title: International guidelines for the clinical application of cervical vestibular evoked myogenic potentials: an expert consensus report.
abstract: BACKGROUND
  Cervical vestibular evoked myogenic potentials (cVEMPs) are electromyogram responses evoked by high-level acoustic stimuli recorded from the tonically contracting sternocleidomastoid (SCM) muscle, and have been accepted as a measure of saccular and inferior vestibular nerve function. As more laboratories are publishing cVEMP data, there is a wider range of recording methods and interpretation, which may be confusing and limit comparisons across laboratories.
  
  
  OBJECTIVE
  To recommend minimum requirements and guidelines for the recording and interpretation of cVEMPs in the clinic and for diagnostic purposes.
  
  
  METHODS
  We have avoided proposing a single methodology, as clinical use of cVEMPs is evolving and questions still exist about its underlying physiology and its measurement. The development of guidelines by a panel of international experts may provide direction for accurate recording and interpretation.
  
  
  RESULTS
  cVEMPs can be evoked using air-conducted (AC) sound or bone conducted (BC) vibration. The technical demands of galvanic stimulation have limited its application. For AC stimulation, the most effective frequencies are between 400 and 800 Hz below safe peak intensity levels (e.g. 140 dB peak SPL). The highpass filter should be between 5 and 30 Hz, the lowpass filter between 1000 and 3000 Hz, and the amplifier gain between 2500 and 5000. The number of sweeps averaged should be between 100 and 250 per run. Raw amplitude correction by the level of background SCM activity narrows the range of normal values. There are few publications in children with consistent results.
  
  
  CONCLUSIONS
  The present recommendations outline basic terminology and standard methods. Because research is ongoing, new methodologies may be included in future guidelines.
authors: Nicosia, Cyprus. Electronic address: neurophy@cing.ac.cy.
authors: Eleftherios S
authors: ES
authors: Papathanasiou
authors: Department of Otolaryngology, Teikyo University School of Medicine, Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Japan.
authors: Toshihisa
authors: T
authors: Murofushi
authors: Audiology 126, VA Medical Center, Mountain Home, TN 37684, USA.
authors: Faith W
authors: FW
authors: Akin
authors: Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Sydney NSW 2052, Australia.
authors: James G
authors: JG
authors: Colebatch
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods; D001844:Bone Conduction / Q000502:physiology; D032921:Consensus; D004568:Electrodiagnosis / Q000379:methods*; D006801:Humans; D009334:Neck Muscles / Q000503:physiopathology; D012016:Reference Values; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D058585:Vestibular Evoked Myogenic Potentials / Q000502:physiology*; D014725:Vestibular Nerve / Q000503:physiopathology*
keywords: Inferior vestibular nerve; Medial vestibulospinal tract; Saccule; Sound; Sternocleidomastoid; Vibration