For each subject, a test ear was selected at random, with the opposite ear serving as the control, non-test ear. VEMP recordings were completed in the test ear using an ICS Chartr 200 Evoked Potential System (GN Otometrics, Taastrup, DK). Air conduction stimuli were delivered monaurally via ER-3A insert earphones. Stimuli used were 4 msec rarefaction, 500 Hz tone bursts at a repetition of rate of 5.1 per second (Blackman gating window, 1 cycle rise/fall time, 0 cycle plateau). Stimuli were presented at 125 dB SPL in adults and 120 dB SPL in children. Published VEMP stimulus parameters and guidelines often anywhere from 125–133 dB SPL as the intensity in which VEMP stimuli are delivered (Janky & Shepard 2009 (
link); Krause et al. 2013 (
link); Piker et al. 2015 ). Few reports have investigated the potential for noise induced hearing loss secondary to the high intensity stimulation level on changes in cochlear status; these investigations are limited to adult populations which is difficult to generalize to the pediatric population.
For cVEMP testing, an active electrode was placed on the muscle belly of the sternocleidomastoid (SCM) muscle, an electromyography (EMG) electrode just below the SCM electrode, a reference electrode on the manubrium of the sternum, and a ground electrode on the chin. For oVEMP testing, an active electrode was placed under the contralateral eye medio-laterally with a reference electrode on the chin and ground electrode on the manubrium of the sternum. One hundred sweeps were averaged for each cVEMP test, and 150 sweeps were averaged for each oVEMP test. Two trials were completed for each cVEMP and oVEMP recording. For c-and oVEMP, a band-pass filter of 10–1000 Hz and 2–500 Hz was used, respectively.
All subjects lay in a semi-recumbent position for both c-and oVEMP testing. For cVEMP, subjects were instructed to turn their head away from the ear being stimulated and lift their head in response to acoustic simulation to contract the SCM muscle. EMG was recorded from the ipsilateral SCM between the range of 100–300 (μV). Measurements included p13 and n23 latencies (msec) and the p13 to n23 peak-to-peak amplitude (uV). For oVEMP, subjects were instructed to direct their gaze to a mark on the ceiling set at 30 degrees up gaze in response to acoustic stimulation. Measurements included n10 and p16 latencies (msec) and the n10 to p16 peak-to-peak amplitude (uV). For c-and-oVEMP, the presence of a response was considered normal, while an absent response was considered abnormal.
Rodriguez A.I., Megan L.A., Thomas D.F, & Janky K.L. (2018). Effects of High Sound Exposure During Air-conducted Vestibular Evoked Myogenic Potential Testing in Children and Young Adults. Ear and hearing, 39(2), 269-277.