Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes
Background: A sensitive test for Superior Semicircular Canal Dehiscence (SCD) is the air-conducted, ocular vestibular evoked myogenic potential (AC oVEMP). However, not all patients with large AC oVEMPs have SCD. This retrospective study sought to identify alternate diagnoses also producing enlarged...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-10-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2020.580184/full |
| _version_ | 1819016464373383168 |
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| author | Rachael L. Taylor Rachael L. Taylor John S. Magnussen Belinda Kwok Belinda Kwok Allison S. Young Berina Ihtijarevic Berina Ihtijarevic Emma C. Argaet Emma C. Argaet Nicole Reid Cheryl Rivas Jacob M. Pogson Jacob M. Pogson Sally M. Rosengren Sally M. Rosengren G. Michael Halmagyi G. Michael Halmagyi Miriam S. Welgampola Miriam S. Welgampola Miriam S. Welgampola |
| author_facet | Rachael L. Taylor Rachael L. Taylor John S. Magnussen Belinda Kwok Belinda Kwok Allison S. Young Berina Ihtijarevic Berina Ihtijarevic Emma C. Argaet Emma C. Argaet Nicole Reid Cheryl Rivas Jacob M. Pogson Jacob M. Pogson Sally M. Rosengren Sally M. Rosengren G. Michael Halmagyi G. Michael Halmagyi Miriam S. Welgampola Miriam S. Welgampola Miriam S. Welgampola |
| author_sort | Rachael L. Taylor |
| collection | DOAJ |
| description | Background: A sensitive test for Superior Semicircular Canal Dehiscence (SCD) is the air-conducted, ocular vestibular evoked myogenic potential (AC oVEMP). However, not all patients with large AC oVEMPs have SCD. This retrospective study sought to identify alternate diagnoses also producing enlarged AC oVEMPs and investigated bone-conducted (BC) oVEMP outcome measures that would help differentiate between these, and cases of SCD.Methods: We reviewed the clinical records and BC oVEMP results of 65 patients (86 ears) presenting with dizziness or balance problems who underwent CT imaging to investigate enlarged 105 dB nHL click AC oVEMP amplitudes. All patients were tested with BC oVEMPs using two different stimuli (1 ms square-wave pulse and 8 ms 125 Hz sine wave). Logistic regression and odds ratios were used to determine the efficacy of BC oVEMP amplitudes and latencies in differentiating between enlarged AC oVEMP amplitudes due to dehiscence from those with an alternate diagnosis.Results: Fifty-three ears (61.6%) with enlarged AC oVEMP amplitudes were identified as having frank dehiscence on imaging; 33 (38.4%) had alternate diagnoses that included thinning of the bone covering (near dehiscence, n = 13), vestibular migraine (n = 12 ears of 10 patients), enlarged vestibular aqueduct syndrome (n = 2) and other causes of recurrent episodic vertigo (n = 6). BC oVEMP amplitudes of dehiscent and non-dehiscent ears were not significantly different (p > 0.05); distributions of both groups overlapped with the range of healthy controls. There were significant differences in BC oVEMP latencies between dehiscent and non-dehiscent ears for both stimuli (p < 0.001). A prolonged n1 125 Hz latency (>11.5 ms) was the best predictor of dehiscence (odd ratio = 27.8; 95% CI:7.0-111.4); abnormal n1 latencies were identified in 79.2% of ears with dehiscence compared with 9.1% of ears without dehiscence.Conclusions: A two-step protocol of click AC oVEMP amplitudes and 125 Hz BC oVEMP latency measures optimizes the specificity of VEMP testing in SCD. |
| first_indexed | 2024-12-21T02:48:03Z |
| format | Article |
| id | doaj.art-5967d28fd071414290c2cb384ca2ebb0 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-21T02:48:03Z |
| publishDate | 2020-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-5967d28fd071414290c2cb384ca2ebb02022-12-21T19:18:30ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-10-011110.3389/fneur.2020.580184580184Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP AmplitudesRachael L. Taylor0Rachael L. Taylor1John S. Magnussen2Belinda Kwok3Belinda Kwok4Allison S. Young5Berina Ihtijarevic6Berina Ihtijarevic7Emma C. Argaet8Emma C. Argaet9Nicole Reid10Cheryl Rivas11Jacob M. Pogson12Jacob M. Pogson13Sally M. Rosengren14Sally M. Rosengren15G. Michael Halmagyi16G. Michael Halmagyi17Miriam S. Welgampola18Miriam S. Welgampola19Miriam S. Welgampola20Department of Physiology and Center for Brain Research, The University of Auckland, Auckland, New ZealandCentral Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaMacquarie Medical Imaging, Macquarie University Hospital, Sydney, NSW, AustraliaCentral Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaThe Balance Clinic and Laboratory, Sydney, NSW, AustraliaCentral Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaCentral Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaThe Balance Clinic and Laboratory, Sydney, NSW, AustraliaCentral Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaThe Balance Clinic and Laboratory, Sydney, NSW, AustraliaNeurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, AustraliaThe Balance Clinic and Laboratory, Sydney, NSW, AustraliaCentral Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaNeurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, AustraliaCentral Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaNeurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, AustraliaCentral Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaNeurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, AustraliaCentral Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaThe Balance Clinic and Laboratory, Sydney, NSW, AustraliaNeurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, AustraliaBackground: A sensitive test for Superior Semicircular Canal Dehiscence (SCD) is the air-conducted, ocular vestibular evoked myogenic potential (AC oVEMP). However, not all patients with large AC oVEMPs have SCD. This retrospective study sought to identify alternate diagnoses also producing enlarged AC oVEMPs and investigated bone-conducted (BC) oVEMP outcome measures that would help differentiate between these, and cases of SCD.Methods: We reviewed the clinical records and BC oVEMP results of 65 patients (86 ears) presenting with dizziness or balance problems who underwent CT imaging to investigate enlarged 105 dB nHL click AC oVEMP amplitudes. All patients were tested with BC oVEMPs using two different stimuli (1 ms square-wave pulse and 8 ms 125 Hz sine wave). Logistic regression and odds ratios were used to determine the efficacy of BC oVEMP amplitudes and latencies in differentiating between enlarged AC oVEMP amplitudes due to dehiscence from those with an alternate diagnosis.Results: Fifty-three ears (61.6%) with enlarged AC oVEMP amplitudes were identified as having frank dehiscence on imaging; 33 (38.4%) had alternate diagnoses that included thinning of the bone covering (near dehiscence, n = 13), vestibular migraine (n = 12 ears of 10 patients), enlarged vestibular aqueduct syndrome (n = 2) and other causes of recurrent episodic vertigo (n = 6). BC oVEMP amplitudes of dehiscent and non-dehiscent ears were not significantly different (p > 0.05); distributions of both groups overlapped with the range of healthy controls. There were significant differences in BC oVEMP latencies between dehiscent and non-dehiscent ears for both stimuli (p < 0.001). A prolonged n1 125 Hz latency (>11.5 ms) was the best predictor of dehiscence (odd ratio = 27.8; 95% CI:7.0-111.4); abnormal n1 latencies were identified in 79.2% of ears with dehiscence compared with 9.1% of ears without dehiscence.Conclusions: A two-step protocol of click AC oVEMP amplitudes and 125 Hz BC oVEMP latency measures optimizes the specificity of VEMP testing in SCD.https://www.frontiersin.org/articles/10.3389/fneur.2020.580184/fullvestibular-evoked myogenic potentialssuperior semicircular canal dehiscencetullio phenomenonvertigohyperacusisbone-conduction |
| spellingShingle | Rachael L. Taylor Rachael L. Taylor John S. Magnussen Belinda Kwok Belinda Kwok Allison S. Young Berina Ihtijarevic Berina Ihtijarevic Emma C. Argaet Emma C. Argaet Nicole Reid Cheryl Rivas Jacob M. Pogson Jacob M. Pogson Sally M. Rosengren Sally M. Rosengren G. Michael Halmagyi G. Michael Halmagyi Miriam S. Welgampola Miriam S. Welgampola Miriam S. Welgampola Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes Frontiers in Neurology vestibular-evoked myogenic potentials superior semicircular canal dehiscence tullio phenomenon vertigo hyperacusis bone-conduction |
| title | Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes |
| title_full | Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes |
| title_fullStr | Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes |
| title_full_unstemmed | Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes |
| title_short | Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes |
| title_sort | bone conducted ovemp latency delays assist in the differential diagnosis of large air conducted ovemp amplitudes |
| topic | vestibular-evoked myogenic potentials superior semicircular canal dehiscence tullio phenomenon vertigo hyperacusis bone-conduction |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2020.580184/full |
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