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
