Vestibular evoked myogenic potential (VEMP) is applied to explore the integrity of sacculocollic reflex. Although tests to evaluate vestibular-ocular reflex pathway have shown that vestibular function is adversely affected by aging, VEMP, in this study, is used as a novel test to define how aging influences sacculocollic reflex pathway. Prospective study. Academic tertiary referral center. Eighty normal subjects, equally divided into four groups according to their age, were enrolled to this study. Group I included patients aged <20 years, Group II patient ages ranged from 21 to 40 years, Group III patients were 41 to 60 years, and Group IV included patients older than 60 years. Recordings of VEMP responses. The response rate and parameters of VEMP, including p13 latency, n23 latency, amplitude, and interaural difference ratio. The VEMP response rates from Groups I to IV was 98%, 98%, 90%, and 60%, respectively, disclosing a significant difference only between Group IV and other groups (p < 0.05). The amplitude was negatively correlated with age in contrast to the n23 latency, correlating positively with age; both reached a significant difference (p < 0.05). Although the p13 latency had a trend to prolong as age increased, no significant correlation existed (p < 0.06). Moreover, the interaural difference ratio was also not significantly correlated with age. As age increased over 60 years, the VEMP response rate decreased dramatically. While age increased, the VEMP amplitude decreased in comparison to n23 latency prolonged. These findings might suggest that aging could deteriorate the saccular and corresponding neural functions. When interpreting the VEMP parameters, it should be kept in mind that aging could affect VEMP responses. Based on this study, we suggest establishing different reference values according to different age groups when evaluating VEMP response in patients with vestibular diseases.

Vestibular evoked myogenic potential (VEMP) has become a diagnostic tool to evaluate the integrity of sacculo-collic reflex. To obtain a more consistent VEMP response in normal-hearing subjects, we examine whether clicks or short tone bursts are more effective in eliciting VEMP responses. Prospective study. Twenty-nine normal-hearing volunteers (58 ears) were given VEMP tests. Clicks and short tone bursts were presented alternately to evoke VEMPs. The latencies of peak p13 and n23, peak-to-peak interval and amplitude (p13-n23) were measured and compared. Click stimulation of 57 ears (98%) produced VEMPs (C-VEMPs), whereas 51 (88%) revealed positive short tone burst-evoked VEMPs (STB-VEMPs), exhibiting a significant difference (p < 0.05). Furthermore, C-VEMPs displayed shorter latency, longer interval and larger amplitude than STB-VEMPs, with a significant difference (p < 0.05), respectively. C-VEMPs had a higher response rate, shorter latency, and larger amplitude than STB-VEMPs. These findings suggest that click is superior to short tone burst to trigger VEMPs. Because C-VEMPs have a shorter p13 latency than STB-VEMPs, the interpretation of prolonged latency differs in each stimulus condition.

Nasal obstruction, although not life threatening, can interfere with quality of life. Enlargement of the inferior turbinates is a common cause of obstruction of the nasal airway, in addition to deviation of the septum. Turbinate surgery is an effective treatment for chronic nasal obstruction induced by perennial allergic rhinitis.¹ Many techniques of turbinate reduction have been performed, including partial or total turbinate resection, cauterization, cryotherapy, laser therapy, and radiofrequency ablation.^2-6 Disadvantages of these traditional techniques include bleeding, crusting, synechia formation, osteitis, inadequate volume reduction, and atrophic rhinitis. Furthermore, the multiplicity of techniques indicates the lack of consensus on the “gold standard” for inferior turbinate reduction.

This study investigated whether audiovestibular function tests, namely auditory brain stem response (ABR) and vestibular-evoked myogenic potential (VEMP) tests were correlated to hearing outcomes after controlling the effects of other potential confounding factors in severe to profound sudden sensorineural hearing loss (SSHL). Eighty-eight patients with severe to profound SSHL were enrolled in this study. Pretreatment hearing levels, results of audiovestibular function tests, and final hearing outcomes were recorded from retrospective chart reviews. Other factors, including age, gender, delay of treatment, vertigo, diabetes mellitus, and hypertension, were collected as well. Comparative analysis between multiple variables and hearing outcomes was conducted using the cumulative logits model in overall subjects. Further, multivariate analysis of prognostic factors was conducted in the stratified groups of severe (70 dB HL 90 dB HL) SSHL. Multivariate analysis showed that pretreatment hearing levels, presence of vertigo, and results of ABR and VEMP testing were significant outcome predictors in the overall subjects. Stratification analysis demonstrated that both the presence of ABR and VEMP waveforms were significantly correlated with better hearing outcomes in the group of severe SSHL [ABR: adjusted odds ratio (aOR) = 14.7, 95% confidence interval (CI) = 1.78 to 122, p = 0.01; VEMP: aOR = 5.91, 95% CI = 1.18 to 29.5, p = 0.03], whereas the presence of vertigo was the only significant negative prognostic factor in the group of profound SSHL (aOR = 0.24, 95% CI = 0.06 to 0.95, p = 0.04). Other variables, including age, gender, diabetes mellitus, hypertension, and delay of treatment, were not significantly related to hearing outcomes in both groups (p > 0.05). A predictive hearing recovery table with the combined ABR and VEMP results was proposed for the group of severe SSHL. ABR and VEMP tests should be included in the battery of neurootological examinations in patients with severe SSHL because the presence of both waveforms might indicate favorable hearing outcomes. The presence of vertigo might portend a worse prognosis in patients with profound SSHL. A presumed table in predicting hearing outcomes was suggested for patients with severe SSHL.

Research from JAMA Otolaryngology–Head & Neck Surgery — Office-Based Potassium Titanyl Phosphate Laser–Assisted Endoscopic Vocal Polypectomy