A total of 14 healthy volunteers were recruited (8 females; age: 50–60 years, mean age 55.1 ± 3.0 years). All participants were interviewed via telephone to exclude previous medical history with dizziness, neurological or psychiatric disorders of any kind, and use of potential neuromodulating medication. Only right‐handed volunteers according to the 10‐item inventory of the Edinburg test (Oldfield, 1971 ) and nonsmokers were included in the study. Cervical VEMP, ocular VEMP (Curthoys, 2017 ) (Eclipse, Interacoustics, Middelfart, Denmark), and video head impulse test (EyeSeeCam, Interacoustics, Middelfart, Denmark) were carried out prior to the PET examinations to ensure normal function of the vestibular organ (Halmagyi et al., 2017 ). All 14 healthy volunteers were included in the study and underwent three 18F‐FDG‐PET scans. Informed oral and written consent were obtained from all participants. The study was approved by the Central Region of Denmark Research Ethics Committee (no: 1‐10‐72‐135‐16). The results of the study are reported in agreement with the STROBE statement (von Elm et al., 2014 ).
Eclipse
Manufactured by Interacoustics
Sourced in Denmark
The Eclipse is a comprehensive diagnostic platform that offers a range of advanced capabilities for hearing assessment. It is designed to provide clinicians with reliable and accurate data to support their diagnostic decisions.
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7 protocols using eclipse
1
Vestibular Function Assessment in Healthy Adults
2
Comprehensive Vestibular Assessment
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Due to the more invasive therapy, the two patients with intracochlear Ozurdex® implantation received a detailed neurotological assessment including vestibular-ocular reflex (vHIT, ICS Impulse, Natus Medical Inc., San Carlos, CA, United States), cervical and ocular vestibular evoked myogenic potentials (c/oVEMPs, Eclipse, Interacoustics, Middelfart, Danmark) and response to caloric stimulation (Hortmann Vestlab 100, Natus Medical Inc., San Carlos, CA, United States).
3
Cervical Vestibular Evoked Myogenic Potentials
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Cervical VEMPs were recorded using surface electrodes placed over the sternocleidomastoid (SCM) muscles, while reference and ground electrodes were placed on the upper sternum and in the midline of the forehead, respectively. Subjects sat comfortably on a chair, keeping the SCM activated and tense through head rotation. We used the Eclipse, EP25-Interacoustics® equipment with research license, Denmark. The electromyographic (EMG) signal was amplified and band-pass filtered (10–1,000 Hz), and the rectified EMG signal was measured to obtain valid trials with muscle activation. The stimulus consisted of 500 Hz tone bursts, presented at 5.1 Hz rate through earphones at 100 dB nHL. To obtain cVEMPs waveforms, 200 trials were averaged, and P1–N1 amplitudes and P1 latencies were measured. To rule out middle ear conductive alterations, an otoscopic examination of the tympanic membrane was performed and middle ear impedance was measured.
4
Vestibular Function Testing Protocol
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Vestibular function testing included video head impulse tests (VHITs) and cVEMPs. The VHIT (EyeSeeCam, Interacoustics, Middelfart, Denmark or ICS impulse, Otometrics, Taastrup, Denmark) is performed by applying rapid horizontal head thrusts randomly to each side, with gaze fixation (5 (link)). The VHIT outcome for the lateral semicircular canals was determined by the vestibulo-ocular reflex (VOR) median gain value (LVOR gain) and compensatory saccades (covert or overt). VOR vestibulopathy (uni- or bilateral) was defined as an ipsilateral gain value below 0.70 or presence of saccades (5 (link)). Complete loss of VOR function was defined as a gain value <0.25. Gain values below zero were defined as 0. CVEMPs evaluate the vestibulo-cervical reflex (and thus the function of the saccule in the vestibule of the inner ear) and were performed by applying air-conducted click sounds of 100 dB nHL to the external ear canal and recording myogenic potentials evoked in the ipsilateral sternocleidomastoid muscle (Eclipse, Interacoustics, Middelfart, Denmark) (6 (link)). The outcome was evaluated binarily: presence or absence of a potential. VEMP vestibulopathy (uni- or bilateral) was defined as absence of an ipsilateral potential.
5
Cervical Vestibular Evoked Myogenic Potentials
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Otolithic function was measured using the vestibulospinal reflex elicited in response to cVEMP. Prior to cVEMP testing, the test equipment (Eclipse, Interacoustics) controls for EMG activation. In-ear air-conducted sound stimuli (100 dBnHL tone bursts at 500 Hz) (31 (link)) were used, and the electrode monitoring the elicited myogenic response was placed on the sternocleidomastoid muscle. cVEMP responses with both P1 and N1 present were considered [dichotomous outcomes (+/–)]. We did not report on the cVEMP asymmetry ratio because of the high variability of results reported in the literature (23 (link)).
6
Comprehensive Audiological Assessment
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The audiological assessment encompassed tympanometry (Interacoustics Impedance Audiometer AT235, Middelfart, Denmark), transitory evoked otoacoustic emissions (Eclipse, Interacoustics, Assens, Denmark), and play audiometry for younger or less cooperative children and pure tone audiometry (Clinical Audiometer AC40, Interacoustics, Middelfart, Denmark) for older or more cooperative children.
7
Comprehensive Audiological Evaluation Protocol
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Comprehensive audiological evaluations were performed by trained professional sta s in our hearing center. Behavior audiometry was obtained with TDH-39P earphones (Interacoustics, AD229e) with the maximum output of 120dB HL in the frequency of 500-4000Hz and 110dB HL in the frequency of 250 and 8000Hz bilaterally. Auditory steady-state response (ASSR) was obtained with TDH-39P earphones (Interacoustics, Eclipse) with the maximum output of 100dB nHL bilaterally. Better ear hearing threshold was calculated for the thresholds of 500, 1000, 2000, and 4000Hz, with a value of 5dB over the limit at the frequency used as the calculation for no response thresholds (19) . The di erence between binaural hearing was calculated by the results of ASSR. If the di erence was no more than10 dB nHL, we defined it symmetry of binaural hearing; if it was more than10 dB nHL, we thought it asymmetry (20) .
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