,A 42-year-old male is being seen for vestibular testing. He reports that his primary
symptoms are feeling off balance and some triggered symptoms of slight
dizziness with head movements. Vestibular evoked myogenic potentials (VEMPs)
were performed as part of a comprehensive vestibular evaluation. The results of
the cervical (cVEMP) and ocular (oVEMP) responses for each ear are summarized
in the following table. Testing was performed at 125125 decibels dB SPL at 500
Hz500 hertz for air conduction stimuli. Otoscopy and tympanometry were
performed prior to VEMP testing and verified normal outer and middle ear status.
Appropriate electromyography (EMG) levels were maintained throughout testing.
Which of the following statements best describes the VEMP test results? -
✔✔The ocular VEMP afferent pathway consists of the utricle and superior
vestibular nerve branch and is recorded contralateral to the ear of stimulation. In
this example, when the stimulus (125125 decibels dB SPL) is applied to the left
ear, there is no recordable response from the right inferior oblique. The ear in
question is the left ear as no repeatable waveforms were obtained.
, A 60-year-old patient has bilateral, mild-to-moderate sensorineural hearing loss.
Dissatisfaction is reported by the patient during a behind-the-ear (BTE) hearing
aid trial period because sounds heard from behind are louder than sounds heard
from the front. The patient wants the issue resolved. Which of the following is the
best first option for determining hearing aid directionality? - ✔✔Front-to-back
real ear measures. Directional microphones are designed to reduce sounds from
behind the listener. If the listener perceives that sounds are loud from behind, it is
likely that the front microphone is functioning like the back microphone and
undesirable sounds are not being canceled from behind. Measuring the front-to-
back ratio will determine which microphone has greater output and help to
resolve the problem.
A 61-year-old female patient is referred to the vestibular clinic with symptoms of
imbalance and dizziness associated with loud sounds, including her own voice and
chewing. She is more sensitive to loud sounds in the right ear. A recent audiogram
revealed normal hearing sensitivity with no air-bone gaps in the left ear. A mild low-
frequency conductive hearing loss was observed for the right ear with normal
tympanometry. The patient denies any additional symptoms. Which of the following
vestibular tests is the most clinically appropriate first step to evaluate
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