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Vestibular evoked myogenic potential is a specialized test within the vestibular test battery that specifically examines the integrity of the otolithic organs within the inner ear. The way in which the test is executed varies between individual clinics. Therefore, it is important for each individual clinic to establish its own set of normative data that are unique to their chosen recording and stimulus parameters. The goal of this current study is to establish normative data for cervical and ocular vestibular myogenic evoked potential tests at the Towson University Hearing and Balance clinic.
The vestibular labyrinth consists of ? ve compartments: the lateral, anterior, and posterior semicircular canals, the utricule, and the saccule. At the beginning of the twentieth century, Robert Bárány proposed the caloric test as a clinical test of the lateral semicircular canal. This test enabled clinicians to assess the individual lateral semicircular canal function easily by using the simple method of irrigating the external ear canal with cold or warm water and observing the induced nyst- mus. We believe that the caloric test was a breakthrough in the ? eld of vestibular research. However, as far as the other compartments were concerned, there was no simple clinical test equal to the caloric test for the lateral semicircular canal function. At the end of the twentieth century, the vestibular evoked myogenic potential (VEMP) test was proposed as a new method for assessing the individual saccule function. This test has some unique attributes. First, it uses sound stimulation, even though it is a test of the vestibular system. This appears to be a contradiction n- rophysiologically. As a result, in its early stages there were controversies conce- ing the origin of the responses. However, such controversies have been overcome by basic neurophysiological studies and clinical studies. Above all, sound sensit- ity of the saccular afferents shown in cats and guinea pigs with single-unit recording methods became the main supporting evidence. Nowadays, VEMP is one of the routine clinical tests for balance disorder.
Although the Vestibular Evoked Myogenic Potential (VEMP) was discovered nearly fifty years ago, clinical interest in the vestibular evoked potential has only recently resurfaced. Since the VEMP is a relaxation potential, it is important to investigate stimulus and parameter characteristics in order to minimize variability among the recordings and maximize clinical benefit. The present study aims to determine what effect head position, bandwidth, and ear stimulated have on the VEMP recordings. The present study will also correlate the relationship between test and re-test reliability for VEMP amplitude and latency measures. Twenty normal hearing (defined as ≤ 15 dB HL for frequencies 250-8000 Hz) females with no current or previous history of otologic and/or vestibular dysfunction were enrolled in the study. Participants underwent serial VEMP testing utilizing four different head positions: Head Rotation, Head Rotation with Forward Tilt, Head Rotation with Backward Tilt, and Head on Chin. A 95 dB nHL 100 musec click and 500 Hz toneburst stimuli were utilized to elicit a VEMP for each head position. For each test condition, a VEMP response was recorded twice. Intensity was decreased in 10 dB steps until threshold was reached. Threshold was defined as the lowest intensity level where a VEMP recording was repeated. Both the right and left ears were stimulated monaurally for all participants. Condition order was randomized for head position, bandwidth, and ear to counterbalance order effect. For all VEMP recordings, absolute amplitude and latency measures for P1, N1, and P2 recorded. Absolute threshold was also documented. Interaural threshold measures were also calculated for analysis. Results demonstrated high test re-test reliability between VEMP recordings. There was no significant ear effect for amplitude or latency measures. A significant bandwidth effect was found with the 500 Hz toneburst stimuli producing larger amplitude and unanticipated longer latencies than the 100 musec click stimuli for P1, N1, and P2 measurements. Lower absolute thresholds were also noted when utilizing the 500 Hz toneburst stimulus. Head position was also shown to have a significant effect on VEMP recording, with the Head Rotation and Head on Chin conditions producing larger amplitudes for P1, N1, and P2 than the other two head positions. P1 latency did not demonstrate a significant head position effect. However, slightly longer N1 latencies were found for the Head Rotation and Head on Chin conditions. Slightly longer P2 latencies were documented for the Head Rotation with Forward Tilt and Backward Tilt, respectively. The Head Rotation and Head on Chin conditions produced lower thresholds than the remaining two conditions.
THE BEST-SELLING BOOK ON THE TOPIC! The third edition of Balance Function Assessment and Management, the leading textbook on the subject, continues to comprehensively address the assessment and treatment of balance system impairments through contributions from top experts in the areas of dizziness and vertigo. Designed for use in graduate audiology programs and by practicing audiologists, this is also a valuable text for those in the fields of physical therapy, otolaryngology, and neurology. New to the Third Edition: * Reorganized with the expertise of four additional Editors: Kamran Barin, PhD, Robert F. Burkard, PhD, Kristen Janky, AuD, PhD, and Devin L. McCaslin, PhD * Three new chapters: An Historical Perspective of the Perception of Vertigo, Dizziness, and Vestibular Medicine (Zalewski); Vestibular Balance Therapy for Children (Christy); and Challenging Cases (Shepard) * All existing chapters have been revised and updated * An effort has been made to make the text more concise * Three new helpful appendices covering the pathophysiology behind dizziness, coding and billing, and an overview of Interprofessional Education (IPE) and Interprofessional Practice (IPP) Disclaimer: Please note that ancillary content (such as documents, audio, and video, etc.) may not be included as published in the original print version of this book.
The topography of the brainstem is complex, and even experienced neurologists find it challenging to localize brainstem lesions and diagnose brainstem disorders. This richly illustrated book provides a comprehensive review of brainstem disorders and presents the clinical knowledge necessary for diagnosis. The opening sections document the brainstem neuroanatomy and discuss current diagnostic methods. The entire spectrum of clinical findings in brainstem disorders is then described, and topodiagnostic aspects of the neurological findings are explained in detail. The descriptions of brain stem disorders are consistently structured and are supported by many MR images and short case reports. In addition to primary brainstem lesions, such as vascular brainstem syndromes, other disorders are considered that do not exclusively show brainstem symptoms or signs, e.g., multiple sclerosis. This book will serve as an invaluable reference work for neurologists in clinical practice or further education.
Through four editions, Cummings Otolaryngology has been the world's most trusted source for comprehensive guidance on all facets of head and neck surgery. This 5th Edition - edited by Paul W. Flint, Bruce H. Haughey, Valerie J. Lund, John K. Niparko, Mark A. Richardson, K. Thomas Robbins, and J. Regan Thomas – equips you to implement all the newest discoveries, techniques, and technologies that are shaping patient outcomes. You'll find new chapters on benign neoplasms, endoscopic DCR, head and neck ultrasound, and trends in surgical technology... a new section on rhinology... and coverage of hot topics such as Botox. Plus, your purchase includes access to the complete contents of this encyclopedic reference online, with video clips of key index cases! Overcome virtually any clinical challenge with detailed, expert coverage of every area of head and neck surgery, authored by hundreds of leading luminaries in the field. See clinical problems as they present in practice with 3,200 images - many new to this edition. Consult the complete contents of this encyclopedic reference online, with video clips of key index cases! Stay current with new chapters on benign neoplasms, endoscopic DCR, head and neck ultrasound, and trends in surgical technology... a new section on rhinology... and coverage of hot topics including Botox. Get fresh perspectives from a new editorial board and many new contributors. Find what you need faster through a streamlined format, reorganized chapters, and a color design that expedites reference.
With advancements across various scientific and medical fields, professionals in audiology are in a unique position to integrate cutting-edge technology with real-world situations. Scientific Foundations of Audiology provides a strong basis and philosophical framework for understanding various domains of hearing science in the context of contemporary developments in genetics, gene expression, bioengineering, neuroimaging, neurochemistry, cochlear and mid-brain implants, associated speech processing and understanding, molecular biology, physics, modeling, medicine, and clinical practice. Key features of this text include: Highly technical information presented in a cohesive and understandable manner (i.e., concepts without complex equations)Discussion of integrating newly developed technology within the clinical practice of audiologyState-of-the-art contributions from a stellar array of international, world-class experts Scientific Foundations of Audiology is geared toward doctoral students in audiology, physics, and engineering; residents in otolaryngology, neurology, neurosurgery, and pediatrics; and those intermediaries between innovation and clinical reality.
Accompanying DVDs contain videos of actual patient assessment, testing, and treatment (disc 1(CD). Chapters 1, 5, 7, 8, 9, 14, 18, 20, 26; chapters 12, 13: Disc 1. Interactive Excel files and videos; Disc 2. Rotary chair testing: Normal patient) for balance function.
Tania Stadsbader wrestled with a balance disorder for 15 years before undergoing an operation that cured her of her condition. In this book, she looks back on her long search for a proper diagnosis, and on the impact of her years of illness. She tells her story directly and clearly, and also gives a voice to many of her fellow sufferers. Professor Floris Wuyts adds a scientific viewpoint and presents the most up-to-date discoveries from the field of vestibular research. The groundbreaking combination of patients’ and professionals’ voices makes this volume unique of its type.