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Toward Optimizing VEMP

Calculating VEMP Inhibition Depth With a Generic Template

Noij, Kimberley S.1; van Tilburg, Mark J.1; Herrmann, Barbara S.2,3; Marciniak, Piotr3; Rauch, Steven D.1,2; Guinan, John J. Jr.2,4

doi: 10.1097/AUD.0000000000000579
Research Articles

Objectives: Cervical vestibular evoked myogenic potentials (cVEMP) indirectly reveal the response of the saccule to acoustic stimuli through the inhibition of sternocleidomastoid muscle electromyographic response. VEMP inhibition depth (VEMPid) is a recently developed metric that estimates the percentage of saccular inhibition. VEMPid provides both normalization and better accuracy at low response levels than amplitude-normalized cVEMPs. Hopefully, VEMPid will aid in the clinical assessment of patients with vestibulopatholgy. To calculate VEMPid a template is needed. In the original method, a subject’s own cVEMP was used as the template, but this method can be problematic in patients who do not have robust cVEMP responses. We hypothesize that a “generic” template, created by assembling cVEMPs from healthy subjects, can be used to compute VEMPid, which would facilitate the use of VEMPid in subjects with pathological conditions.

Design: A generic template was created by averaging cVEMP responses from 6 normal subjects. To compare VEMPid calculations using a generic versus a subject-specific template, cVEMPs were obtained in 40 healthy subjects using 500, 750, and 1000 Hz tonebursts at sound levels ranging from 98 to 123 dB peSPL. VEMPids were calculated both with the generic template and with the subject’s own template. The ability of both templates to determine whether a cVEMP was present or not was compared with receiver operating characteristic curves.

Results: No significant differences were found between VEMPid calculations using a generic template versus using a subject-specific template for all frequencies and sound levels. Based on the receiver operating characteristic curves, the subject-specific and generic template did an equally good job at determining threshold. Within limits, the shape of the generic template did not affect these results.

Conclusions: A generic template can be used instead of a subject-specific template to calculate VEMPid. Compared with cVEMP normalized by electromyographic amplitudes, VEMPid is advantageous because it averages zero when there is no sound stimulus and it allows the accumulating VEMPid value to be shown during data acquisition as a guide to deciding when enough data has been collected.

1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA

2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA

3Department of Audiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA

4Eaton Peabody Lab, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.

Received November 1, 2017; accepted February 10, 2018.

This work was presented as a poster at the Association of Research in Otolaryngology Midwinter meeting in Baltimore, MD (February 11-15, 2017).

This study was approved by the Human Studies Committee of the Massachusetts Eye and Ear Infirmary. Protocol number: 13-097H. Principal Investigator: Steven D. Rauch.

The authors have no conflicts of interest to disclose.

Address for correspondence: John J. Guinan Jr., 243 Charles Street, Boston, MA 02114, USA. E-mail:

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