Download PDF
J Am Acad Audiol 2017; 28(08): 708-717
DOI: 10.3766/jaaa.16071
Articles
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Safe Use of Acoustic Vestibular-Evoked Myogenic Potential Stimuli: Protocol and Patient-Specific Considerations

Cory D. F. Portnuff
*   University of Colorado Health, Hearing and Balance Center, Aurora, CO
†   Department of Otolaryngology, University of Colorado Denver, Aurora, CO
,
Samantha Kleindienst
‡   Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, AZ
,
Jamie M. Bogle
‡   Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, AZ
› Author Affiliations
Further Information

Publication History

Publication Date:
26 June 2020 (online)

Also available at
   Permissions and Reprints

Abstract

Background:

Vestibular-evoked myogenic potentials (VEMPs) are commonly used clinical assessments for patients with complaints of dizziness. However, relatively high air-conducted stimuli are required to elicit the VEMP, and ultimately may compromise safe noise exposure limits. Recently, research has reported the potential for noise-induced hearing loss (NIHL) from VEMP stimulus exposure through studies of reduced otoacoustic emission levels after VEMP testing, as well as a recent case study showing permanent sensorineural hearing loss associated with VEMP exposure.

Purpose:

The purpose of this report is to review the potential for hazardous noise exposure from VEMP stimuli and to suggest clinical parameters for safe VEMP testing.

Research Design:

Literature review with presentation of clinical guidelines and a clinical tool for estimating noise exposure.

Results:

The literature surrounding VEMP stimulus-induced hearing loss is reviewed, including several cases of overexposure. The article then presents a clinical calculation tool for the estimation of a patient’s safe noise exposure from VEMP stimuli, considering stimulus parameters, and includes a discussion of how varying stimulus parameters affect a patient’s noise exposure. Finally, recommendations are provided for recognizing and managing specific patient populations who may be at higher risk for NIHL from VEMP stimulus exposure. A sample protocol is provided that allows for safe noise exposure.

Conclusions:

VEMP stimuli have the potential to cause NIHL due to high sound exposure levels. However, with proper safety protocols in place, clinicians may reduce or eliminate this risk to their patients. Use of the tools provided, including the noise exposure calculation tool and sample protocols, may help clinicians to understand and ensure safe use of VEMP stimuli.

Key Words

noise-induced hearing loss - otolith testing - saccule - utricle - VEMP protocol - VEMP safety - vestibular-evoked myogenic potential
 

  • REFERENCES

  • Abdala C, Keefe D. 2012. Morphological and functional ear development. In: Werner L, Fay RR, Popper AN. Human Auditory Development. New York, NY: Springer; 19-59
    Google Scholar
  • Adamec I, Skorić MK, Handžić J, Barušić AK, Bach I, Gabelić T, Habek M. 2014; The role of cervical and ocular vestibular-evoked myogenic potentials in the follow-up of vestibular neuritis. Clin EEG Neurosci 45 (02) 129-136
    CrossrefPubMedGoogle Scholar
  • Aranda de Toro MA, Ordoñez R, Reuter K, Hammershøi D. 2010; Recovery of distortion-product otoacoustic emissions after a 2-kHz monaural sound-exposure in humans: effects on fine structures. J Acoust Soc Am 128 (06) 3568-3576
    CrossrefPubMedGoogle Scholar
  • Basta D, Todt I, Ernst A. 2005; Normative data for P1/N1-latencies of vestibular evoked myogenic potentials induced by air- or bone-conducted tone bursts. Clin Neurophysiol 116 (09) 2216-2219
    CrossrefPubMedGoogle Scholar
  • Beattie RC, Rochverger I. 2001; Normative behavioral thresholds for short tone-bursts. J Am Acad Audiol 12 (09) 453-461
    PubMedGoogle Scholar
  • Beck DL, Speidel DP, Huijnen J, Petrak MR. 2009; Tympanometry and acoustic reflex: innovation, review, and application. Hear Rev 16 (04) 28-33
    Google Scholar
  • Boettcher FA, Henderson D, Gratton MA, Danielson RW, Byrne CD. 1987; Synergistic interactions of noise and other ototraumatic agents. Ear Hear 8 (04) 192-212
    CrossrefPubMedGoogle Scholar
  • British Society of Audiology 2012 Performing cervical vestibular evoked myogenic potential measures.. https://www.thebsa.org.uk/wp-content/uploads/2014/04/VEMP_Guidance_v1.1_20121.pdf
    PubMedGoogle Scholar
  • Burkard R. 1984; Sound pressure level measurement and spectral analysis of brief acoustic transients. Electroencephalogr Clin Neurophysiol 57 (01) 83-91
    CrossrefPubMedGoogle Scholar
  • Chang CM, Young YH, Cheng PW. 2013; Feasibility of simultaneous recording of cervical and ocular vestibular-evoked myogenic potentials via galvanic vestibular stimulation. Acta Otolaryngol 133 (12) 1278-1284
    CrossrefPubMedGoogle Scholar
  • Chen CN, Wang SJ, Wang CT, Hsieh WS, Young YH. 2007; Vestibular evoked myogenic potentials in newborns. Audiol Neurootol 12 (01) 59-63
    CrossrefPubMedGoogle Scholar
  • Cheng PW, Yang CS, Huang TW, Young YH. 2008; Optimal stimulation mode for galvanic-evoked myogenic potentials. Ear Hear 29 (06) 942-946
    CrossrefPubMedGoogle Scholar
  • Colebatch JG, Halmagyi GM, Skuse NF. 1994; Myogenic potentials generated by a click-evoked vestibulocollic reflex. J Neurol Neurosurg Psychiatry 57 (02) 190-197
    CrossrefPubMedGoogle Scholar
  • Colebatch JG, Rosengren SM. 2014; Safe levels of acoustic stimulation: comment on “effects of acoustic stimuli used for vestibular evoked myogenic potential studies on the cochlear function”. Otol Neurotol 35 (05) 932-933
    CrossrefPubMedGoogle Scholar
  • Committee on Hearing and Bio-Acoustics 1992. Hazardous Exposure to Impulse Noise. Washington, DC: National Academy Press;
    Google Scholar
  • Curthoys IS, Iwasaki S, Chihara Y, Ushio M, McGarvie LA, Burgess AM. 2011; The ocular vestibular-evoked myogenic potential to air-conducted sound; probable superior vestibular nerve origin. Clin Neurophysiol 122 (03) 611-616
    CrossrefPubMedGoogle Scholar
  • Erbek S, Erbek SS, Gokmen Z, Ozkiraz S, Tarcan A, Ozluoglu LN. 2007; Clinical application of vestibular evoked myogenic potentials in healthy newborns. Int J Pediatr Otorhinolaryngol 71 (08) 1181-1185
    CrossrefPubMedGoogle Scholar
  • European Union (EU). (2003) Directive 2003/10/EC of the European Parliament and of the Council of 6 February 2003 on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (noise) (Seventeenth individual Directive within the meaning of Article 16(1) of Directive 89/391/EEC). Official Journal L 042:0038-0044.
  • Feigin JA, Kopun JG, Stelmachowicz PG, Gorga MP. 1989; Probe-tube microphone measures of ear-canal sound pressure levels in infants and children. Ear Hear 10 (04) 254-258
    CrossrefPubMedGoogle Scholar
  • Felipe L, Kingma H. 2014; Ocular vestibular evoked myogenic potentials. Int Arch Otorhinolaryngol 18 (01) 77-79
    PubMedGoogle Scholar
  • Gabelić T, Krbot M, Šefer AB, Išgum V, Adamec I, Habek M. 2013; Ocular and cervical vestibular evoked myogenic potentials in patients with multiple sclerosis. J Clin Neurophysiol 30 (01) 86-91
    CrossrefPubMedGoogle Scholar
  • Gozke E, Erdal N, Ozkarakas H. 2010; Ocular vestibular evoked myogenic potentials in patients with migraine. Acta Neurol Belg 110 (04) 321-324
    PubMedGoogle Scholar
  • Güven H, Bayır O, Aytaç E, Ozdek A, Comoğlu SS, Korkmaz H. 2014; Vestibular-evoked myogenic potentials, clinical evaluation, and imaging findings in multiple sclerosis. Neurol Sci 35 (02) 221-226
    CrossrefPubMedGoogle Scholar
  • Hong SM, Kim SK, Park CH, Lee JH. 2011; Vestibular-evoked myogenic potentials in migrainous vertigo. Otolaryngol Head Neck Surg 144 (02) 284-287
    CrossrefPubMedGoogle Scholar
  • International Electrotechnical Commission (IEC). (2007) Electroacoustics-audiometric equipment—Part 3: Test signals of short duration. IEC 60645-3. Geneva, Switzerland: IEC.
  • Janky KL, Nguyen KD, Welgampola M, Zuniga MG, Carey JP. 2013; Air-conducted oVEMPs provide the best separation between intact and superior canal dehiscent labyrinths. Otol Neurotol 34 (01) 127-134
    CrossrefPubMedGoogle Scholar
  • Janky KL, Shepard N. 2009; Vestibular evoked myogenic potential (VEMP) testing: normative threshold response curves and effects of age. J Am Acad Audiol 20 (08) 514-522
    Article in Thieme ConnectPubMedGoogle Scholar
  • Kantner C, Gürkov R. 2012; Characteristics and clinical applications of ocular vestibular evoked myogenic potentials. Hear Res 294 (1-2) 55-63
    CrossrefPubMedGoogle Scholar
  • Kingma CM, Wit HP. 2011; Asymmetric vestibular evoked myogenic potentials in unilateral Menière patients. Eur Arch Otorhinolaryngol 268 (01) 57-61
    CrossrefPubMedGoogle Scholar
  • Konings A, Van Laer L, Van Camp G. 2009; Genetic studies on noise-induced hearing loss: a review. Ear Hear 30 (02) 151-159
    CrossrefPubMedGoogle Scholar
  • Krause E, Mayerhofer A, Gürkov R, Drexl M, Braun T, Olzowy B, Boetzel K. 2013; Effects of acoustic stimuli used for vestibular evoked myogenic potential studies on the cochlear function. Otol Neurotol 34 (07) 1186-1192
    CrossrefPubMedGoogle Scholar
  • Kujawa SG, Liberman MC. 2006; Acceleration of age-related hearing loss by early noise exposure: evidence of a misspent youth. J Neurosci 26 (07) 2115-2123
    CrossrefPubMedGoogle Scholar
  • Laukli E, Burkard R. 2015; Calibration/standardization of short-duration stimuli. Semin Hear 36 (01) 3-10
    Article in Thieme ConnectPubMedGoogle Scholar
  • Lin CM, Young YH. 2011; Identifying the affected branches of vestibular nerve in vestibular neuritis. Acta Otolaryngol 131 (09) 921-928
    CrossrefPubMedGoogle Scholar
  • Maes L, Dhooge I, D’haenens W, Bockstael A, Keppler H, Philips B, Swinnen F, Vinck BM. 2010; The effect of age on the sinusoidal harmonic acceleration test, pseudorandom rotation test, velocity step test, caloric test, and vestibular-evoked myogenic potential test. Ear Hear 31 (01) 84-94
    CrossrefPubMedGoogle Scholar
  • Mattingly JK, Portnuff CD, Hondorp BM, Cass SP. 2015; Sudden bilateral hearing loss after cervical and ocular vestibular evoked myogenic potentials. Otol Neurotol 36 (06) 961-964
    CrossrefPubMedGoogle Scholar
  • Mazurek B, Olze H, Haupt H, Szczepek AJ. 2010; The more the worse: the grade of noise-induced hearing loss associates with the severity of tinnitus. Int J Environ Res Public Health 7 (08) 3071-3079
    CrossrefPubMedGoogle Scholar
  • Milojcic R, Guinan Jr JJ, Rauch SD, Herrmann BS. 2013; Vestibular evoked myogenic potentials in patients with superior semicircular canal dehiscence. Otol Neurotol 34 (02) 360-367
    CrossrefPubMedGoogle Scholar
  • Minor LB. 2005; Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope 115 (10) 1717-1727
    CrossrefPubMedGoogle Scholar
  • Miyamoto A, Seo T, Node M, Hashimoto M, Sakagami M. 2006; Preliminary study on vestibular-evoked myogenic potential induced by bone-conducted stimuli. Otol Neurotol 27 (08) 1110-1114
    CrossrefPubMedGoogle Scholar
  • Modugno GC, Brandolini C. 2014; Can lateral semicircular canal dysplasia play a role in the genesis of hyperacusis. Acta Otorhinolaryngol Ital 34 (01) 71-74
    PubMedGoogle Scholar
  • Monroe HA, Sinks BC. 2014; Hyperacusis as a symptom of superior semicircular canal dehiscence. Semin Hear 35 (02) 145-156
    Article in Thieme ConnectGoogle Scholar
  • Murnane OD, Akin FW, Kelly KJ, Byrd S. 2011; Effects of stimulus and recording parameters on the air conduction ocular vestibular evoked myogenic potential. J Am Acad Audiol 22 (07) 469-480
    Article in Thieme ConnectPubMedGoogle Scholar
  • National Institute for Occupational Safety and Health (NIOSH) 1998. Occupational Noise Exposure, Revised Criteria 1998. Cincinnati, OH: Department of Health and Human Services;
    Google Scholar
  • Occupational Safety and Health Administration (OSHA) 1981; Occupational noise exposure: hearing conservation amendment 29 CFR 1910.95. Fed Regist 46 (11) 4078-4181
    Google Scholar
  • Okabe K, Tanaka S, Hamada H, Miura T, Funai H. 1988; Acoustic impedance measurement on normal ears of children. J Acoust Soc Japan 9: 287-294
    Google Scholar
  • Papathanasiou ES, Murofushi T, Akin FW, Colebatch JG. 2014; International guidelines for the clinical application of cervical vestibular evoked myogenic potentials: an expert consensus report. Clin Neurophysiol 125 (04) 658-666
    CrossrefPubMedGoogle Scholar
  • Piker EG, Baloh RW, Witsell DL, Garrison DB, Lee WT. 2015; Assessment of the clinical utility of cervical and ocular vestibular evoked myogenic potential testing in elderly patients. Otol Neurotol 36 (07) 1238-1244
    CrossrefPubMedGoogle Scholar
  • Price GR. 1981; Implications of a critical level in the ear for assessment of noise hazard at high intensities. J Acoust Soc Am 69: 171-177
    CrossrefGoogle Scholar
  • Reuter K, Ordoñez R, Hammershoi D. 2007; Overexposure effects of a 1-kHz tone on the distortion product otoacoustic emission in humans. J Acoust Soc Am 122 (01) 378-386
    CrossrefPubMedGoogle Scholar
  • Rosengren SM, Govender S, Colebatch JG. 2009; The relative effectiveness of different stimulus waveforms in evoking VEMPs: significance of stimulus energy and frequency. J Vestib Res 19 1–2 33-40
    CrossrefPubMedGoogle Scholar
  • Sandhu JS, Low R, Rea PA, Saunders NC. 2012; Altered frequency dynamics of cervical and ocular vestibular evoked myogenic potentials in patients with Ménière’s disease. Otol Neurotol 33 (03) 444-449
    CrossrefPubMedGoogle Scholar
  • Sheykholeslami K, Megerian CA, Arnold JE, Kaga K. 2005; Vestibular-evoked myogenic potentials in infancy and early childhood. Laryngoscope 115 (08) 1440-1444
    CrossrefPubMedGoogle Scholar
  • Sheykholeslami K, Schmerber S, Habiby Kermany M, Kaga K. 2004; Vestibular-evoked myogenic potentials in three patients with large vestibular aqueduct. Hear Res 190 1–2 161-168
    CrossrefPubMedGoogle Scholar
  • Stromberg AK, Olofsson A, Westin M, Duan M, Stenfelt S. 2016; Changes in cochlear function related to acoustic stimulation of cervical vestibular evoked myogenic potential stimulation. Hear Res 340: 43-49
    CrossrefPubMedGoogle Scholar
  • Taylor RL, Zagami AS, Gibson WP, Black DA, Watson SR, Halmagyi MG, Welgampola MS. 2012; Vestibular evoked myogenic potentials to sound and vibration: characteristics in vestibular migraine that enable separation from Meniere’s disease. Cephalalgia 32 (03) 213-225
    CrossrefPubMedGoogle Scholar
  • Walther LE, Blödow A. 2013; Ocular vestibular evoked myogenic potential to air conducted sound stimulation and video head impulse test in acute vestibular neuritis. Otol Neurotol 34 (06) 1084-1089
    CrossrefPubMedGoogle Scholar
  • Wang SJ, Jaw FS, Young YH. 2009; Ocular vestibular-evoked myogenic potentials elicited from monaural versus binaural acoustic stimulations. Clin Neurophysiol 120 (02) 420-423
    CrossrefPubMedGoogle Scholar
  • Ward WD, Selters W, Glorig A. 1961; Exploratory studies on temporary threshold shift from impulses. J Acoust Soc Am 33: 781-793
    CrossrefGoogle Scholar
  • Welgampola MS, Colebatch JG. 2001; Characteristics of tone burst-evoked myogenic potentials in the sternocleidomastoid muscles. Otol Neurotol 22 (06) 796-802
    CrossrefPubMedGoogle Scholar
  • Welgampola MS, Myrie OA, Minor LB, Carey JP. 2008; Vestibular-evoked myogenic potential thresholds normalize on plugging superior canal dehiscence. Neurology 70 (06) 464-472
    CrossrefPubMedGoogle Scholar
  • Welgampola MS, Rosengren SM, Halmagyi GM, Colebatch JG. 2003; Vestibular activation by bone conducted sound. J Neurol Neurosurg Psychiatry 74 (06) 771-778
    CrossrefPubMedGoogle Scholar
  • Zaleski A, Bogle J, Starling A, Zapala DA, Davis L, Wester M, Cevette M. 2015; Vestibular evoked myogenic potentials in patients with vestibular migraine. Otol Neurotol 36 (02) 295-302
    CrossrefPubMedGoogle Scholar
  • Zhou G, Gopen Q. 2011; Characteristics of vestibular evoked myogenic potentials in children with enlarged vestibular aqueduct. Laryngoscope 121 (01) 220-225
    CrossrefPubMedGoogle Scholar
  • Zhou G, Gopen Q, Poe DS. 2007; Clinical and diagnostic characterization of canal dehiscence syndrome: a great otologic mimicker. Otol Neurotol 28 (07) 920-926
    CrossrefPubMedGoogle Scholar