Rapid cVEMP and oVEMP responses elicited by a novel head striker and recording device

P Ashley Wackym, Jennifer A Ratigan, Jonathan D Birck, Steven H Johnson, Josef Doornink, Michael Bottlang, Stuart K Gardiner, F Owen Black
Otology & Neurotology 2012, 33 (8): 1392-400

OBJECTIVE: To develop a reliable, easy to use bedside, office, or field system that allows the rapid measurement of cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) using a bone-conduction stimulus.

STUDY DESIGN: Prospective bioengineering design and proof of concept of the test system with saccular and utricular otolith response studies in human subjects.

SETTING: Private practice, tertiary neurotology referral center.

SUBJECTS: Twenty healthy adult controls without history of auditory or vestibular dysfunction and 5 preoperative and postoperative patients with confirmed superior canal dehiscence (SCD) participated.

INTERVENTIONS: The subjects underwent auditory stimuli-based cVEMP and oVEMP studies using a commercially available system as well as testing with a novel bone-conduction cVEMP and oVEMP head striker system.

MAIN OUTCOME MEASURES: Duration of each study, healthy subject and patient comfort, reproducibility, latency, and amplitude of auditory and striker evoked cVEMP and oVEMP responses.

RESULTS: The mean age of the healthy controls was 43.8, with a range of 19 to 69 years (10 male and 10 female subjects). The mean age of the SCD patient group was 46, with a range of 25 to 54 years; all female subjects. Although the cVEMP responses were similar using either the auditory or head strike stimuli, the healthy subjects preferred the latter, but the SCD patients became more symptomatic. The oVEMP data showed more consistent responses using the striker system. A statistically significant reduction in latency for the striker-evoked cVEMP occurred compared with the auditory cVEMP evoked response in the 5 SCD preoperative patients. All normalized postoperatively.

CONCLUSION: Recording the cVEMP and oVEMP responses using the striker system was much more rapid than with auditory stimuli and was more comfortable for the healthy subjects. The striker system and the acoustic method elicited strong otolithic receptor dysfunction symptoms in all SCD patients; however, they preferred the shorter striker studies. The striker system, because of the statistically shorter latency of p13 during the striker evoked cVEMP, which normalized after SCD closure, suggests that this method may be useful in identifying SCD patients before imaging studies. In addition, based on our biomechanical data, the striker was able to reliably produce a consistent and defined head striker impact.

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