The effect of electrode positioning on the ocular vestibular evoked myogenic potential to air-conducted sound

Objective: To assess the effect of electrode position on the amplitude and latency of ocular vestibular evoked myogenic potentials (oVEMPs) produced by air-conducted (AC) sound with a view to optimisation of the recording paradigm. Methods: Eight otologically normal subjects (16 ears) were stimulated by 500 Hz AC tone bursts at 95 dBnHL; oVEMP traces were recorded below the eye contralateral to the acoustic stimulation. Five independent oVEMP measurements were recorded with the active electrode in equally spaced positions in the infra-orbital plane relative to a reference electrode positioned 2 cm below the lower lid in the orbital midline. These measurements included the accepted standard-montage in which the electrodes were positioned vertically above and below each other in the orbital midline. A further recording was made using a belly-tendon montage with reference to the inferior oblique muscle. Results: Of the six recording paradigms tested the largest amplitude oVEMP response was found using the belly-tendon montage with an n(10) average of 5.67 +/- 3.42 mu V (sd). This was significantly larger than the amplitude recorded using the standard-montage (p < 0.01). With the reference electrode in the orbital midline, the position of the active electrode in the infra-orbital plane was found to significantly alter the response magnitude. As the active electrode was moved laterally the response reduced in amplitude, however when moved medially the response polarity reversed indicating the existence of a null-point at which no response was present. Conclusions: The location of oVEMP recording electrodes significantly alters the response amplitude. Whilst the standard-montage provides a reasonable method for recording oVEMPs, the belly-tendon montage results in a significantly larger amplitude response. Furthermore medial and lateral variations in the position of the active electrode using the standard-montage significantly affect the magnitude and polarity of the response. Significance: The standard-montage used for recording oVEMPs is sensitive to the placement of the active electrode. Small variations in position result in significant changes in the n(10) amplitude and this may account for the variability reported in the literature. Using the belly-tendon montage, larger amplitude responses can be elicited which may improve the robustness with which oVEMPs can be collected. However this enhancement in response amplitude must be balanced against the increased possibility of signal contamination from neighbouring extraocular muscles. (C) 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.