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Vestibular Foundations - VEMP Part 1

Anatomy and Physiology30 CardsCreated 3 months ago

This deck covers the fundamentals of Vestibular Evoked Myogenic Potentials (VEMP), including types, methods of elicitation, and clinical applications in assessing vestibular function.

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How do we measure the function of the utricle and the saccule organs?

Using VEMP
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Key Terms

Term
Definition
How do we measure the function of the utricle and the saccule organs?
Using VEMP
How many types of VEMP are there?
1=cVEMP is recorded from the neck (sternocleidomastoid muscle) and measures the function of the saccule and inferior vestibular nerve 2=oVEMP is recor...
What does cVEMP stand for?
Cervical Vestibular Evoked Myogenic Potential
How do we elicit (evoke) cVEMP?
By using either: -acoustic -vibratory -galvanic
What is the most common method of recording cVEMP?
-Using an acoustic stimulus, either a 2-1-2 or 2-2-2 tone burst at a loud intensity usually at around 95dBnHL the response is then recorded by using s...
What is the most common electrode montage for cVEMP?
Is to record from the clavicular joint, forehead and each sternocleidomastoid muscle
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Vestibular Foundations - VEMP Part 1
TermDefinition
How do we measure the function of the utricle and the saccule organs?
Using VEMP
How many types of VEMP are there?
1=cVEMP is recorded from the neck (sternocleidomastoid muscle) and measures the function of the saccule and inferior vestibular nerve 2=oVEMP is recorded from the eye and reflects primarily utricular function
What does cVEMP stand for?
Cervical Vestibular Evoked Myogenic Potential
How do we elicit (evoke) cVEMP?
By using either: -acoustic -vibratory -galvanic
What is the most common method of recording cVEMP?
-Using an acoustic stimulus, either a 2-1-2 or 2-2-2 tone burst at a loud intensity usually at around 95dBnHL the response is then recorded by using surface electrodes at fore-cites at the head and neck
What is the most common electrode montage for cVEMP?
Is to record from the clavicular joint, forehead and each sternocleidomastoid muscle
What is it important for the patient to do to record a cVEMP?
To maintain a contracted sternocleidomastoid muscle. the patient is instructed to either turn their head left or right depending on which side is stimulated
How can a patient monitor their muscle contraction?
-Visually by using a patient ENG monitor or audibly by using a ENG monitor tone
How is the cVEMP represented?
By 2 distinct peaks. P1 occurs at approximately 13 milliseconds and N1 at approximately 23 milliseconds p13n23 complex, anything after n23, is cochlear in origin so ignore
What is the purpose of the cVEMP?
It's a clinical method of assessing the integrity of the saccule, inferior vestibular nerve and VCR pathway in humans it forms an ipsilateral waveform response generated by activation of vestibular afferents.
What does the latency of the cVEMP waveforms depend on?
The design and stimulus chosen to elicit the cVEMP
How do we ensure even muscle contraction?
Using ENG scaling (Amplitude normalization)
How is the amplitude, latency and threshold be analysed/measured?
Using cVEMP
What ratio is used in cVEMP testing to detect vestibular dysfunction?
The amplitude ratio between the right and left ears a difference greater than 36% is indicative of vestibular dysfunction
What can cVEMP be used for?
Can detect Superior semicircular canal Dehiscence, Saccular Dysfunction as well as disorders of the Inferior Vestibular Nerve
What is VNG used for?
To assess vestibular and ocular motor function VOR
What is vHIT used for?
To assess function of all 6 semi-circular canals
What does oVEMP stand for?
Ocular Vestibular Evoked Myogenic Potential
Which muscle is the oVEMP measured from?
The evoked potential is measured from the Inferior Oblique muscle
Which vestibular structures and nerve does the oVEMP test primarily depend on?
It's largely dependent on the utricle and the superior vestibular nerve
What kind of stimulus evoke the oVEMP?
-Acoustic (most common) -Vibratory -Galvanic
What is the most common method of recording oVEMP?
-Using an acoustic stimulus using a 2-2-2 tone burst at a loud intensity usually at around 95dBnHL
What is the most common electrode montage for oVEMP?
The response is then recorded by using surface electrodes at fore-cites at the Underneath each eye, Chin, Forehead (Ground). the oVEMP is largest when recorded contralaterally which is why the right reference electrode is placed underneath the left eye.
What is the patient positioning and instructions for oVEMP?
Patient should be seated or reclined maintain an upwards gaze of 35 degrees for the duration of the recording
How is oVEMP represented?
By 2 distinct peaks. N1 occurs at approximately 10 milliseconds and P1 at approximately 15 milliseconds you do the tone presentations for the 100-150 times, we do a weighted add, where it adds these results together and gives an average of them
What information can be interpreted with the oVEMP?
-Amplitude -Latency -Threshold
What is the most robust ratio to analyse with oVEMP?
Amplitude ratio between right and left ears. A difference of >33% is a sign of dysfunction
What is the benefit of combining oVEMP with other vestibular tests like vHIT and VNG?
It helps assist diagnose: SSCD (superior SemiCircular Dehiscence) Meniere's Disease -disorders of the superior superior vestibular nerve
What does VEMP stand for?
Vestibular - comes from the vestibular system (sound evoked stimulus via air conduction- patients don't have to hear the sound Evoked- in response to a stimulus Myogenic- its a muscle response that we are recording Potential- we place electrodes on the skin to record this muscle changes
What part of the structure for VEMPs test?
The otolith organs