CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2018; 22(03): 197-202
DOI: 10.1055/s-0037-1599151
Original Research
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Cervical Vestibular-Evoked Myogenic Potentials in Sedated Toddlers

Ola Abdallah Ibraheem
1   Audiology Unit, Department of Otolaryngology, University of Zagazig, Zagazig, Egypt
Mohammad Ramadan Hassaan
1   Audiology Unit, Department of Otolaryngology, University of Zagazig, Zagazig, Egypt
› Author Affiliations
Further Information

Publication History

19 September 2016

02 January 2017

Publication Date:
21 March 2017 (online)


Introduction Cervical vestibular-evoked myogenic potentials (cVEMPs) are difficult to test in toddlers who cannot follow instructions or stay calm.

Objective Due to the growing need for vestibular testing in very young children as a part of a delayed walking assessment battery, this study aimed to provide a solution to this problem by recording the cVEMPs in toddlers during sedation.

Method The cVEMPs measures were assessed in 30 toddlers aged 12 to 36 months with normal motor milestones. They were sedated with chloral hydrate. Then, the head was retracted ∼ 30° backward with a pillow under the shoulders, and turned 45° contralateral to the side of stimulation to put the sternocleidomastoid (SCM) muscle in a state of tension.

Results The P13 and N23 waves of the cVEMPs were recordable in all sedated toddlers. The cVEMPs measures resulted in the following: P13 latency of 17.5 ± 1.41 milliseconds, N23 latency of 25.58 ± 2.02 milliseconds, and peak-to-peak amplitude of 15.39 ± 3.45 µV. One-sample t-test revealed statistically significant longer latencies and smaller amplitude of the toddlers' cVEMPs relative to the normative data for adults.

Conclusions The difficulty of cVEMPs testing in toddlers can be overcome by sedating them and attaining a position that contracts the SCM muscle. However, the toddlers' recordings revealed delayed latencies and smaller amplitudes than those of adults.

  • References

  • 1 Valente M. Adaptation of adult techniques for evaluating vestibular function in children. Hear J 2007; a; 6 (10) 34-44
  • 2 Weiss AH, Phillips JO. Congenital and compensated vestibular dysfunction in childhood: an overlooked entity. J Child Neurol 2006; 21 (07) 572-579
  • 3 Valente M. Maturational effects of the vestibular system: a study of rotary chair, computerized dynamic posturography, and vestibular evoked myogenic potentials with children. J Am Acad Audiol 2007; b; 18 (06) 461-481
  • 4 O'Reilly RC, Greywoode J, Morlet T. , et al. Comprehensive vestibular and balance testing in the dizzy pediatric population. Otolaryngol Head Neck Surg 2011; 144 (02) 142-148
  • 5 Sheykholeslami K, Megerian CA, Arnold JE, Kaga K. Vestibular-evoked myogenic potentials in infancy and early childhood. Laryngoscope 2005; 115 (08) 1440-1444
  • 6 Kelsch TA, Schaefer LA, Esquivel CR. Vestibular evoked myogenic potentials in young children: test parameters and normative data. Laryngoscope 2006; 116 (06) 895-900
  • 7 Chen CN, Wang SJ, Wang CT, Hsieh WS, Young YH. Vestibular evoked myogenic potentials in newborns. Audiol Neurootol 2007; 12 (01) 59-63
  • 8 Picciotti PM, Fiorita A, Di Nardo W, Calò L, Scarano E, Paludetti G. Vestibular evoked myogenic potentials in children. Int J Pediatr Otorhinolaryngol 2007; 71 (01) 29-33
  • 9 Young YH, Chen CN, Hsieh WS, Wang SJ. Development of vestibular evoked myogenic potentials in early life. Eur J Paediatr Neurol 2009; 13 (03) 235-239
  • 10 Ecevit A, Anuk-Ince D, Erbek S. , et al. Comparison of cervical vestibular evoked myogenic potentials between late preterm and term infants. Turk J Pediatr 2012; 54 (05) 509-514
  • 11 El-Danasoury I, El-Sirafy G, Taha H, Hegazy S. Vestibular evoked myogenic potentials (VEMPs) in young children: Test parameters and normative data. Egypt J Ear Nose Throat Allied Sci 2015; 16: 81-85
  • 12 Murofushi T, Halmagyi GM, Yavor RA, Colebatch JG. Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis. An indicator of inferior vestibular nerve involvement?. Arch Otolaryngol Head Neck Surg 1996; 122 (08) 845-848
  • 13 Halmagyi GM, Curthoys IS. Clinical testing of otolith function. Ann N Y Acad Sci 1999; 871: 195-204
  • 14 Clarke AH, Schönfeld U, Helling K. Unilateral examination of utricle and saccule function. J Vestib Res 2003; 13 (4-6): 215-225
  • 15 Cyr DG. Vestibular testing in children. Ann Otol Rhinol Laryngol Suppl 1980; 89 (5 Pt 2): 63-69
  • 16 Cyr DG. The vestibular system: pediatric considerations. Semin Hear 1983; 4 (01) 33-45
  • 17 Hain T. . Vestibular evoked myogenic potential (VEMP) testing; 2015 Available at: . Accessed June, 2015
  • 18 Murofushi T, Kaga K. Neurootological application of VEMP recording during infancy and childhood. Vestibular Evoked Myogenic Potential: Its Basics and Clinical Applications. Part IV: Pediatric Applications. Tokyo: Springer; 2009: 101-109
  • 19 Tobias JD, Leder M. Procedural sedation: A review of sedative agents, monitoring, and management of complications. Saudi J Anaesth 2011; 5 (04) 395-410
  • 20 Buck ML. The use of chloral hydrate in infants and children. Pediat Pharmacother 2005 11(09) Available at:
  • 21 Krauss B, Green SM. Sedation and analgesia for procedures in children. N Engl J Med 2000; 342 (13) 938-945
  • 22 O'Reilly R, Grindle C, Zwicky EF, Morlet T. Development of the vestibular system and balance function: differential diagnosis in the pediatric population. Otolaryngol. Clin North Am 2011; 44 (02) 251-271
  • 23 Young YH, Huang TW, Cheng PW. Assessing the stage of Meniere's disease using vestibular evoked myogenic potentials. Arch Otolaryngol Head Neck Surg 2003; 129 (08) 815-818
  • 24 Razali NM, Wah YB. Power comparisons of Shapiro-Wilk, Kolmogorov-Smirnov, Lilliefors and Anderson-Darling tests. J stat modeling analytics 2011; 2 (01) 21-33
  • 25 Ghasemi A, Zahediasl S. Normality tests for statistical analysis: a guide for non-statisticians. Int J Endocrinol Metab 2012; 10 (02) 486-489
  • 26 Hassaan MR. Ocular versus cervical vestibular evoked myogenic potentials in different stages of Meniere's disease. Egypt J Ear Nose Throat Allied Sci 2011; 12: 39-47
  • 27 Colten HR, Altevogt BM. Sleep disorders and sleep deprivation: An unmet public health problem. Washington, DC: The national academic press; 2006. DOI: 10.17226/11617
  • 28 Brody BA, Kinney HC, Kloman AS, Gilles FH. Sequence of central nervous system myelination in human infancy. I. An autopsy study of myelination. J Neuropathol Exp Neurol 1987; 46 (03) 283-301