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Potential application of VEMP testing in otology
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
Yi-Ho Young
Stimulation via air-conducted sound or bone-conducted vibration enables recording of vestibular-evoked myogenic potential (VEMP) from cervical muscles (called cervical VEMP, cVEMP) and extraocular muscles (called ocular VEMP, oVEMP). These two emerging tests expand the test battery available to clinicians for exploring dynamic otolithic function, and create a potential use for the sacculo-collic reflex and vestibulo-ocular reflex, respectively. Coupled with audiometry and caloric test, the inner ear test battery is designed for comprehensive assessment of the inner ear function including the cochlea, saccule, utricle and semicircular canals. Clinically, the inner ear test battery has been widely adopted in cases of peripheral vestibular diseases such as vestibular neuritis, Meniere¡¯s disease, sudden deafness, acoustic trauma, chronic noise-induced hearing loss, superior canal dehiscence syndrome, herpes zoster oticus, chronic otitis media with vertigo, otosclerosis with vertigo, etc. In central vestibular disorders, the use of oVEMP and cVEMP tests in vestibular schwannoma patients helps assess the tumor origin from the superior or inferior vestibular nerve. For the brainstem lesion, the oVEMP and cVEMP tests can discriminate it, presumably because the former ascends via the upper brainstem, while the latter descends through the lower brainstem. The oVEMP test can differentiate between cerebellar and brainstem lesions. Abnormal oVEMPs in patients with cerebellar disorder may indicate adjacent brainstem involvement. Further, when the affected territory in the PICA/AICA infarction could not be meticulously demonstrated by MR imaging, it could be picked up by an inner ear test battery. In conclusion, it is believable that complete assessment of the inner ear function via an inner ear test battery may stimulate to elucidate the mechanism of peripheral and central vestibular disorders.


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