92517 Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP)

Name of the Procedure:

Vestibular Evoked Myogenic Potential (VEMP) Testing; Cervical (cVEMP)

Summary

The Vestibular Evoked Myogenic Potential (VEMP) test is a non-invasive diagnostic procedure that evaluates the function of certain parts of the inner ear and the nerves associated with balance. Specifically, the cervical VEMP (cVEMP) measures the response of the sternocleidomastoid muscle in the neck to sound stimuli, providing information about the saccule and inferior vestibular nerve.

Purpose

The cVEMP test helps diagnose and assess various vestibular disorders that affect balance, such as:

• Superior Canal Dehiscence Syndrome (SCDS)
• Vestibular Neuritis
• Multiple Sclerosis
• Meniere's Disease

The goal is to determine the integrity and functionality of the saccule and the inferior vestibular nerve, aiding in the diagnosis and treatment planning for balance-related issues.

Indications

This procedure is particularly indicated for:

• Patients experiencing unexplained dizziness or vertigo
• Individuals with imbalance or unsteadiness
• Cases where vestibular function needs evaluation due to suspected vestibular pathology

Preparation

• The patient may be instructed to avoid caffeine and certain medications that could affect the test results.
• No special fasting is typically required.
• The patient should wear comfortable clothing and avoid wearing necklaces or earrings.

Procedure Description

1. The patient rests in a supine position with their head slightly elevated.
2. Electrode sensors are placed on the patient's neck and behind the ears.
3. The patient is asked to lift their head to activate the sternocleidomastoid muscle.
4. During the test, a series of loud clicks or tone bursts are delivered via headphones.
5. The muscle responses are recorded by the electrodes and analyzed.

Duration

The cVEMP test generally takes about 30 to 45 minutes to complete.

Setting

The test is usually performed in an audiology clinic, outpatient clinic, or a specialized diagnostic center.

Personnel

• An audiologist or a trained technician administers the test.
• An ENT specialist (otolaryngologist) may be involved in interpreting the results.

Risks and Complications

The cVEMP test is generally safe, with minimal risks:

• Discomfort from the loud sounds
• Mild muscle fatigue or soreness from holding the head up
• Rarely, dizziness or vertigo may be temporarily induced.

Benefits

• Non-invasive with no need for sedation or anesthesia
• Provides valuable information about vestibular function
• Helps tailor appropriate treatments for balance disorders

Recovery

• The patient can typically resume normal activities immediately after the test.
• Any muscle soreness usually resolves quickly.
• Follow-up appointments may be scheduled to discuss results and further management.

Alternatives

• Electronystagmography (ENG) or Videonystagmography (VNG)
• Rotary Chair Testing
• Posturography

Each alternative has its own strengths; for example, ENG/VNG provides detailed eye movement analysis, whereas cVEMP focuses specifically on the saccule and inferior vestibular nerve function.

Patient Experience

• Patients may feel some discomfort from the sound stimuli.
• Muscle soreness from keeping the head elevated can occur but is generally mild.
• Comfort measures such as short breaks and supportive pillows may be offered to improve patient experience.