JAAA CEU Program

Questions refer to Portnuff et al, “Safe Use of Acoustic Vestibular-Evoked Myogenic Potential Stimuli: Protocol and Patient-Specific Considerations,” 708–717.

Learner Outcomes:

Readers of this article should be able to:

• Summarize the risk of hearing loss from high stimulus presentation levels used in testing vestibular evoked myogenic potentials (VEMPs).

• Discuss how stimulus parameters for recording VEMPs must be evaluated to minimize noise induced hearing loss.

1. Vestibular evoked myogenic potentials (VEMPs) originating from the sternocleidomastoid muscle are:

   • cervical VEMPs (cVEMPs)

   • ocular VEMPs (oVEMPs)

   • triceps VEMPs (tVEMPs)

2. Acoustic stimuli considered most effective in eliciting VEMPs are:

   • 250 Hz bone conduction clicks

   • 500 Hz air conduction tone bursts

   • short duration electrical clicks

3. Mattingly et al (2015) observed sudden permanent sensorineural hearing loss after VEMP testing with stimuli of:

   • 95 – 100 dB nHL

   • 128 and 135 dB pSPL

   • 133 dB pSPL

4. Price (1981) suggested that for ears at the 25^th percentile of susceptibility, the critical level for instantaneous damage by impulsive noises was:

   • 132 dB pSPL

   • 136 dB pSPL

   • 140 dB pSPL

5. Based on Beattie and Rochverger (2001), the difference between a “fast response” sound level meter reading of a 500 Hz tone burst, and the actual peak value is approximately:

   • 3 dB

   • 6 dB

   • 12 dB

6. To assess risk for acoustic trauma from VEMP stimuli, the authors recommend establishing presentation levels in:

   • dB m

   • dB nHL or dB HL

   • dB pSPL or dB peSPL

7. Reducing ear canal volume from 2.0 cc to 1.0 cc changes a stimulus level by a(n):

   • decrease of 6 dB

   • increase of 3 dB

   • increase of 6 dB

8. The benefit of VEMP testing might not outweigh the risk for noise induced hearing loss for:

   • cochlear implant candidates

   • elderly patients (> 70 years of age)

   • patients with superior semicircular canal dehiscence (SSCD)

9. When SSCD is suspected, VEMP testing:

   • can begin at lower starting presentation levels

   • requires a larger number of trials

   • should not be conducted

10. In the authors' protocol for VEMP stimuli designed not to exceed NIOSH noise exposure values, fewer total sweeps are recommended for

    • cVEMPs

    • oVEMPs

    • tVEMPs