Electrode Montage for Bilateral Cervical Vestibular Evoked Myogenic Potential (cVEMP) Testing

Background: Cervical vestibular evoked myogenic potentials (cVEMPs) are predominantly ipsilateral, myogenic responses originating from saccular activation. Some individuals have contralateral-crossed cVEMP responses with monaural air-conducted stimulation (ACS) which can contaminate cVEMP responses with bilateral stimulation. While the origin of the contralateral-crossed response is under debate, its presence has implications for cVEMP testing with midline bone conduction vibration (BCV). Purpose: The purpose of this study was to determine the origin of the contralateral-crossed cVEMP response. It was hypothesized that the crossed response is due to electrode contamination and would disappear with a modified electrode montage. Research Design: Cross-sectional research study. Study Sample: Fifteen healthy participants (30 ears; mean age: 27.4 19-39; 10 females). Data Collection and Analysis: Participants completed cVEMP testing using three stimulation methods (monoaural ACS, binaural ACS, and midline BCV) and two electrode montages (sternum reference and Fp reference). Results: In the monoaural ACS with sternum reference condition, 53.3% ears had contralateral-crossed cVEMP responses that were in-phase with the ipsilateral response for all but 3 ears. Whereas in the monoaural ACS with Fp reference condition, 3% had a contralateral-crossed cVEMP response. ACS and BCV cVEMP corrected amplitudes were significantly larger in the sternum reference conditions, which is attributed to artificial enhancement from the in-phase contralateral-crossed responses. Conclusions: The significant reduction of contralateral-crossed responses in the Fp reference condition suggests that the contralateral-crossed cVEMP response is due to reference electrode contamination and may be a more appropriate reference placement when completing cVEMPs with midline BCV. Purpose: The purpose of this study was to determine the origin of the contralateral-crossed cVEMP response. It was hypothesized that the crossed response is due to electrode contamination and would disappear with a modified electrode montage. Research Design: Cross-sectional research study. Study Sample: Fifteen healthy participants (30 ears; mean age: 27.4 19-39; 10 females). Data Collection and Analysis: Participants completed cVEMP testing using three stimulation methods (monoaural ACS, binaural ACS, and midline BCV) and three electrode montages (sternum reference, Fp reference, and active on Fp). Results: In the monoaural ACS with sternum reference condition, 53.3% ears had contralateral-crossed cVEMP responses that were in-phase with the ipsilateral response for all but 3 ears. Whereas in the monoaural ACS with Fp reference condition, 3% had a contralateral-crossed cVEMP response. No participants demonstrated responses using Fp for the active electrode suggesting this is a neutral site. ACS and BCV cVEMP corrected amplitudes were significantly larger in the sternum reference conditions, which is attributed to artificial enhancement from the in-phase contralateral-crossed responses. Conclusions: The significant reduction of contralateral-crossed responses in the Fp reference condition suggests that the contralateral-crossed cVEMP response is due to reference electrode contamination and may be a more appropriate reference placement when completing cVEMPs with midline BCV.

Publication History

Received: 01 August 2023

Accepted after revision: 16 January 2024

Accepted Manuscript online:
19 January 2024