Portnuff Cory D F, Kleindienst Samantha, Bogle Jamie M
University of Colorado Health, Hearing and Balance Center, Aurora, CO.
Department of Otolaryngology, University of Colorado Denver, Aurora, CO.
J Am Acad Audiol. 2017 Sep;28(8):708-717. doi: 10.3766/jaaa.16071.
Vestibular-evoked myogenic potentials (VEMPs) are commonly used clinical assessments for patients with complaints of dizziness. However, relatively high air-conducted stimuli are required to elicit the VEMP, and ultimately may compromise safe noise exposure limits. Recently, research has reported the potential for noise-induced hearing loss (NIHL) from VEMP stimulus exposure through studies of reduced otoacoustic emission levels after VEMP testing, as well as a recent case study showing permanent sensorineural hearing loss associated with VEMP exposure.
The purpose of this report is to review the potential for hazardous noise exposure from VEMP stimuli and to suggest clinical parameters for safe VEMP testing.
Literature review with presentation of clinical guidelines and a clinical tool for estimating noise exposure.
The literature surrounding VEMP stimulus-induced hearing loss is reviewed, including several cases of overexposure. The article then presents a clinical calculation tool for the estimation of a patient's safe noise exposure from VEMP stimuli, considering stimulus parameters, and includes a discussion of how varying stimulus parameters affect a patient's noise exposure. Finally, recommendations are provided for recognizing and managing specific patient populations who may be at higher risk for NIHL from VEMP stimulus exposure. A sample protocol is provided that allows for safe noise exposure.
VEMP stimuli have the potential to cause NIHL due to high sound exposure levels. However, with proper safety protocols in place, clinicians may reduce or eliminate this risk to their patients. Use of the tools provided, including the noise exposure calculation tool and sample protocols, may help clinicians to understand and ensure safe use of VEMP stimuli.
前庭诱发肌源性电位（VEMPs）是常用于评估头晕患者的临床检查方法。然而，诱发VEMP需要相对较高的气导刺激，最终可能会超出安全噪声暴露限值。最近，研究通过对VEMP测试后耳声发射水平降低的研究，以及最近一项显示与VEMP暴露相关的永久性感音神经性听力损失的病例研究，报道了VEMP刺激暴露导致噪声性听力损失（NIHL）的可能性。
本报告的目的是回顾VEMP刺激导致有害噪声暴露的可能性，并提出安全进行VEMP测试的临床参数。
文献综述，同时介绍临床指南和一种估计噪声暴露的临床工具。
对围绕VEMP刺激导致听力损失的文献进行了综述，包括几例过度暴露的病例。本文随后提出了一种临床计算工具，用于根据刺激参数估计患者接受VEMP刺激时的安全噪声暴露，并讨论了不同刺激参数如何影响患者的噪声暴露。最后，针对识别和管理可能因VEMP刺激暴露而患NIHL风险较高的特定患者群体提供了建议。提供了一个允许安全噪声暴露的示例方案。
由于高声暴露水平，VEMP刺激有可能导致NIHL。然而，通过制定适当的安全方案，临床医生可以降低或消除对患者的这种风险。使用所提供的工具，包括噪声暴露计算工具和示例方案，可能有助于临床医生理解并确保安全使用VEMP刺激。
