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The Effects of Age and the Middle Ear on the Frequency Tuning of the cVEMP and oVEMP
The featured article this month is a paper by our colleagues at James Madison University, Jha, Piker, and Romero. The title of the paper is “Effects of Age and Middle Ear on the Frequency Tuning of the cVEMP and oVEMP.”
When a new method of assessment is developed, a flurry of activity normally occurs. This activity usually is focused on the determination of the optimal stimulating, subject, and recording variables. Also, we need to know what constitutes normal and abnormal performance on the new metric. The introduction to our profession of the cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP, respectively) was no exception.
Clinical laboratories throughout the nation and the world contributed to this knowledge base. Among the many observations emanating from the international scientific community was that neither the cVEMP nor the oVEMP were present 100 percent of the time in “normal” subjects. In fact, Su and colleagues (2004) suggested that up to approximately 40 percent of “normal” individuals over the age of 60 years could be expected to fail to generate a cVEMP. Our group (Piker et al. 2013) and others have attempted to identify variables that are responsible for the absence of these evoked responses in “normal” subjects.
Where the oVEMP is concerned, part of the explanation was attributable to the location of the inverting (i.e., reference) input (Piker et al. 2018). It was observed that, when the contralateral inverting electrode was placed immediately inferior to the non-inverting electrode input, there was a significant amount of reference contamination (i.e., cancellation of the evoked response because the inverting electrode contained a significant amount of the non-inverting input).
For the cVEMP, it was observed that the presence of the response often was absent when the stimulus was a 500 Hz tone burst, but might be present when a higher frequency stimulus (e.g., a 750 Hz or 1000 Hz tone burst) was used as the evoking stimulus. When this observation was studied systematically, it was shown that subject age is a significant variable in the recording of VEMPs. In general, it was shown that older individuals (e.g., > 60 years) were more likely to generate VEMPs if the stimulus is > 500 Hz. It is significant that, for most clinical investigations, a 500 Hz tone burst is the recommended stimulus frequency.
This brings us to the current investigation. In this study, the investigators added to what we know by assessing the effect of tone burst frequency and middle ear status on the recording of cVEMP and oVEMP. They evaluated 107 subjects that were divided into three groups (young, middle-aged, and older adults). The researchers recorded VEMPs in response to 500 Hz, 750 Hz, and 1000 Hz tone bursts. Further, they measured static admittance and measures of middle ear resonant frequency.
I am not going to give away the results of the study, but will say that they contribute significantly to our knowledge base on VEMP testing and have motivated me to alter my recording techniques.
Article published online:
23 December 2022
© 2022. American Academy of Audiology. This article is published by Thieme.
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- 1 Su HC, Huang TW, Young YH, Cheng PW. Aging effect on vestibular evoked myogenic potential. Otol Neurotol 2004; 25: 977-980
- 2 Piker EG, Jacobson GP, Burkard RF, McCaslin DL, Hood LJ. Effects of age on tuning the cVEMP and oVEMP. Ear Hear 2013; 34: 65-73
- 3 Piker EG, Jacobson GP, Makowiec KF, Atabek PM, Krolewicz S. The medial canthus reference electrode is not electrically indifferent to the ocular vestibular evoked myogenic potential. Otol Neurotol 2018; 39: 1069-1077