Die Ableitung zervikaler und okulärer vestibulär evozierter myogener Potenziale

Abstract

VEMP measurements are subject to various influencing factors: patient age, threshold, sound intensity and frequency. Using air (AC) and bone conduction (BC) the vestibular receptors and afferents of the otolith organs can be activated to varying degrees. Recordings of cervical (cVEMP) and ocular VEMP (oVEMP) are clinically possible. AC-cVEMP are primarily an indicator of the sacculocollic reflex pathway. Together with findings on the vestibuloocular reflex (VOR) and complimentary otolith tests, VEMP enable otolith function analysis of each side separately. In addition, the distinction between combined or isolated canal and otolith dysfunction in terms of subtyping and patterns of damage in mono- and bilateral disorders, such as vestibular neuritis or bilateral vestibulopathy, is possible. Moreover, VEMP is relevant in terms of prognostic and therapeutic considerations as well as expert assessments.

Current diagnostic procedures for diagnosing vertigo and dizziness

“…The cervical measurements (cVEMP) (about <500 µV) in air conduction reflect the dominating sacculus function or the sacculo-collic reflex. Ocular air-conduction-induced VEMP (oVEMP) (about <20 µV) are an indicator for the dominant percentage of the otolith-ocular reflex or the utricular function [ 42 ], [ 43 ], [ 44 ], [ 45 ]. The part of the reflexes for cVEMP and oVEMP stimulation was recently calculated by Govender et al [ 75 ].…”

“…In the last years, modern technical vestibular diagnostics, in particular the video head impulse test and VEMP diagnostics, led to the fact that a complex examination of the vestibular reflex structures can be realized. Those examination methods are increasingly wide-spread in Germany [ 37 ], [ 38 ], [ 39 ], [ 42 ], [ 43 ], [ 44 ], [ 45 ]. Also the application in the context of ENT-specific expert opinions is more and more established [ 56 ].…”

“…The development of those modern diagnostic instruments led to a paradigm shift in clinical vestibular diagnostics that increasingly influences the current medical standards of the diagnosis of vertigo and balance disorders [ 37 ]. In Germany, modern methods are more and more established in the outpatient and inpatient ENT-specific sector [ 37 ], [ 38 ], [ 42 ], [ 43 ], [ 44 ], [ 45 ]. The medical benefit of modern diagnostic procedures, their quality and effectiveness are meanwhile scientifically confirmed.…”

Luftleitungsinduzierte oculäre VEMP I. Methodik und Untersuchungen bei normalen Probanden

“…Pathologische VEMP k ö nnen somit rezeptorbedingt, neurogen oder myogen induziert sein [4] . W ä hrend die seltenen neurogen St ö rungen mit einer Ä nderung der Latenzzeiten und der Amplitude einhergehen, lassen sich rezeptorbedingte peripher-vestibul ä re St ö rungen mit einer Beteiligung der Otolithenorgane dann eindeutig annehmen, wenn VEMP nicht nachweisbar sind.…”

Luftleitungsinduzierte oculäre VEMP: II. Erste klinische Untersuchungen

“…Das diagnostische Spektrum f ü r Patienten mit Schwindel und Gleichgewichtsst ö rungen hat sich mit der Einf ü hrung der vestibul ä r evozierten myogenen Potenziale erweitert. Im Rahmen der Diff erenzialdiagnostik von Beeintr ä chtigungen der Rezeptorfunktion besteht somit die M ö glichkeit, Otolithenfunktionsst ö rungen mittels cVEMP und neuerdings den oVEMP identifizieren zu k ö nnen und zudem eine seitengetrennte Aussage ü ber die Funktion von Anteilen des Nervus vestibularis bis in den zentralvestibul ä ren Bereich anhand von Amplituden und Latenzzeiten zu erhalten [1,2,14,15] . Das macht die VEMP-Diagnostik gegenw ä rtig neben der Untersuchung des vestibulookul ä ren Refl exes zu einem immer mehr beachteten Element in der Funktionsdiagnostik bei vestibul ä ren St ö rungen.…”