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Can I Use a Binaural/Bilateral Procedure for cVEMP Testing?

Kamran Barin, PhD

April 11, 2016

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Question

I’m going to start performing cVEMP testing. Can I use a binaural/bilateral procedure?

Answer

Dr. Kamran Barin: When performing Cervical Vestibular Evoked Myogenic Potentials or cVEMP,  using a binaural or bilateral procedure is not recommended for clinical decision making.

The reason is related to the crossover effect where some of the response from one side shows up in testing of the other side.  For example, let’s assume we are able to measure VEMPs perfectly and the response from the right side is 100 microvolt and from the left is 30 microvolt.  The asymmetry ratio (AR) is:

AR = (100-30)/(100+30) = 54%

In real testing, let’s assume that there is a crossover effect and 20% of the response from one side shows up on the other side.  So the responses in binaural testing will be:

Right = response from right + 20% of response from left = 100 + 0.2*30 =100 + 6 = 106 microvolt

Left = response from left + 20% of response from right = 30 + 0.2*100 = 30 + 20 = 50 microvolt

AR = (106 – 50)/(106 + 50) = 36%

So, the asymmetry is underestimated.  This does not happen with monaural testing because there is no input to the other side; it only happens with binaural testing when there is a difference between right and left responses.

Further resources and information:


kamran barin

Kamran Barin, PhD

Kamran Barin, Ph.D. is Assistant Professor Emeritus, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University.  He served as the Director of Balance Disorders Clinic at the Ohio State University Medical Center for over 25 years until his retirement in June 2011.  He received his Master’s and Doctorate degrees in Electrical/Biomedical Engineering from the Ohio State University. He has taught national and international courses and seminars in different areas of vestibular assessment and rehabilitation.  Kamran Barin is a consultant to Otometrics and provides courses and other educational material to the company.


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