Characteristics and clinical applications of vestibular-evoked myogenic potentials

A recent technique of assessing vestibular function, the vestibular-evoked myogenic potential (VEMP), is an otolith-mediated, short-latency reflex recorded from averaged sternocleidomastoid electromyography in response to intense auditory clicks delivered via headphones. Since their first description 10 years ago, VEMPs are now being used by investigators worldwide, and characteristic changes observed with aging and in a variety of peripheral and central vestibulopathies have been described. Additional methods of evoking VEMPs, which use air- and bone-conducted short-tone bursts, forehead taps, and short-duration transmastoid direct current (DC) stimulation, have been described, and these complement the original technique. Click-evoked VEMPs are attenuated or absent in a proportion of patients with vestibular neuritis, herpes zoster oticus, late Ménière disease, and vestibular schwannomas; their amplitudes are increased and thresholds are pathologically lowered in superior semicircular canal dehiscence presenting with the Tullio phenomenon. VEMPs evoked by clicks and DC are useful when monitoring the efficacy of intratympanic gentamicin therapy used for chemical vestibular ablation. Prolonged p13 and n23 peak latencies and decreased amplitudes have been observed in association with central vestibulopathy. VEMPs evoked by clicks are a robust, reproducible screening test of otolith function. DC stimulation enables differentiation of labyrinthine from retrolabyrinthine lesions; bone-conducted stimuli permit VEMP recording despite conductive hearing loss and deliver a relatively larger vestibular stimulus for a given level of auditory perception.