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.