Safe Use of Acoustic Vestibular-Evoked Myogenic Potential Stimuli: Protocol and Patient-Specific Considerations

Abstract

VEMP stimuli have the potential to cause NIHL due to high sound exposure levels. However, with proper safety protocols in place, clinicians may reduce or eliminate this risk to their patients. Use of the tools provided, including the noise exposure calculation tool and sample protocols, may help clinicians to understand and ensure safe use of VEMP stimuli.

Vestibular evoked myogenic potentials in practice: Methods, pitfalls and clinical applications

“…If the ANSI standard applies, then, for a 500 Hz stimulus and TDH49 earphones, 13.5 dB needs to be added to the HL value to get the SPL equivalent, thereby allowing sound exposure to be calculated. For additional information see the following references (Colebatch and Rosengren, 2014, Portnuff et al, 2017). …”

Diagnostic Accuracy of Ocular Vestibular Evoked Myogenic Potentials for Superior Canal Dehiscence Syndrome in a Large Cohort of Dizzy Patients

“…VEMP testing, on the contrary, is often conducted on patients with audiovestibular complaints in a clinical context. This cohort may express an abnormal acoustic vulnerability, especially considering patients with inner ear affection and auditory complaints such tinnitus, hyperacusis, hearing loss (110). Noteworthy is that the real acoustic vulnerability of SCDS or analogous conditions characterized by hypersensitivity to sounds and vibrations, has not been completely stated yet.…”

Evidence-based diagnostic use of VEMPs

“…Short ACS and BCV stimuli can be used for recording both o-and cVEMPs (for detailed stimulus parameters see below and [63,68,74]). A stimulus frequency of 500 Hz is generally recommended for most clinical applications because most of the neurophysiological data in the guinea pig model were obtained for 500 Hz sound or vibration [21,74].…”

“…If the sound pressure level is indicated in "dB nHL" (normal hearing level) by the manufacturer of the VEMP platform, it has to be converted into "dB pSPL" or "pe (peak equivalent) SPL" in order to calculate safe sound exposure levels. The individual conversion factor depends on multiple variables, such as headphone type, stimulus parameters (see below), and ear canal volume [39,68]. Conversion factors for the most common test conditions are often provided in the manufacturer's instructions (e.g., [38]), otherwise they have to be determined during calibration of the sound source.…”

“…The peak (p) SPL should not exceed 140 dB(A). Detailed information concerning the calculation of sound exposure and prevention of noise trauma has been provided by [ 7 , 8 , 68 , 74 ]. If the sound pressure level is indicated in “dB nHL” (normal hearing level) by the manufacturer of the VEMP platform, it has to be converted into “dB pSPL” or “pe (peak equivalent) SPL” in order to calculate safe sound exposure levels.…”