An Analysis of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo

Yetışer, Sertaç; İnce, Dilay; Gül, Murat

doi:10.1177/0003489414532778

Cited by 31 publications

(25 citation statements)

References 30 publications

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“…Abnormal VEMP findings such as prolonged p1 and/or n1 latencies, decreased interpeak amplitudes, and asymmetric responses in BPPV have been reported in these studies at 10-50% [2,8,10] . However, when these studies are thoroughly analyzed, some data regarding the affected and unaffected ears of BPPV patients are controversial.…”

Section: Discussionsupporting

confidence: 53%

“…The first studies on cVEMP abnormalities in BPPV showed prolonged p1 and n1 latencies; however, in recent studies, no alternation in latencies has been reported [2,10,[26][27][28][29] . Similarly, we could not detect any prolongation in the p1 and n1 latencies.…”

Section: Discussionmentioning

confidence: 99%

“…Because background muscle activities could interfere with the VEMP amplitudes, the interpeak amplitudes were normalized [2,25] . The asymmetry ratio was calculated for comparison between the right and left ears, using the formula described by Murofushi et al [22] .…”

Section: Stimulus Design and Recording Setupmentioning

confidence: 99%

“…At present, the widely accepted theory about the pathophysiology of the disease is the separation of the otoconia and otoconial debris from the neuroepithelial membrane of the utricular or saccular macula [1] . The otoconia, freely floating in the semicircular canal or sticking to the cupula, provoke short-term nystagmus and vertigo [2] . Due to the topography of the semicircular canals, freely floating otoconia more frequently move into the posterior semicircular canal than into the lateral semicircular canal [3] .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

Karataş

Yüce²,

Cebi³

et al. 2016

Int Adv Otol

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OBJECTIVE:Although there has been a wide consensus on the mechanism of nystagmus and clinical presentation of benign paroxysmal positional vertigo (BPPV), the neuroepithelial pathophysiology of BPPV still remains unclear. In this study, we aimed to clarify the pathophysiology of BPPV by evaluating the cervical vestibular-evoked myogenic potential (cVEMP) findings of patients. MATERIALS and METHODS:Thirty-six BPPV patients and 20 healthy volunteers were included. Bilateral cVEMP tests were performed on all participants. The participants were divided into the following three groups: those with a BPPV-affected ear, those with a BPPV-unaffected ear, and the healthy control group. RESULTS:There were no significant differences regarding the latencies of the first positive (p1) and negative (n1) peaks among the three groups. The mean normalized amplitude asymmetry ratio also did not differ between the BPPV and control groups. However, the normalized amplitudes of the BPPV patients (with both affected and unaffected ears) were significantly lower than those of the healthy control group. CONCLUSION:We detected that the cVEMP data of the affected and unaffected ears of the BPPV patients was similar and that their normalized amplitudes significantly differed from those of the healthy controls. Eventually, we concluded that even if the symptoms of BPPV were unilateral, the findings suggest that the bilateral involvement of the macular neuroepithelium is important in understanding the pathophysiology of BPPV. This finding supports the conclusion that the pathophysiological process starts with neuroepithelial membrane degeneration and continues with otoconia separation.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Stimulus Design and Recording Setupmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

Karataş

Yüce²,

Cebi³

et al. 2016

Int Adv Otol

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“…Iwasaki et al [10] have reported abnormal vestibular-evoked myogenic potentials (VEMP) in some patients with BPPV having normal caloric responses. VEMP abnormality seems to be more correlated with the recurrence of symptoms in patients with BPPV [11] .…”

Section: Discussionmentioning

confidence: 86%

Caloric Analysis of Patients with Benign Paroxysmal Positional Vertigo

Yetışer

İnce

2017

Int Adv Otol

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Original Article INTRODUCTIONPositional vertigo following sudden head motion in patients with benign paroxysmal positional vertigo (BPPV) is assumed to be due to freely floating otoconia inside the semicircular canals or those adhering to the cupula which make labyrinth sensitive to gravitational forces [1] . The majority of patients have quick relief of symptoms after repositioning maneuvers, although underlying pathology is obscure. Origin of these deposits is claimed to be due to degeneration of utricular neuroepithelium. Functional studies are needed to exclusively detect possible organic pathology of the utricule. Innervation of utricule is provided by superior vestibular nerve which also collects impulses from lateral and superior semicircular canals. The inferior vestibular nerve is connected to the posterior semicircular canal and the saccule.Caloric testing was first studied by the Nobel Prize winner Robert Barany in 1906, and later it was introduced to the otologic practice by Fitzgerald and Hallpike [2] in 1942. Videonystagmograpy (VNG) with caloric stimulation has been widely used in the analysis of severity of vestibular disorders. It reflects the degree to which the vestibular system is responsive and how symmetric the responses are between left and right. Caloric irrigation through the ear canal selectively stimulates the lateral canal [3] . However, studies indicate the contribution of other semicircular canals to the final response. Gacek et al. [4] have found severe dysfunction after caloric stimulation in seven patients who had singular neurectomy. Sensitivity of caloric stimulation to detect the vestibular pathology is subject to discussion [5] . Some problems may remain undiagnosed unless they cause severe vestibular dysfunction. The aim of this study is to analyze the incidence of caloric hypo-excitability, to investigate the role of symptom duration, and to compare the caloric responses in patients with lateral canal (LC-BPPV) and posterior canal (PC-BPPV). MATERIALS and METHODS MATERIALS and METHODS:A prospective study was conducted in 65 patients with BPPV (20 LC and 45 PC) who were subjected to caloric testing. Average slow-phase velocity and nystagmus duration were analyzed. RESULTS:Caloric hypo-excitability was 20.4%. It was more evident in patients with apogeotropic-type LC-BPPV. The comparison of average slowphase velocity of the nystagmus and nystagmus duration between selected types of BPPV for pathologic, non-pathologic, and the control ears after warm and cold stimulation was not statistically significant (p>0.05). No correlation was found between caloric results and symptom duration (p>0.05). CONCLUSION:Some patients presented caloric hypo-excitability. Reliability of caloric testing to differentiate the ear with normal and abnormal vestibular function in different types of BPPV was low. No difference was found in the analysis of the impact of symptom duration. Caloric testing is not an ideal tool to study BPPV.

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Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal

Singh

Apeksha

2015

Eur Arch Otorhinolaryngol

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Benign paroxysmal positional vertigo (BPPV) constitutes a major proportion of the population with peripheral vestibulopathies. Although the freely floating otoconia within the semicircular canals is responsible for the symptoms of BPPV, the source of the otoconia debris is mainly believed to be the otolith organs. Therefore, the pathology in either or both the otolith organs appears a logical proposition. Cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), being the tests for functional integrity of the otolith organs, appear promising for investigating otolith involvement in BPPV. While recent evidences are suggestive of equivocal findings for cVEMP, there are only a few studies on oVEMP. Additionally, both these potentials have never been explored in the same set of individuals with BPPV. Therefore, the present study aimed to evaluate the functional integrity of the otolith organs through cVEMP and oVEMP in individuals with posterior canal BPPV. Thirty-one individuals with unilateral posterior canal BPPV and 31 age- and gender-matched healthy controls underwent 500 Hz tone-burst-evoked cVEMP and oVEMP. The results demonstrated no significant group difference on any of the cVEMP parameters (p > 0.05). A similar trend was noticed for the latency-related parameters of oVEMP. However, the peak-to-peak amplitude was significantly smaller in the affected ears of individuals with BPPV than their unaffected ears and the ears of healthy controls (p < 0.05). The BPPV group showed significantly higher inter-aural amplitude difference ratio than the healthy controls (p < 0.05). Further, the sensitivity and specificity of oVEMP were also found to be far superior to those of cVEMP. Thus, the outcome of the present study revealed involvement of utricle rather than saccule in posterior canal BPPV, and therefore, oVEMP appears to be better suited to clinical investigation than cVEMP in individuals with posterior canal BPPV.

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An Analysis of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo

Abstract: Vestibular evoked myogenic potential is a useful tool to study the otolithic function in patients with BPPV and should be included in the test battery.

Cited by 31 publications

References 30 publications

Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

Caloric Analysis of Patients with Benign Paroxysmal Positional Vertigo

Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal

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