Evaluation of the Decrease in DPOAE Levels After VEMP Testing in Clinical Patients Referred to the Vertigo Outpatient Clinic

Abstract

Background/Objectives: The objective of this study is to determine whether the strong acoustic stimuli used in vestibular evoked myogenic potential (VEMP) testing contribute to distortion product otoacoustic emission (DPOAE) level reduction due to noise-induced hearing loss. Methods: The DPOAE levels were measured routinely to evaluate vestibular balance disorders with sensorineural hearing loss and to monitor changes in cochlear function before and after VEMP. The changes in DPOAE levels after VEMP testing in 174 patients (80 males and 94 females; median age, 53 years [interquartile range, 39-67 years; range, 15-85 years]) who were examined in the vertigo outpatient clinic between June 2021 and December 2024 were retrospectively analyzed. Results: The DPOAE levels decreased significantly after VEMP testing at 1.4 kHz, 2 kHz, 2.8 kHz, sum all 1/2 octave, and average 1/2 octave (1-6 kHz). The decrease in DPOAE levels at 6 kHz exhibited a significant negative linear correlation with age (the coefficient of determination: 0.0189, p = 0.01), but not sex or side. Conclusions: The strong sound stimulation used in VEMP testing can decrease DPOAE levels. The frequencies at which DPOAE levels decreased significantly were overtones of the stimulus frequency, suggesting a possible effect of acoustic stimulation. VEMP testing can be an invasive test method and should be performed with detailed consideration of the risks and benefits. The age factor can influence the decrease in DPOAE levels in VEMP testing.

Keywords: DPOAE; NIHL; SNHL; VEMP; noise-induced hearing loss; sensorineural hearing loss.

Figure A1

The distribution between DPOAE levels before VEMP testing and age. X-axis: ages in years. R²: the coefficient of determination. p-values of Pearson product moment correlation coefficient analysis: p < 0.0001 in all parameters. (n = 348 ears in 1, 1.4, 2, 2.8, 4, and 6 kHz and n = 298 in sum and average). (A): sum; (B): average; (C): 1 kHz; (D): 1.4 kHz; (E): 2 kHz; (F): 2.8 kHz; (G): 4 kHz; (H): 6 kHz.

Figure A2

The boxplots of DPOAE levels of pre-VEMP and post-VEMP for each frequency.

Figure A3

The boxplots of DPOAE level decreases from pre-VEMP to post-VEMP for each frequency.

Figure A4

The boxplots of DPOAE level decreases from pre-VEMP to post-VEMP in the older group aged 65 years or over and the younger group for each frequency.

Figure A5

The distribution of DPOAE level decreases from pre-VEMP to post-VEMP for each frequency. The X-axis shows the number of cases.

Figure 1

The distribution of decreased DPOAE levels and age. X-axis: ages in years. R²: the coefficient of determination. p-values of Pearson product moment correlation coefficient analysis: p = 0.45, p = 0.83, p = 0.95, p = 0.06, p = 0.44, p = 0.01, p = 0.15, and p = 0.20 in 1, 1.4, 2, 2.8, 4, and 6 kHz, sum and average. (n = 348 ears in 1, 1.4, 2, 2.8, 4, and 6 kHz and n = 298 in sum and average). (A): sum; (B): average; (C): 1 kHz; (D): 1.4 kHz; (E): 2 kHz; (F): 2.8 kHz; (G): 4 kHz; (H): 6 kHz.

Figure 2

The distribution between decreased DPOAE levels and DPOAE levels before VEMP testing. R²: the coefficient of determination. p-values of Pearson product moment correlation coefficient analysis: p < 0.0001, p < 0.0001, p = 0.0015, p < 0.0001, p < 0.0001, p < 0.0001, p = 0.03, and p = 0.01 in 1, 1.4, 2, 2.8, 4, and 6 kHz, sum and average. (n = 348 ears in 1, 1.4, 2, 2.8, 4, and 6 kHz and n = 298 in sum and average). (A): sum; (B): average; (C): 1 kHz; (D): 1.4 kHz; (E): 2 kHz; (F): 2.8 kHz; (G): 4 kHz; (H): 6 kHz.