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DOI: 10.7162/S1809-97772013000200006
Vestibular evoked myogenic potentials and digital vectoelectro-nystagmography's study in patients with benign paroxysmal positional vertigo
Publication History
19 August 2012
25 December 2012
Publication Date:
09 January 2014 (online)

Summary
Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a very common vestibular disorder characterized by brief but intense attacks of rotatory vertigo triggered by simple rapid movement of the head. The integrity of the vestibular pathways can be assessed using tests such as digital vectoelectronystagmography (VENG) and vestibular evoked myogenic potentials (VEMP).
Aim: This study aimed to determine the VEMP findings with respect to latency, amplitude, and waveform peak to peak and the results of the oculomotor and vestibular components of VENG in patients with BPPV.
Method: Although this otoneurological condition is quite common, little is known of the associated VEMP and VENG changes, making it important to research and describe these results.
Results: We examined the records of 4438 patients and selected 35 charts after applying the inclusion and exclusion criteria. Of these, 26 patients were women and 9 men. The average age at diagnosis was 52.7 years, and the most prevalent physiological cause, accounting for 97.3% of cases, was ductolithiasis. There was a statistically significant association between normal hearing and mild contralateral sensorineural hearing loss. The results of the oculomotor tests were within the normal reference ranges for all subjects. Patients with BPPV exhibited symmetrical function of the semicircular canals in their synergistic pairs (p < 0.001). The caloric test showed statistically normal responses from the lateral canals. The waveforms of all patients were adequate, but the VEMP results for the data-crossing maneuver with positive positioning showed a trend toward a relationship for the left ear Lp13. There was also a trend towards an association between normal reflexes in the caloric test and the inter-peak VEMP of the left ear. It can be concluded that although there are some differences between the average levels of the VENG and VEMP results, these differences were not statistically significant.
Conclusion: In conclusion, the results of audiologic assessment, hearing thresholds, positioning maneuvers, and caloric tests have no effect on the quantitative results of VEMP. Additional research is warranted to establish the relationships among VENG, VEMP, and BPPV, especially as concerns the oculomotor tests.
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References
- 1 Ganança MM, Vieira RM, Caovilla HH. Princípios de otoneurologia. Vol. 1. São Paulo: Atheneu; 1998. . Capther, Equilibriometria
- 2 Ganança MM, Caovilla HH. Desequilíbrio e reequilíbrio. In: Ganança MM, , editor. Vertigem tem cura?: o que aprendemos nestes últimos 30 anos. São Paulo: Lemos Editorial; 1998. p. 13-9
- 3 Pereira CB, Scaff M. Vertigem de posicionamento paroxística benigna. Arq. Neuro-Psiquiatr. [Internet] 2001 June [cited 2011 Apr 28];59(2B): 466-70 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2001000300031&lng=en . doi: 10.1590/S0004-282X2001000300031
- 4 Manso A, Ganança CF, Ganança FF, Ganança MM, Caovilla HH. Achados à prova calórica e canal semicircular acometido na vertigem posicional paroxística benigna. Rev. soc. bras. fonoaudiol. [Internet] 2009 [cited 2011 May 01]; 14 (1) 91-7 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-80342009000100015&lng=pt . doi: 10.1590/S1516-80342009000100015
- 5 Costa VSP, Marchiori LL, Melo JJ, Guedes RFRP, Amâncio MK, Fontana AD , et al. Avaliação da manobra de reposicionamento de Epley em indivíduos com vertigem posicional paroxística benigna. Rev. CEFAC [Internet] . 2010 Oct [cited 2011 May 06]; 12 (5) 727-32 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-18462010000500002&lng=pt . Epub 23-Abr-2010. doi: 10.1590/S1516-18462010005000023
- 6 Dorigueto RS. Estudo do potencial evocado miogênico vestibular na vertigem posicional paroxística benigna [dissertation]. São Paulo: Universidade Federal de São Paulo, Curso de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço; 2010
- 7 Kasse CA, Santana GG, Scharlach RC, Gazzola JM, Branco FCB, Doná F. Resultados do Balance Rehabilitation Unit na Vertigem Posicional Paroxística Benigna. Braz. j. otorhinolaryngol. (Impr.) [Internet] 2010 Oct [cited 2011 May 21]; 76 (5) 623-9 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942010000500015&lng=pt
- 8 Pereira AB, Santos JN, Volpe FM. Efeito da manobra de Epley na qualidade de vida dos pacientes com vertigem posicional paroxística benigna. Braz. j. otorhinolaryngol. (Impr.) [Internet] 2010 Dec [cited 2011 May 21]; 76 (6) 704-8 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942010000600006&lng=pt
- 9 Costa KCF, Silva SMR, Ganança CF. Estudo das provas oculomotoras e vestibulares por meio da vectoeletronistagmografia digital. Disturb.Comun [internet] 2005; Dec [cited 2011 May 25]; 17 (3) 315-22 Available from: http://www.pucsp.br/revistadisturbios/artigos/Artigo_420.pdf
- 10 Chung KW, Park KN, Ko MH, Jeon HK, Choi JY, Cho YS , et al. Incidence of horizontal canal benign paroxysmal positional vertigo as a function of the duration of symptoms. Otol Neurotol. [Internet] 2009 Feb [cited 2011 May 20]; 30 (2) 202-5 . Available from: http://www.ncbi.nlm.nih.gov/pubmed/19180679?dopt=Abstract
- 11 Moon SY, Kim JS, Kim BK, Kim JI, Lee H, Son SI , et al. Clinical characteristics of benign paroxysmal positional vertigo in Korea: a multicenter study. Korean Med Sci. [Internet] 2006 Jun [cited 2011 May 20]; 21 (3) 539-43 . Available from: http://www.ncbi.nlm.nih.gov/pubmed/16778402
- 12 Murofushi T, Shimizu K, Takegoshi H, Cheng PW. Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg 2001; Sep; 127 (9) 1069-72
- 13 Akkuzu G, Akkuzu B, Ozluoglu LN. Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere's disease. Eur Arch Otorhinolaryngol 2006; Jun; 263 (6) 510-7
- 14 Ganança FF. Tratamento da Vertigem e de outras tonturas. São Paulo: Lemos; 2002. . p. 28-34
- 15 Ganança MM , et al. Lidando com a Vertigem Posicional Paroxística Benigna. Acta ORL [Internet]. 2005 jan [cited 2011 July 31]; 23 (1) ). Available from: http://www.actaorl.com.br/detalhe_artigo.asp?id=57
- 16 Caldas MA, Ganança CF, Ganança FF, Ganança MM, Caovilla HH. Vertigem posicional paroxística benigna: caracterização clínica. Braz. j. otorhinolaryngol. (Impr.) [Internet] 2009 Ago [cited 2011 Aug 06]; 75 (4) 502-6 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942009000400006&lng=pt
- 17 Lee NH, Ban JH, Lee KC, Kim SM. Benign paroxysmal positional vertigo secondary to inner ear disease. Otolaryngol Head Neck Surg. [Internet] 2010 Sep[cited 2011 Aug 05]; 143 (3) 413-7 . Available from: http://www.ncbi.nlm.nih.gov/pubmed/20723780
- 18 Atas A, Aksoy A, Turan E. VENG Abnormalties. In: BPPV. [Internet]. 10th Congress of the German Society of Audiology; 2007 Jun 06-09. Heidelberg; Germany; 2007. [Cited 2011 Oct 01]. Available from: http://www.uzh.ch/orl/dga2007/program/scientificprogram/Atas__A._et_al.pdf
- 19 Tuma VC, Ganança C, Ganança FF, Ganança MM, Caovilla HH. Avaliação oculomotora em pacientes com disfunção vestibular periférica. Rev. Bras. Otorrinolaringol. [Internet] 2006 Jun [cited 2011 Apr 28]; 72 (3) 407-13 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992006000300019&lng=pt . DOI: 10.1590/S0034-72992006000300019
- 20 Lourenço EA, Lopes KC, Pontes Jr Á, Oliveira MH, Umemura A, Vargas AL. Distribuição dos achados otoneurológicos em pacientes com disfunção vestíbulo-coclear. Rev. Bras. Otorrinolaringol. [Internet] . 2005 Jun [cited 2011 May 22]; 71 (3) 288-96 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992005000300005&lng=pt
- 21 Korres SG, Balatsouras DG, Ferekidis E. Electronystagmographic findings inbenign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol. [Internet] 2004 Apr [cited 2011 Oct 14]; 113 (4) 313-8 . Available from: http://www.ncbi.nlm.nih.gov/pubmed/15112976
- 22 Maia Roberto A, Diniz FL, Carlesse A. Manobras de reposicionamento no tratamento da vertigem paroxística posicional benigna. Rev. Bras. Otorrinolaringol. [Internet] . 2001 Set [cited 2011 Oct 10]; 67 (5) 612-6 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992001000500003&lng=pt
- 23 Furman JM, Cass SP. Laboratory evaluation: Part Il Vectronystagmography and rotational testing. In: Baloh RW, Halmagyi GM, , editors. Disorders of the Vestibular System. New York: Oxford University Press; 1996. . p. 191-210
- 24 Felipe L, Santos MAR, Gonçalves DU. Potencial evocado miogênico vestibular (Vemp): avaliação das respostas em indivíduos normais. Pró-Fono R. Atual. Cient. [Internet] 2008 Dec [cited 2011 Oct 17]; 20 (4) 249-54 . Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-56872008000400008&lng=en
- 25 Korres S, Gkoritsa E, Giannakakou-Razelou D, Yiotakis I, Riga M, Nikolpoulos TP. Vestibular evoked myogenic potentials in patients with BPPV. Med Sci Monit 2011; Jan; 17 (1) CR42-47