Vestibular‐Evoked Myogenic Potential Outcomes Associated with Pediatric Sports‐Related Concussion

Abstract

Objectives/Hypothesis: To 1) characterize vestibular-evoked myogenic potential responses in children and young adults with sports-related concussion (SRC) histories as compared with a normal healthy control group, and 2) correlate VEMP characteristics to SRC/sport history outcomes.Study Design: Prospective cohort study. Methods: Seventy-six children and young adults with and without a history of SRC received cervical and ocular VEMP testing using a 500 Hz tone burst air conduction stimuli. VEMP response parameters (response rates, peak latencies, and peak-to-peak amplitudes) were assessed. Other clinical vestibular measures were performed. In the SRC group, sport history outcomes including number of SRC sustained over a lifetime, years of playing contact sports, and length of time playing contact sports were collected via in-person questionnaire.Results: Children and young adults with SRC had significantly reduced oVEMP responses and peak-to-peak amplitudes and greater amplitude response asymmetries between left and right ear. There was no effect of group on cVEMP findings. A greater frequency of SRCs sustained throughout a lifetime, a greater number of contact sports played, and a longer duration of playing a contact sport correlated with significantly poorer VEMP response characteristics.Conclusions: Our results suggest that SRC and repeated subclinical head impact events have an effect on oVEMP outcomes. SRC may affect the utricle, superior vestibular nerve, and/or brainstem-mediated vestibular-ocular-reflex pathway. The prevalence of post-concussion-related dizziness is becoming increasingly common in a pediatric-otology clinic, thus performing VEMP testing in youth post-SRC provides an objective, noninvasive, and cost-effective method for monitoring the effects of sports-related impact on the vestibular system and related neural pathways.

Eye movements in mild traumatic brain injury: Ocular biomarkers

“…During VOR provocation, signals from vestibulo-ocular projections from the otoliths are quantified, providing a more precise measure of function, especially during vHIT (Magliulo et al, 2014;Weber et al, 2012). Two studies have evaluated oVEMPs in mTBI cohorts (Meehan et al, 2019;Rodriguez et al, 2022;Zaleski et al, 2015). Rodriguez and colleagues studied an asymptomatic paediatric cohort (51 mTBI 3 months to 7 years post-injury and 25 controls, mean age 16) of which 20 previous-mTBI patients were in non-contact sports and 31 in contact sports.…”

“…Richard and colleagues tested a cohort of recently concussed (sports-related) and historically concussed (1-5 years post-injury) athletes. They found the acutely concussed experienced worse impairment in vertical and circular smooth pursuit which remained impaired in the older mTBI group, suggesting the smooth pursuit impairments persist beyond symptomatic recovery ( 149 ). Likewise, Cochrane and colleagues’ cohort (mentioned in Saccades revealed similar results: decreased vertical position gain relative to controls which was only significant at increasing speeds ( 38 ).…”

“…Abnormal or absent oVEMP responses were more prevalent in contact-sports athletes than non-contact athletes with a history of mTBI, particularly when compared to controls. This was considered to arise from the susceptibilty of the utricle’s relatively weak support in the temporal bone, making it more vulnerable to repetitive trauma ( 149 ). Meehan and colleagues also showed prolonged oVEMP latencies, but in a cohort of 71 military service members with previous mTBI (75 normative controls).…”