Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl Vestibular evoked myogenic potential in healthy adolescents Gitte Stokvad Brix a,∗ , Therese Ovesen a,b , Louise Devantier a,b a Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, 8000, Aarhus C, Denmark b Department of Otorhinolaryngology, Region Hospital Holstebro, Lægårdvej 12, 7500, Holstebro, Denmark ARTICLE INFO Keywords: VEMP Vestibular Otoliths Normative Children Adolescents ABSTRACT Objective: Vestibular dysfunction, which may lead to delayed motor development and reduced quality of life, is an overlooked entity among children and adolescents. Vestibular evoked myogenic potential (VEMP) is a common, safe diagnostic tool in adults with vestibular disorders. No normative data exist for children and adolescents. Our objective was to collect and assess normative VEMP data for adolescents. Methods: Cervical VEMP (cVEMP) with air-conducted sound. Endpoints were peak latencies after 13 and 23 ms (P13 and N23) and amplitude. Ocular VEMP (oVEMP) with bone-conducted vibration on the mastoid. Endpoints were latencies (N10 and P15) and amplitude. A meta-analysis of existing cVEMP data in children. Results: cVEMP response rate (RR) was 85%, mean P13 and N23 latencies were 15.44 and 25.55 ms, respec- tively, and the asymmetry ratio (AR) was 14%. oVEMP RR was 100%, mean N10 and P15 were 10.61 and 16.58 ms, respectively, and the AR was 12%. In the meta-analysis, the pooled mean P13 and N23 were 12.75 and 21.8 ms, respectively. Head elevation (HE) gave shorter latencies than head rotation (HR). Conclusion: The oVEMP data represents normal values for adolescents aged 13–16 years. Height should be considered more important than age when interpreting cVEMP in adolescents. Separate normative cVEMP data should be established for HE and HR. 1. Introduction The vestibular system is responsible for integrating visual, gravita- tional, and positional information and crucial to perception and co- ordination of movement in children and adolescents. A defciency can lead to dizziness, vertigo, imbalance, and abnormal gait [1–3], and it has a considerable efect on health-related quality of life in children and adolescents. In particular the psychological well-being in males, au- tonomy in females, and physical well-being in both genders may be impaired [4]. The prevalence of balance disturbances among children is inexplicit and depends on the method of data collection. In a large retrospective database study of patient encounters, O'Reilly et al. [1] found a pre- valence of diagnosed balance disorder of 0.45% in patients aged from newborn to 18 years. However, the real prevalence of vestibular dys- function is probably higher and the underestimation may be owing to diferent causes: neuroplasticity is increased in children which may lead to high accommodation and/or masking of vestibular problems; chil- dren often have difculties describing vestibular phenomena such as dizziness and vertigo; and children display other symptoms than adults [1,5]. At Center for Evaluation of Balance Disorders in Children in Paris, data collected over a 5-year period from 1037 children having gone through a large selection of vestibular tests indicated that the most common causes of balance disorders were migraine equivalents (15.6%), inner ear malformations (13.5%), delayed posturomotor syn- drome (13.4%), hearing loss (3.9%), and trauma (3.9%) [3]. 19% were diagnosed with balance disorder of unknown etiology. The balance disorders with the highest prevalence of vestibular impairment were vestibular neuritis (100%), labyrinthitis (100%), meningitis (84.6%), inner ear malformation (67.9%) and hearing loss (65%). In another study, the same author came to a slightly diferent conclusion on the basis of 14 years of data [6]. Here, benign paroxysmal vertigo of childhood (BPVC) was the cause of 20% cases of vertigo. The vestibular test battery allows for diferent parts of the vestibular apparatus to be assessed separately. The video head impulse test (vHIT) and caloric testing both investigate a part of the vestibulo-ocular refex (VOR). Where vHIT assesses all six semicircular canals' response to high-frequency movement, caloric testing assesses the lateral semi- circular canals’ response to temperature change and low-frequency movement. Posturography investigates the integration of somatosen- sory (proprioception), visual and gravitational signals and is thus https://doi.org/10.1016/j.ijporl.2018.10.019 Received 7 July 2018; Received in revised form 16 September 2018; Accepted 11 October 2018 ∗ Corresponding author. E-mail addresses: gittbi@rm.dk (G.S. Brix), theroves@rm.dk (T. Ovesen), louisedevantier@clin.au.dk (L. Devantier). International Journal of Pediatric Otorhinolaryngology 116 (2019) 49–57 Available online 13 October 2018 0165-5876/ © 2018 Elsevier B.V. All rights reserved. T