Cervical Vestibular-evoked Myogenic Potential in Healthy Adults: A Cross-sectional Study Investigating the Impact of Various Stimuli and Recording Conditions

Abstract

Background: Cervical vestibular-evoked myogenic potentials (c-VEMPs) is a noninvasive procedure that captures the electrical activity of sternocleidomastoid (SCM) muscles in response to auditory stimuli. The clinical value of VEMP, however, is affected by the use of appropriate stimuli and correct testing techniques. This study investigates the effects of different stimuli and recording conditions on c-VEMP recordings.

Materials and methods: Sixty healthy participants, aged 18-60 years, underwent c-VEMP recordings. Air-conducted sound stimuli (tone bursts and clicks) in sitting, supine neck torsion, and supine head lift and neck torsion positions along with the variation in the active electrode positions were employed to obtain the c-VEMP records. The c-VEMP parameters were compared by paired t-test, Wilcoxon signed-rank test and one-way ANOVA. P < 0.05 was considered statistically significant.

Results: Tone burst and click-evoked c-VEMP varied with statistically significant differences in terms of amplitudes, corrected amplitudes, and thresholds (P = 0.0000). Tone burst stimuli produced larger amplitudes and lower thresholds in both ears. No significant difference was found in c-VEMP parameters tested for differences in active electrode placement except for threshold asymmetry (P = 0.0123) (Wilcoxon signed-rank test). c-VEMP recordings in the sitting position produced significantly larger corrected amplitudes compared to the supine head lift and neck torsion positions, for both sides (one-way ANOVA).

Conclusion: The results of the current study revealed a greater response rates and larger amplitudes for tone burst-evoked c-VEMP responses as compared to those with click stimuli. A seated, head-turned position with the active electrode placed in the middle of the SCM muscle yielded larger tone burst-evoked c-VEMP responses. The variation in the VEMP data obtained owing to different stimuli and recording conditions should be considered when evaluating patients in clinical practice to optimize the clinical applicability of the VEMP examination.

Keywords: Amplitudes; cervical vestibular-evoked myogenic potential; click stimuli; latencies; otolith organs; sternocleidomastoid; tone burst stimuli; vestibular function tests; vestibular-evoked myogenic potential.

Figure 1

Cervical vestibular-evoked myogenic potential procedure

Figure 2

Cervical vestibular-evoked myogenic potential response waves (left ear) recorded from a healthy participant. The figure depicts the stimulus threshold, obtained as 78 dB nHL). [(Electrode placement: Active-sternocleidomastoid muscle, reference-sternoclavicular junction and Ground-Fpz; Position of the subject: Sitting; type of stimuli: Tone burst acoustic stimuli) (delivered to left ear with decreasing intensity to detect the threshold)]

Figure 3

Comparison of right ear p13-n23 amplitude between cervical vestibular-evoked myogenic potential recordings by tone burst and click stimuli. μv: Microvolts

Figure 4

Comparison of left ear p13-n23 amplitude between cervical vestibular-evoked myogenic potential recordings by tone burst and click stimuli. μv: Microvolts

Figure 5

Comparison of right ear corrected p13-n23 amplitude between cervical vestibular-evoked myogenic potential recordings by tone burst and click stimuli

Figure 6

Comparison of left ear corrected p13-n23 amplitude between cervical vestibular-evoked myogenic potential recordings by tone burst and click stimuli

Figure 7

Comparison of right ear cervical vestibular-evoked myogenic potential threshold between cervical vestibular-evoked myogenic potential recordings by tone burst and click stimuli

Figure 8

Comparison of left ear cervical vestibular-evoked myogenic potential thresholds between cervical vestibular-evoked myogenic potential recordings by tone burst and click stimuli

Figure 9

Comparison of right ear corrected p13-n23 amplitude between cervical vestibular-evoked myogenic potential recordings in sitting, supine neck torsion and supine head lift-neck torsion position. Supine NT: Supine neck torsion, Supine HLNT: Supine head lift-neck tors

Figure 10

Comparison of left ear corrected p13-n23 amplitude between cervical vestibular-evoked myogenic potential recordings in sitting, supine neck torsion and supine head lift-neck torsion position. Supine NT: Supine neck torsion, Supine HLNT: Supine head lift-neck torsion