Measurement of Ocular Vestibular Evoked Myogenic Potentials: Nasion Reference Montage as an Alternative to the Clinical Standard Montage

Scherer, Florian; Beule, Achim Georg; Lütkenhöner, Bernd; Heitkötter, Felix; Rudack, Claudia

Abstract

Objective: To compare two novel electrode montages for ocular, vestibular evoked myogenic potential using single-nasion reference electrodes with the clinical standard montage. Study Design: Randomized crossover experiment. Setting: Tertiary referral center. Participants: Sixty healthy participants. Intervention: Normal hearing and vestibular function were confirmed with an extensive test-battery. All ocular, vestibular evoked myogenic potential settings were measured with air-conducted tone bursts at 100-dB normal hearing level and a frequency of 500 Hz. Three electrode montages were measured in randomized order: the clinical standard montage (“S”), the nasion reference montage (“N”), and the nasion reference montage with a more lateral active electrode (“L”). Upgaze was standardized to 35 degrees. Main Outcome Measures: Detection rate, latency of N1 and P1, peak-to-peak amplitude of N1 and P1, signal-to-noise ratio (SNR), asymmetry ratio (AR), concordance of expert assessment, and reliability. Results: All electrode montages showed detection rates greater than 90%. Latencies for “L” were shorter than for “S” and “N.” Amplitudes and SNR for “S” and “N” were higher than for “L,” whereas the values for “S” and “N” did not differ significantly. For AR, no significant differences between the montages were assessed. Concordance of experts ranged from 78% for “L” and 89.8% for “N.” All montages provided excellent day-to-day reliability (intraclass correlation coefficient ≥0.9) for amplitudes and SNR. Conclusions: Montage N could be a useful alternative to the clinical standard montage: although results are roughly equivalent, montage N requires one less electrode to do so. Key Words: Belly-tendon montage—Clinical standard montage— Electrode montages—Nasion reference—oVEMP.