Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease☆, ☆☆

Silva, Tatiana Rocha; Resende, Luciana Macedo de; Santos, Marco Aurélio Rocha

doi:10.1016/j.bjorl.2016.04.017

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Otorhinolaryngology

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Artigos originais • Braz. j. otorhinolaryngol. 83 (3) • May-Jun 2017 • https://doi.org/10.1016/j.bjorl.2016.04.017 copy

Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease^☆ ☆ Please cite this article as: Silva TR, de Resende LM, Santos MA. Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease. Braz J Otorhinolaryngol. 2017;83:330-40. , ^☆☆ ☆☆ Study conducted at the Audiology Clinic of the Anexo São Geraldo of the Hospital das Clínicas of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response to high-intensity sounds. This study presents a combined or simultaneous technique of cervical and ocular vestibular evoked myogenic potential in individuals with changes in the vestibular system, for use in otoneurologic diagnosis.

Objective:

To characterize the records and analyze the results of combined cervical and ocular VEMP in individuals with vestibular hyporeflexia and in those with Ménière's disease.

Methods:

The study included 120 subjects: 30 subjects with vestibular hyporeflexia, 30 with Ménière's disease, and 60 individuals with normal hearing. Data collection was performed by simultaneously recording the cervical and ocular vestibular evoked myogenic potential.

Results:

There were differences between the study groups (individuals with vestibular hyporeflexia and individuals with Ménière's disease) and the control group for most of wave parameters in combined cervical and ocular vestibular evoked myogenic potential. For cervical vestibular evoked myogenic potential, it was observed that the prolongation of latency of the P13 and N23 waves was the most frequent finding in the group with vestibular hyporeflexia and in the group with Ménière's disease. For ocular vestibular evoked myogenic potential, prolonged latency of N10 and P15 waves was the most frequent finding in the study groups.

Conclusion:

Combined cervical and ocular vestibular evoked myogenic potential presented relevant results for individuals with vestibular hyporeflexia and for those with Ménière's disease. There were differences between the study groups and the control group for most of the wave parameters in combined cervical and ocular vestibular evoked myogenic potential.

KEYWORDS
Vestibular nerve; Motor evoked potential; Labyrinth vestibule; Vestibular disorders; Saccule and utricle

Wave parameters	Hyporeflexia					CG1
	Mean	Median	SD	Max.	Min.	Mean	Median	SD	Max.	Min.
St. RE
Cervical
Ampl P13	26.16	22.72	19.03	74.47	0.00	34.48	32.63	18.16	74.22	7.64
Ampl N23	29.80	28.41	18.29	67.76	0.00	57.20	43.32	39.27	169.58	10.58
Inter ampl	56.07	55.97	33.57	128.73	0.00	91.67	76.51	54.38	225.27	18.22
Lat P13	15.94	14.60	5.70	31.30	0.00	12.82	12.90	1.07	14.90	10.70
Lat N23	23.33	22.05	6.18	37.80	0.00	22.19	21.90	1.46	24.90	20.50

Ocular
Ampl N10	2.80	1.52	3.80	15.81	0.09	2.66	2.04	1.32	5.87	1.02
Ampl P15	2.64	1.67	3.31	12.95	0.10	3.34	2.60	1.98	8.82	1.22
Inter ampl	5.44	3.28	7.04	28.76	0.19	6.03	5.26	3.10	14.69	2.90
Lat N10	12.37	11.20	3.17	20.20	8.30	10.26	10.25	0.79	12.00	8.70
Lat P15	19.48	18.35	4.28	28.50	13.40	15.24	15.10	0.89	17.03	13.40

St. LE
Cervical
Ampl P13	19.34	15.33	13.59	51.41	0.00	26.53	22.89	13.37	66.69	9.08
Ampl N23	18.66	13.58	13.34	47.07	0.00	44.07	37.26	21.66	96.86	17.31
Inter ampl	38.00	34.49	25.26	91.03	0.00	70.60	62.41	32.47	163.55	28.17
Lat P13	17.50	16.45	5.92	28.30	0.00	12.99	12.75	1.05	15.10	10.90
Lat N23	25.41	25.70	6.87	35.40	0.00	22.57	22.35	1.49	25.30	20.10

Ocular
Ampl N10	1.91	0.86	2.67	12.19	0.00	2.25	2.18	0.92	4.02	1.04
Ampl P15	1.92	0.68	2.56	10.60	0.00	2.55	2.68	0.83	4.09	1.12
Inter ampl	3.83	1.53	5.03	19.20	0.00	4.80	5.02	1.64	7.70	2.54
Lat N10	12.94	12.80	5.51	28.30	0.00	10.52	10.50	0.89	11.90	8.80
Lat P15	19.67	20.35	7.46	37.10	0.00	15.41	15.50	0.78	17.00	13.80

Wave parameters	Ménière's disease					CG2
	Mean	Median	SD	Max.	Min.	Mean	Med.	SD	Max.	Min.
St. RE
Cervical
Ampl P13	25.96	24.54	13.18	52.02	4.31	43.68	45.02	19.06	77.98	7.64
Ampl N23	34.59	31.42	20.25	85.63	6.90	62.28	60.49	27.16	111.38	10.58
Inter ampl	60.55	54.11	31.96	128.65	11.39	105.98	106.98	44.51	170.63	18.22
Lat P13	15.08	13.90	3.12	23.50	11.60	13.40	13.45	0.96	14.90	11.60
Lat N23	23.53	22.80	3.15	31.70	20.50	22.39	22.45	1.48	24.90	20.00

Ocular
Ampl N10	4.40	1.87	7.63	28.81	0.14	2.33	2.05	0.80	5.25	1.04
Ampl P15	5.95	1.89	12.32	45.18	0.15	3.21	3.05	1.18	8.48	1.13
Inter ampl	10.35	3.88	19.93	73.70	0.29	5.57	5.26	1.90	13.73	2.17
Lat N10	12.18	10.95	3.49	22.60	9.10	10.40	10.40	0.84	12.10	9.20
Lat P15	18.13	16.45	3.94	28.50	13.80	15.27	15.05	0.96	17.20	13.40

St. LE
Cervical
Ampl P13	23.73	21.98	13.77	54.56	0.00	37.64	32.47	15.63	76.04	14.97
Ampl N23	29.42	29.60	16.19	68.61	0.00	51.47	51.34	16.88	95.88	23.74
Inter ampl	53.15	50.75	28.91	123.17	0.00	89.11	83.84	29.77	158.22	39.60
Lat P13	14.05	13.40	4.82	22.70	0.00	13.18	13.30	1.16	14.90	11.20
Lat N23	21.40	20.95	6.47	29.30	0.00	22.65	22.60	1.36	24.80	20.50

Ocular
Ampl N10	1.58	1.55	0.88	3.37	0.00	2.64	2.50	0.96	5.34	1.07
Ampl P15	1.72	1.79	1.11	4.76	0.00	3.29	3.02	1.31	8.29	1.12
Inter ampl	3.30	3.61	1.91	7.95	0.00	5.93	5.53	2.21	13.63	2.53
Lat N10	11.95	11.05	4.42	28.30	0.00	10.49	10.30	0.94	12.20	9.10
Lat P15	17.42	16.80	5.62	37.10	0.00	15.38	15.25	0.83	17.10	13.80

Parameters	Hyporeflexia			CG1			p -value
	Mean	Median	SD	Mean	Median	SD
Stimulation RE
Cervical
Ampl P13	26.16	22.72	19.03	34.48	32.63	18.16	0.090^a a Wilcoxon's test (p ≤ 0.05). ,^c c Values with trend toward statistical significance (p ≤ 0.10)
Ampl N23	29.80	28.41	18.29	57.20	43.32	39.27	0.001 ^b b t-test (p ≤ 0.05).
Inter ampl	56.07	55.97	33.57	91.67	76.51	54.38	0.005 ^b b t-test (p ≤ 0.05).
Lat P13	15.94	14.60	5.70	12.82	12.90	1.07	0.006 ^b b t-test (p ≤ 0.05).
Lat N23	23.33	22.05	6.18	22.19	21.90	1.46	0.151^a a Wilcoxon's test (p ≤ 0.05).

Ocular
Ampl N10	2.80	1.52	3.80	2.66	2.04	1.32	0.088^a a Wilcoxon's test (p ≤ 0.05). ,^c c Values with trend toward statistical significance (p ≤ 0.10)
Ampl P15	2.64	1.67	3.31	3.34	2.60	1.98	0.026 ^a a Wilcoxon's test (p ≤ 0.05).
Inter ampl	5.44	3.28	7.04	6.03	5.26	3.10	0.024 ^b b t-test (p ≤ 0.05).
Lat N10	12.37	11.20	3.17	10.26	10.25	0.79	0.001 ^b b t-test (p ≤ 0.05).
Lat P15	19.48	18.35	4.28	15.24	15.10	0.89	<0.001 ^b b t-test (p ≤ 0.05).

Stimulation LE
Cervical
Ampl P13	19.34	15.33	13.59	26.53	22.89	13.37	0.045 ^b b t-test (p ≤ 0.05).
Ampl N23	18.66	13.58	13.34	44.07	37.26	21.66	<0.001 ^b b t-test (p ≤ 0.05).
Inter ampl	38.00	34.49	25.26	70.60	62.41	32.47	<0.001 ^b b t-test (p ≤ 0.05).
Lat P13	17.50	16.45	5.92	12.99	12.75	1.05	<0.001 ^b b t-test (p ≤ 0.05).
Lat N23	25.41	25.70	6.87	22.57	22.35	1.49	0.033 ^b b t-test (p ≤ 0.05).

Ocular
Ampl N10	1.91	0.86	2.67	2.25	2.18	0.92	0.038 ^a a Wilcoxon's test (p ≤ 0.05).
Ampl P15	1.92	0.68	2.56	2.55	2.68	0.83	0.054^a a Wilcoxon's test (p ≤ 0.05). ,^c c Values with trend toward statistical significance (p ≤ 0.10)
Inter ampl	3.83	1.53	5.03	4.80	5.02	1.64	0.035 ^a a Wilcoxon's test (p ≤ 0.05).
Lat N10	12.94	12.80	5.51	10.52	10.50	0.89	0.028 ^b b t-test (p ≤ 0.05).
Lat P15	19.67	20.35	7.46	15.41	15.50	0.78	0.004 ^b b t-test (p ≤ 0.05).

Parameters	Ménière's disease			CG2			p-value
	Mean	Median	SD	Mean	Median	SD
Stimulation RE
Cervical
Ampl P13	25.96	24.54	13.18	43.68	45.02	19.06	<0.001 ^b b t-test (p ≤ 0.05).
Ampl N23	34.59	31.42	20.25	62.28	60.49	27.16	<0.001 ^b b t-test (p ≤ 0.05).
Inter ampl	60.55	54.11	31.96	105.98	106.98	44.51	<0.001 ^b b t-test (p ≤ 0.05).
Lat P13	15.08	13.90	3.12	13.40	13.45	0.96	0.010 ^b b t-test (p ≤ 0.05).
Lat N23	23.53	22.80	3.15	22.39	22.45	1.48	0.083^b b t-test (p ≤ 0.05). ,^c c Values with trend toward statistical significance (p ≤ 0.10).

Ocular
Ampl N10	4.40	1.87	7.63	2.55	1.94	1.29	0.713^a a Wilcoxon's test (p ≤ 0.05).
Ampl P15	5.95	1.89	12.32	3.81	3.45	2.04	0.018 ^a a Wilcoxon's test (p ≤ 0.05).
Inter ampl	10.35	3.88	19.93	6.36	5.39	3.23	0.063^a a Wilcoxon's test (p ≤ 0.05). ,^c c Values with trend toward statistical significance (p ≤ 0.10).
Lat N10	12.18	10.95	3.49	10.05	10.10	0.56	0.038 ^a a Wilcoxon's test (p ≤ 0.05).
Lat P15	18.13	16.45	3.94	14.61	14.60	0.59	0.001 ^b b t-test (p ≤ 0.05).

Stimulation LE
Cervical
Ampl P13	23.73	21.98	13.77	37.64	32.47	15.63	<0.001 ^b b t-test (p ≤ 0.05).
Ampl N23	29.42	29.60	16.19	51.47	51.34	16.88	<0.001 ^b b t-test (p ≤ 0.05).
Inter ampl	53.15	50.75	28.91	89.11	83.84	29.77	<0.001 ^b b t-test (p ≤ 0.05).
Lat P13	14.05	13.40	4.82	13.18	13.30	1.16	0.043 ^a a Wilcoxon's test (p ≤ 0.05).
Lat N23	21.40	20.95	6.47	22.65	22.60	1.36	0.316^b b t-test (p ≤ 0.05).

Ocular
Ampl N10	1.58	1.55	0.88	2.64	2.50	0.96	<0.001 ^b b t-test (p ≤ 0.05).
Ampl P15	1.72	1.79	1.11	3.29	3.02	1.31	<0.001 ^b b t-test (p ≤ 0.05).
Inter ampl	3.30	3.61	1.91	5.93	5.53	2.21	<0.001 ^b b t-test (p ≤ 0.05).
Lat N10	11.95	11.05	4.42	10.49	10.30	0.94	0.047 ^a a Wilcoxon's test (p ≤ 0.05).
Lat P15	17.42	16.80	5.62	15.38	15.25	0.83	0.002 ^a a Wilcoxon's test (p ≤ 0.05).

	VEMP results
	Normal	Altered	p-value	Odds ratio	95% CI
	n (%)	n (%)
Hyporeflexia
Hearing loss
Absent	12 (20.00)	26 (43.30)	-	-	-
Mild	0 (0.00)	12 (20.00)	0.047	0.684	0.55-0.85
Moderate	0 (0.00)	6 (10.00)	0.167	-	-
Moderately severe	1 (1.70)	1 (1.70)	1.000	-	-
Severe	0 (0.00)	2 (3.30)	1.000	-	-

Ménière's disease
Hearing loss
Absent	14 (23.30)	9 (15.00)	-	-	-
Mild	7 (11.70)	11 (18.30)	0.162	-	-
Moderate	4 (6.70)	11 (18.30)	0,052^a a Values with a tendency to statistical significance (p ≤ 0.10).	4.278	1.04-17.66
Severe	1 (1.70)	2 (3.30)	0.556	-	-
Deep	1 (1.70)	0 (0.00)	1.000	-	-

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:tatiana.rochas@gmail.com (T.R. Silva).