 dB range.• The SCD patient had larger amplitude responses at all intensities except for the cVEMP at the loudest intensity.• Whilst the cVEMP p13/n23 response was well fitted by a power law relationship the oVEMP n10/p16 response showed a change in gradient for the louder intensities and this may relate to differences in the pathways responsible.

Recruitment properties and significance of short latency reflexes in neck and eye muscles evoked by brief lateral head accelerations

Short lateral head accelerations were applied to investigate the recruitment properties of the reflexes underlying the earliest ocular and cervical electromyographic reflex responses to these disturbances. Components of both reflexes are vestibular dependent and have been termed “ocular vestibular evoked myogenic potentials” and “cervical vestibular evoked myogenic potentials”, respectively. Previous investigations using a unilateral vestibular stimulus have indicated that some but not all these vestibular-dependent reflexes show a simple power law relationship to stimulus intensity. In particular, crossed otolith-ocular reflexes showed evidence of an inflection separating two types of behaviour. The present stimulus acts bilaterally, and only the earliest crossed otolith-ocular reflex, previously shown to have a strictly unilateral origin, showed evidence of an inflection. Reflex changes in ocular torsion could, in principle, correct for the changes associated with translation for an elevated eye, but our findings indicated that the responses were consistent with previous reports of tilt-type reflexes. For the neck, both vestibular and segmental (muscle spindle) reflexes were evoked and followed power law relationships, without any clear separation in sensitivity. Our findings are consistent with previous evidence of “tilt-like” reflexes evoked by lateral acceleration and suggest that the departure from a power law occurs as a consequence of a unilateral crossed pathway. For the neck, responses to transients are likely to always consist of both vestibular and non-vestibular (segmental) components. Most of the translation-evoked ocular and cervical reflexes appear to follow power law relationship to stimulus amplitude over a physiological range.

Properties of 500 Hz air- and bone-conducted vestibular evoked myogenic potentials (VEMPs) in superior canal dehiscence

OBJECTIVES To compare threshold and amplitude properties for air- (AC) and mastoid bone-conducted (BC) cervical (cVEMP) and ocular (oVEMP) vestibular evoked myogenic potentials in superior canal dehiscence (SCD). METHODS Thirteen patients (53±14yrs) clinically diagnosed with SCD were tested using AC 500Hz sound and BC 500Hz transmastoid vibration. Baseline intensities of 135dBpSPL and 138dBpFL respectively were used and reduced until the response amplitudes were less than 2.5 standard deviations of the prestimulus baseline mean. SCD VEMP amplitudes, response gradients and threshold parameters for the initial peaks for the cVEMP (ipsilateral) and the oVEMP (contralateral) were compared with results for normal subjects over a range of intensities. RESULTS Despite higher amplitudes, reflex gradients against intensity for AC and BC cVEMPs were significantly less in SCD than normals (P≪0.001) while AC and BC oVEMP gradients were not significantly different between the groups. Abnormally low thresholds for AC 500Hz were present for 85% of cVEMPs and 62% of oVEMPs. Abnormally low BC 500Hz thresholds were seen for 33% of cVEMPs and 83% of oVEMPs. Amplitudes for AC 500Hz were compared over the 135-105dBpSPL intensity range. The cVEMP showed more pathologically large amplitude responses with the lower stimulus intensities (135dBpSPL: 5%, 105dBpSPL: 100%) whereas the oVEMP demonstrated high rates of amplitude increases for all intensities (129-111dBpSPL: 92%). The pattern of pathologically large amplitudes evoked by BC 500Hz was similar for both reflexes such that both cVEMPs and oVEMPs showed maximum prevalence of abnormally large responses around 117dBpFL (cVEMP: 58%, oVEMP: 83%). CONCLUSIONS In SCD, both AC and BC evoked cVEMPs show evidence of saturation but this is not evident for oVEMPs. Both cVEMPs and oVEMPs show frequent abnormalities of amplitudes and thresholds in SCD compared to normal subjects but the sensitivities differed between measures. SIGNIFICANCE Previous evidence of saturation of cVEMP responses in SCD was confirmed. For diagnosis, AC cVEMP amplitudes at 105dBpSPL or AC-evoked oVEMP amplitudes both have over 90% sensitivity in separating SCD from normal responses.

Properties of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) evoked by 500 Hz and 100 Hz bone vibration at the mastoid

OBJECTIVE To define and compare the input-output properties of 500 Hz and 100 Hz bone-conducted (BC) transmastoid stimulation when evoking cVEMPs and oVEMPs. The findings for 500 Hz were compared with those previously reported for air-conducted (AC) 500 Hz stimulation. METHODS Twelve healthy subjects (18-57 years old) participated in this study, with simultaneous recordings of cVEMPs and oVEMPs bilaterally. Initial intensities of 138 dB (FL) were used and then reduced in 3 or 6 dB increments to 105 dB. RESULTS For BC 500 Hz, like AC 500 Hz, the relationship between the stimulus and reflex output fitted a power law for most peaks, but not the initial peak of the oVEMP. Some of the subjects did not have early crossed oVEMP responses for BC 500 Hz but all did for 100 Hz. For BC 100 Hz, while the initial waveforms were similar, many of the peaks showed a tendency to saturate at the higher intensities. For both BC 500 Hz and 100 Hz, the initial (contralateral) oVEMP peaks had a higher threshold than for the (ipsilateral) cVEMP responses although this difference was more marked for 500 Hz. CONCLUSIONS BC 500 Hz shows similar properties to AC 500 Hz, consistent with an overlapping spectrum of afferents being excited by both, with bilateral effects for the BC stimulus. BC 100 Hz evokes more non-vestibular peaks, presumably from muscle afferents, for the SCM recordings but is a more reliable method of evoking the early crossed potentials of the oVEMP. SIGNIFICANCE BC 500 Hz is a useful adjunct to the AC 500 Hz stimulus and has similar properties. The BC 100 Hz stimulus may be a more reliable method of evoking the early crossed oVEMP responses.

Electrode montage and gaze effects on ocular vestibular evoked myogenic potentials (oVEMPs)

OBJECTIVES To investigate the properties of lateral electrode locations compared to the conventional ones and to bipolar compared to chin-referenced montages for recording ocular vestibular evoked myogenic potentials (oVEMPs). METHODS A total of 18 subjects were studied using 5 electrode locations around the eye, including the conventional location and more lateral ones (i.e. M, ML and L electrodes near the orbital margin, R1 and R2 electrodes below the two more medial ones). Unilateral air-conducted (AC) sound, bone-conducted (BC) impulses at the mastoid and BC vibration (500Hz) at the forehead were used. These were applied while the subjects looked in neutral gaze and with 4 levels of increasing elevation. A subset of 10 subjects were also studied when looking downwards at 4 levels. Five bipolar montages were created offline by subtraction. RESULTS The M and ML electrodes had the largest responses but responses were seen for all 5 electrodes. The chin reference was associated with substantial pickup from the contralateral side (as judged using unilateral AC stimulation). The M-R1 (conventional) montage showed a significantly non-linear response to gaze angle, unlike the ML montages. The ML-R1 montage gave the largest responses. There was a clear change in latency for the conventional montage with downgaze for the AC and BC impulsive stimuli. CONCLUSIONS The ML active electrode has a more stable n1 latency, a larger and a more linear response to gaze angle than the conventional recording site, probably due to contamination by pickup of inferior rectus activity when using the conventional site. SIGNIFICANCE The ML location is a better site for the active pickup for recording oVEMPs if the main object of study is the inferior oblique muscle and particularly if subjects have difficulty with upgaze.