Comparison of tone burst and tapping evocation of myogenic potentials in patients with chronic otitis media

OBJECTIVE: Vestibular evoked myogenic potential (VEMP) has recently been broadly studied in cochleo-vestibular disorders to elucidate its mechanism. Because it is evoked by loud sound stimulation, impairment of the sound transmission through the middle ear may affect VEMP results. This study aims to compare the response rate of VEMPs using the tone burst method and the tapping method in patients with chronic otitis media (COM). DESIGN: Fourteen patients (22 ears) with conductive hearing loss due to COM were subjected to VEMP tests using both the tone burst method and the tapping method. Each ear was stimulated by a short-tone burst (95 dB nHL, 500 Hz), followed by tapping on the forehead with a tendon hammer, 200 times at a frequency of 5 Hz. RESULTS: Thirteen (59%) of the 22 ears showed positive VEMPs using the tone burst method, whereas 20 ears (91%) displayed positive VEMPs by the tapping method (p < 0.05). The latencies of wave p13 and n23, and the amplitude p13-n23 using the tone burst method were 13.4 +/- 4.1 msec, 20.5 +/- 4.6 msec, and 77.2 +/- 17.2 microV, respectively. These results do not significantly differ from those obtained using the tapping method. In ears with perforated eardrums (N = 11), five ears (45%) displayed positive VEMPs by the tone burst method; compared with nine ears (82%) with positive VEMPs using the tapping method, representing a nonsignificant difference. In ears with healed eardrums (N = 11), eight ears exhibited positive VEMPs by tone burst, with a mean air-bone gap of 25.6 +/- 15.2 dB at 500 Hz, in contrast to a gap of 30.0 +/- 22.9 dB in three ears without VEMPs, indicating no significant difference. CONCLUSIONS: When stimulating sound is attenuated by middle ear pathology, VEMPs are expected to be poorly elicited. Under such conditions, myogenic potentials may be evoked with the tapping method to elicit the absent VEMPs that result from middle ear or inner ear pathology.     

Vestibular evoked myogenic potentials in delayed endolymphatic hydrops

OBJECTIVE/HYPOTHESIS: Vestibular evoked myogenic potential (VEMP) has become an established test to explore the sacculo-collic reflex. The study aims to investigate the VEMPs in cases of delayed endolymphatic hydrops because greatly dilated saccule was observed in histopathological specimens of delayed endolymphatic hydrops. STUDY DESIGN: Prospective study. METHODS: Twenty patients with delayed endolymphatic hydrops were subjected to pure-tone audiometry, caloric testing, and VEMP test. Delayed VEMP was defined as the latency of peak I exceeding 22.6 milliseconds or of peak II exceeding 33.1 milliseconds. Interaural amplitude difference over the sum of amplitudes of both ears was measured, and when the ratio exceeded 0.36, it was identified as augmented VEMP or depressed VEMP depending on whether the amplitude of the lesioned side was greater or less than the opposite side. RESULTS: The VEMP test revealed that 9 patients (45%) were normal, 6 (30%) exhibited absent VEMPs, and 5 (25%) displayed abnormal VEMPs, including delayed VEMPs in 2, depressed VEMPs in 2, and augmented VEMPs in 1. The caloric test indicated that 9 (47%) of the 19 ears exhibited normal caloric response, whereas 10 ears displayed abnormal caloric responses including canal paresis in 8 and absent caloric response in 2. Six ears had preserved both the caloric response and the VEMPs, whereas no ear demonstrated both absent caloric response and absent VEMPs. CONCLUSIONS: The residual caloric as well as saccular functions after ear insult may determine whether delayed endolymphatic hydrops will occur. These findings suggest that patients with sudden deafness or juvenile unilateral total deafness should undergo caloric testing and VEMP test to predict the occurrence of delayed endolymphatic hydrops in the future.     

An acoustically evoked short latency negative response in profound hearing loss infants

OBJECTIVE: A large negative deflection with a 3-4 ms latency within the auditory brainstem response has been reported in some profound hearing loss ears under intense stimuli in adult subjects. The wave has been termed the N3 potential or acoustically evoked short latency negative response and it is assumed to be a vestibular-evoked potential. The purpose of the current study was to investigate the relationship between the vestibular-evoked myogenic potentials and the acoustically evoked short latency negative response in infants with a functionless cochlea and normal or impaired semicircular canal. METHODS: Seventeen 3 months old infants with profound bilateral sensorineural hearing loss had acoustically evoked short latency negative responses and vestibular-evoked myogenic potentials recorded and caloric tests performed. RESULTS: No spontaneous symptoms of vestibular dysfunction were found in the examined infants. ASNR with medium latency 3.3 ms and threshold value 80-90 dB normal hearing level was elicited from 10 ears. VEMPs were present in 12 ears. ASNRs and VEMPs were absent in two ears with normal response to caloric stimulation. No response to caloric stimulation was elicited from other two ears with normal saccular function. For the ears with absence of ASNR, four had normal VEMP and the rest were considered to have saccular afunction. Significant correlation was found between the presence of ASNRs and VEMPs. CONCLUSION: Acoustically evoked short latency negative responses could be a valuable tool for assessing vestibular function in infants with profound sensorineural hearing loss.     

Assessing the stage of Meniere's disease using vestibular evoked myogenic potentials

BACKGROUND: The staging of Ménière's disease that was proposed by the American Academy of Otolaryngology-Head and Neck Surgery in 1995 was based on the arithmetic mean of the pure-tone thresholds at 0.5, 1.0, 2.0, and 3.0 kHz using the worst audiogram during the 6-month interval before treatment. The stages were classified as follows: stage I, a 4-tone average of less than 26 dB; stage II, 26 to 40 dB; stage III, 41 to 70 dB; and stage IV, more than 70 dB. OBJECTIVE: Because the saccule, next to the cochlea, is the second most frequent site of hydrops formation, we wanted to find out whether vestibular evoked myogenic potential (VEMP) responses can reflect the stage of Ménière's disease. DESIGN: Prospective study. SETTING: Tertiary university hospital. PATIENTS: Forty patients (23 men and 17 women; mean +/- SD age, 43 +/- 12 years) with unilateral definite Ménière's disease were enrolled in the study. MAIN OUTCOME MEASURES: The interaural amplitude difference (IAD) ratio, which was defined as the difference of the amplitudes of peak p13 to peak n23 (p13-n23) in the right (R) and left (L) ears divided by the sum of p13-n23 in both ears (R-L/R + L), was measured, and the stages of the disease were compared with the types of hearing loss, the percentage of unilateral weakness of caloric response, and the IAD ratio, respectively. RESULTS: Six ears were classified as stage I: the VEMPs were normal in 5 and augmented in 1, with a mean +/- SD IAD ratio of -0.02 +/- 0.20. Twelve ears were classified as stage II: the VEMPs were normal in 7, augmented in 2, depressed in 1, and absent in 2, with an IAD ratio of -0.12 +/- 0.39. Seventeen ears were classified as stage III: the VEMPs were normal in 10, depressed in 4, and absent in 3, with an IAD ratio of -0.30 +/- 0.30. Five ears were classified as stage IV: the VEMPs were normal in 2, depressed in 1, and absent in 2, with an IAD ratio of -0.54 +/- 0.43. A comparison of the IAD ratio and the stage of Ménière's disease demonstrated a significant relationship (P<.05, 1-way analysis of variance test), whereas there was no significant relationship noted between the percentage of unilateral weakness of caloric response and the stage of disease. CONCLUSION: The IAD ratio of VEMPs correlates with the stage of Ménière's disease and can be used as another aid to assess the stage of Ménière's disease.     

单侧耳蜗性聋患者对侧耳耳声发射的表现

目的 :探讨致聋因素在致单耳发病时对对侧耳潜在的影响。方法 :利用OtodynamicILO96耳声发射分析仪 ,对 35例单侧耳蜗性聋患者 (分为 5组 :发病 2个月以内的突发性聋 9例为S1组 ,发病 1年以上的突发性聋 6例为S2 组 ,梅尼埃病 13例分为M1、M2 组 ,不明机理的耳蜗性聋 7例为UNK组 )对侧耳瞬态诱发性耳声发射 (TEOAE)的反应幅值、反应重复率及频带的重复率 ,畸变产物耳声发射 (DPOAE)曲线特点及 1～ 5kHz反应幅值进行分析比较。结果 :S1组、M2 组TEOAE的反应幅值、反应重复性、频带重复性明显低于正常值 ,DPOAE幅值明显降低 ;S2 组、M1组、UNK组TEOAE和DPOAE正常。结论 :在不同致聋因素中 ,有的对单耳产生损伤作用 ,有的对双耳产生损伤作用。     

Ipsilateral and contralateral vestibular schwannomas in unilateral long-term deaf ears

In the past decade, we have encountered two patients with unilateral long-term deaf ear having vestibular schwannoma. One was on the deaf ear in a 53 years’ woman and the other was on the contralateral hearing ear in a 62 years’ woman. These two patients had total deafness on the right ear since childhood, associated with absent auditory brainstem response (ABR) and caloric responses, whereas normal ABR and caloric responses were shown on the left ear. Although similar physiological findings were disclosed on the deaf ears, MRI scan demonstrated vestibular schwannoma on the different side, that is, one in deaf ear and the other in hearing ear. For the former, absent ABR and caloric results indicate that the tumor originates from the superior vestibular nerve. In contrast with the latter, normal ABR and caloric responses, but absent vestibular-evoked myogenic potentials on the hearing ear imply that the tumor originates from the inferior vestibular nerve. The ipsilateral tumor on the deaf ear underwent intracranial surgical excision, followed by radiosurgery due to tumor recurrence 10 years later, while the contralateral one on the only hearing ear received radiosurgery only. Both patients were rather well, 3 years after last treatment.     

Extent of lesions in idiopathic sudden hearing loss with vertigo: study using click and galvanic vestibular evoked myogenic potentials

OBJECTIVE: To clarify the extent of the vestibular lesions in idiopathic sudden hearing loss with vertigo using vestibular evoked myogenic potentials (VEMPs) in response to click (click-VEMP) and galvanic (galvanic-VEMP) stimulation, as well as caloric tests. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: We enrolled 22 patients with idiopathic sudden hearing loss with vertigo in this study. All patients underwent audiometry and click-VEMP and caloric tests. Eight patients underwent a galvanic-VEMP test. RESULTS: Among the 22 patients, 17 (77%) showed an absence of click-VEMPs on the affected side. In response to caloric testing, 10 patients (45%) showed a decreased response on the affected side. All 8 patients who underwent galvanic-VEMP testing showed normal responses. Most patients with decreased caloric responses (9 [90%] of 10 patients) showed an absence of click-VEMPs, whereas 9 (53%) of the 17 patients who showed abnormal click-VEMPs showed decreased caloric responses. Initial hearing level and hearing outcome significantly correlated with abnormalities on the vestibular test results. CONCLUSIONS: The lesion site of vestibular disorders in idiopathic sudden hearing loss with vertigo appeared to be within the labyrinth on the basis of galvanic-VEMP findings. Results of the click-VEMP and caloric tests suggested that the saccule could be involved more frequently than the semicircular canals. The combined use of click-VEMP and caloric tests is useful for evaluating vestibular functions in idiopathic sudden hearing loss with vertigo because the extent of vestibular abnormalities correlated well with hearing outcome.     

Differentiating the cause of acute sensorineural hearing loss between Ménière's disease and sudden deafness

CONCLUSIONS: Most patients with Ménière's disease (MD) reveal abnormal vestibular-evoked myogenic potentials (VEMPs) and the recruitment phenomenon, whereas most sudden deafness patients display normal VEMPs without the recruitment phenomenon. We therefore recommend using both the recruitment phenomenon and VEMP testing as a diagnostic algorithm to differentiate between MD and sudden deafness as the cause of acute hearing loss. OBJECTIVE: To recommend a diagnostic algorithm to differentiate between MD and sudden deafness as the cause of acute hearing loss. MATERIAL AND METHODS: Between January 2002 and December 2003, 14 consecutive patients with "probable" MD who also had acute sensorineural hearing loss were enrolled in the study, together with another 14 age- and sex-matched patients with idiopathic sudden deafness. Each patient underwent a battery of audiovestibular function tests, including pure-tone audiometry, a stapedial reflex test, distortion-product otoacoustic emissions (DPOAEs), electronystagmography and a VEMP test. All patients were followed for at least 12 months after presentation. RESULTS: Significant differences were found between MD and sudden deafness in terms of the recruitment phenomenon (86% and 21% of cases, respectively) and abnormal VEMP responses (71% and 21% of cases, respectively). However, the diseases did not differ significantly in terms of abnormal DPOAEs or caloric test results.     

Evoked otoacoustic emissions in sensorineural hearing impairment: its clinical implications

This study was performed for the purpose of determining whether or not evoked otoacoustic emissions are useful as a clinical test. Two hundred and twenty-six sequences of the emission in response to stimulus tone bursts were averaged. The detection threshold of the emission was elevated in ears of inner ear impairment with profound sensorineural hearing loss, such as inner ear anomaly, mumps deafness, or sudden deafness, but it was not observed in ears of functional deafness. The mean interaural differences of emission threshold were near 35 dB in unilateral inner ear impairments with profound hearing loss. There was a positive correlation between the interaural difference of audiometric threshold and that of emission threshold in sudden deafness ears with various degrees of hearing loss. The incidence of continuous emission, whose duration was longer than 6 msec, was 30% in normal hearing ears and it was close to 90% in ears with bilateral or unilateral dip type hearing loss. The result was verified in a survey of a junior high school brass band. The conclusion is that there is clinical usefulness for the evoked otoacoustic emissions in evaluating cochlear function and in predicting noise susceptibility.     

Vestibular evoked myogenic potentials in patients with bilateral profound hearing loss

We report vestibular evoked myogenic potentials (VEMPs) in 3 patients with bilateral profound hearing loss in order to confirm that they are not of cochlear origin. All of the 3 patients (31-year-old man, 67-year-old man and 47-year-old woman) had bilateral profound hearing loss. They were diagnosed as having congenital hearing loss, bilateral Ménière's disease and inner ear syphilis. Their pure-tone hearing ranged from 81 dB HL to nearly total hearing loss. Stimulation by click (95 dB nHL) evoked biphasic myogenic responses (p13-n23) on the sternocleidomastoid muscle ipsilateral to the stimulated ear. The ear in which the stimulation did not evoke biphasic myogenic responses did not have a caloric response either. These results suggested that VEMPs are not likely of cochlear origin but of vestibular origin.     

Vestibular system in infants with hereditary nonsyndromic deafness.

OBJECTIVE: Seventy percent of genetic deafness occurs without associated phenotypic characteristics and is termed nonsyndromic hereditary hearing impairment, analyzed by numerous genetic loci. Many forms of nonsyndromic hereditary hearing impairment are secondary to diverse cochleosaccular dysfunctions. The purpose of the present study was to evaluate vestibular function in a group of infants with hereditary nonsyndromic deafness using caloric tests and vestibular evoked myogenic potentials. PATIENTS: Fifty-eight infants aged 3 months: 40 healthy controls and 18 infants with hereditary nonsyndromic deafness. Infants with other risk factors of inner ear damage were excluded. INTERVENTION: Diagnostic. Vestibular evoked myogenic potentials and auditory brainstem responses were recorded, and caloric tests were performed. MAIN OUTCOME MEASURES: The vestibular function was impaired in 14 patients. RESULTS: The results of all the tests in the controls were normal. In the patients, no reaction to caloric stimulation was elicited from 12 examined ears, and no vestibular evoked myogenic potentials were recorded from 24 ears. Caloric responses elicited from 12 ears were weakened. Hearing thresholds were in the interval 40- to 80-dB hearing level in 20 ears and more than 80-dB hearing level in 16 ears. The presence of caloric responses correlated with the hearing threshold interval. CONCLUSION: In the group of infants with hereditary nonsyndromic deafness, the degree of the semicircular canal impairment is higher in individuals with profound hearing loss. Vestibular evoked myogenic potentials are more frequently absent than caloric responses. The vestibular organ should be routinely examined in infants with hereditary nonsyndromic deafness.     

Laterality of vestibular evoked myogenic potentials

To clarify the laterality of acoustically evoked vestibulocollic reflexes with a short latency (vestibular evoked myogenic potentials, VEMPs). responses on the bilateral sternocleidomastoid muscles (SCMs) to unilateral acoustic stimulation were studied. Twenty-one healthy volunteers were enrolled. Surface electrodes were placed on the upper half of each SCM (active) and on the lateral end of the upper sternum (reference). Clicks and 500-Hz tone-bursts (95dB nHL) were used. All subjects showed positive-negative biphasic responses on the ipsilateral SCM by clicks and tone-bursts. Click-stimulation of 41 of the 42 ears did not evoke any response on the contralateral SCM. However, in one ear, positive-negative biphasic responses were evoked on the contralateral SCM. Recordings on the contralateral SCM by tone-bursts showed no response in 32 ears, small positive-negative biphasic responses in four ears, and small negative-positive biphasic responses in six ears. These findings show that VEMPs are ipsilateral-dominant, basically consistent with the hypothesis that they are of saccular origin.     

Laterality of vestibular evoked myogenic potentials

To clarify the laterality of acoustically evoked vestibulocollic reflexes with a short latency (vestibular evoked myogenic potentials, VEMPs), responses on the bilateral sternocleidomastoid muscles (SCMs) to unilateral acoustic stimulation were studied. Twenty-one healthy volunteers were enrolled. Surface electrodes were placed on the upper half of each SCM (active) and on the lateral end of the upper sternum (reference). Clicks and 500-Hz tone-bursts (95 dB nHL) were used. All subjects showed positive-negative biphasic responses on the ipsilateral SCM by clicks and tone-bursts. Click-stimulation of 41 of the 42 ears did not evoke any response on the contralateral SCM. However, in one ear, positive-negative biphasic responses were evoked on the contralateral SCM. Recordings on the contralateral SCM by tonebursts showed no response in 32 ears, small positive-nega-tive biphasic responses in four ears, and small negative-positive biphasic responses in six ears. These findings show that VEMPs are ipsilateral-dominant, basically consistent with the hypothesis that they are of saccular origin.     

Vestibular evoked myogenic potentials in patients with contralateral delayed endolymphatic hydrops

We studied vestibular evoked myogenic potentials (VEMPs) in nine patients with unilateral profound hearing loss followed by contralateral delayed hearing fluctuation and episodic vertigo. This condition has been called contralateral delayed endolymphatic hydrops. Five of nine ears with profound hearing loss (56%) showed an absence of VEMPs. One ear (11%) showed decreased responses, and three ears (33%) had normal responses. Of the ears with fluctuation of hearing, six (67%) showed an absence of responses, and three ears (33%) showed normal responses. In four patients we recorded VEMPs before and after oral administration of glycerol. Three hours after glycerol administration, two of four ears with fluctuating hearing loss showed the appearance of VEMPs although there was an absence of VEMPs before glycerol administration. These results suggested that saccular dysfunction could exist not only in the ears with profound hearing loss but also in ears with fluctuating hearing loss and that saccular endolymphatic hydrops could exist in the ears with fluctuating hearing loss. “Contralateral delayed endolymphatic hydrops” might be an appropriate term. Received: 22 March 2001 / Accepted: 11 July 2001     

Evaluation of sensorineural hearing loss by late response of vestibular evoked myogenic potentials

The aim of this paper was assessment of usefulness of MPPW recording in diagnosis of hearing loss. Study of MPPW performed in 65 people, in these 22 cases with normal hearing (44 ears), 20 subjects with sensorineural hearing loss (27 ears), 10 examined with retrocochlear hearing loss (12 ears) and 10 patients with unilateral totally deafness. Differences of latency wave n34 p44 (later response of VEMPs) were stated in sensorineural and retrocochlear hearing loss with reference to latencies this wave in normal hearing subjects. Vestibular organ lesion may be not only diagnosed based on VEMPs results but also cochlear organ lesion can.     

Vestibular evoked myogenic potentials in acute acoustic trauma.

OBJECTIVES: Anatomical proximity of the saccule to the stapedial footplate points to the possibility of acoustic trauma associated with saccular dysfunction. Therefore, it was the authors' premise that abnormal vestibular evoked myogenic potential (VEMP) after acute acoustic trauma may be caused by saccular damage from very high intensity noise; consequently, irreversible hearing loss ensued. The aim of this study was to investigate the VEMP responses in those with acute acoustic trauma. STUDY DESIGN: A prospective study. SETTING: University hospital. PATIENTS: Twenty patients (29 ears) without previous ear disorders diagnosed as acute acoustic trauma were enrolled in this study. MAIN OUTCOME MEASURES: Before treatment, each patient underwent pure tone audiometry and caloric and VEMP tests. Correlations between the hearing outcome and mean hearing level, sources of noise, caloric responses, or VEMP results were investigated. RESULTS: After 3 months of medication, complete recovery was achieved in 4 ears and hearing improvement in 4 ears, whereas hearing in 21 ears (72%) remained unchanged. Eighteen ears presenting normal VEMPs revealed hearing improvement in eight ears (44%) and unchanged hearing in ten ears (56%). However, hearing loss remained unchanged in all 11 ears (100%) with absent or delayed VEMPs, exhibiting a significant relationship between VEMP results and hearing outcome. Thus, VEMP test can predict the hearing outcome after acute acoustic trauma with a sensitivity of 44% and a specificity of 100%. CONCLUSION: The greater the noise intensity, the severer damage on the cochlea and saccule is shown. Absent or delayed VEMPs in ears after acute acoustic trauma may indicate poor prognosis with respect to hearing improvement, whereas normal VEMP is not a powerful indicator for expectation of hearing improvement.     

Evaluation of brainstem function in patients with spasmodic dysphonia using vestibular evoked myogenic potentials and auditory brainstem responses

CONCLUSION: The vestibular area is closer than the auditory region to nucleus ambiguus. If a 'shared' lesion involves regions of adjacent nuclei of the brainstem in patients with spasmodic dysphonia then vestibular area involvement is more possible than that of the auditory region. OBJECTIVES: The authors hypothesize that lower brainstem lesions and involvement of descending pathways of the spinal tract may be the site of lesion in patients with spasmodic dysphonia. PATIENTS AND METHODS: Ten patients with spasmodic dysphonia were tested using the auditory brainstem response (ABR) and vestibular evoked myogenic potentials (VEMPs). RESULTS: No ABR abnormalities were found in right ears. Results of ABR on the left ear showed that one patient had abnormal ABR. This patient had severe sensorineural hearing loss on the left side. VEMPs displayed normal response in two patients bilaterally. First positive (p13) and second negative (n23) waves of VEMP could not be recorded in three cases unilaterally and in five patients bilaterally.     

Vestibular evoked myogenic potentials in patients with spinocerebellar degeneration

To estimate vestibulo-collic reflexes in patients with spinocerebellar degeneration (SCD), vestibular evoked myogenic potentials (VEMPs) were recorded in 16 patients with SCD and in 9 normal subjects. The patients with SCD were classified into three groups: those with olivo-ponto-cerebellar ataxia (OPCA; n = 10); those with cortical cerebellar atrophy (CCA; n = 3); and those with Machado-Joseph disease (MJD; n = 3). While all of the patients with OPCA and CCA showed biphasic responses (p13-n23), 2 of the 3 patients with MJD showed abnormal VEMPs bilaterally. Three sides in these 2 patients showed an absence of VEMPs, and one side showed a remarkably delayed p13. These two patients showed little response in caloric tests. These results suggest that the vestibulo-collic reflex as well as the vestibulo-ocular reflex could be damaged in MJD patients but preserved in OPCA and CCA patients.     

前庭诱发肌源性电位对眩晕患者的诊断价值

目的通过记录、分析眩晕患者的前庭诱发肌源性电位(VEMP),了解眩晕患者的球囊功能。方法对15例梅尼埃病患者和16例突聋伴眩晕患者行VEMP检查,分析其VEMP的不同表现形式,并将该结果与冷热试验结果比较。结果正常双侧短纯音刺激p13波和n23波出现率为100%,30%梅尼埃病患者、50%突聋伴眩晕患者VEMP不能正常引出,VEMP患侧有3种表现形式：无反应,振幅正常,振幅低。结论VEMP检查有助于客观评价眩晕患者球囊功能。     

The influence of clicks versus short tone bursts on the vestibular evoked myogenic potentials

OBJECTIVE: 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. DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.