Comparison of preoperative and postoperative cervical vestibular evoked myogenic potential (CVEMP) values ​​in children with otitis media with chronic effusion

Objective: In this study we aimed to compare preoperative and postoperative VEMP values of children who were applied ventilation tube for chronic otitis media with effusion and to compare these values and VEMP values of healthy chidren whose ear examination and hearing were normal. Patients and method: This study was conducted between May 2016- September 2016 in Afyon Kocatepe University Medical School Practice and Research Hospital among 40 patients and 40 healthy children. For the patient group; 40 children at the age of 4-16 who were applied bilateral ventilation tube for bilateral chronic otitis media with effusion because of not responding to medical treatment were chosen. 38 of patients were male, 12 of patients were female. These patients were performed ear examination, pure tone audiometry or otoacoustic emission who couldn't have performed pure tone audiometry, tympanometry and cVEMP test which was used as principal test for this study, preoperatively and postoperatively 1. and 3. month respectively. Latencies and amplitudes of p13 and n23 waves of patients were interpreted for cVEMP test. For the healthy group; 40 healthy children at the age of 4-16, who outpatiented to polyclinic because of other reasons, with no previous ear disease,hearing loss and vertigo and whose bilateral ear examination was normal were chosen. 19 of patients were male, 21 of patients were female. These patients were performed otoscopic examination and pure tone audiometry or otoacoustic emission who couldn't have performed pure tone audiometry, tympanometry for hearing evaluation.All patients were performed cVEMP test. Latencies and amplitudes of p13 and n23 waves of patients were interpreted for cVEMP test. 90 Study project was examined and approved by Dumlupınar University Medical School Ethics Committee. Volenteer subject inform and consent form was signed by families.Statistical analyze was performed with SPSS Windows software (Statistical Package for Social Sciences, version, version 20.0, SPSS Inc, Chicago , USA). Both ears of children in patient group were separately analyzed. Student T test for dependent groups was used for analyze (p<0.05). Student T test for independent groups was used for comparation of control group and patient group (p<0.05). Results: 40 subjects (21 female, 19 male) for control group and 40 patients (38 male, 12 female) for patient group were included in the study.Median age was 8.5 (4-16) for control group and 9.4 (4-16) for patient group. Otoscopic examinatios of of children in control group were all normal. 22 of 40 children in control group could adapt to pure tone audiometry and all of their hearings were normal. TEOAE was apllied for 18 children who couldn't could adapt to pure tone audiometry. All of their responses were normal. Tympanometry of all 40 children were compatible with type A. Preoperative otoscopic examimation was performed for patient group.In the examination 80 ears of 40 patients were assessed. In the assessment while 34 patients had bilateral dullness, 6 patients had grade 1 retraction. 24 of 40 patients were performed pure tone audiometry preoperatively. 22 patients had mild conductive hearing loss, 2 patients had moderate conductive hearing loss. TEOAE was applied for 16 children who couldn't could adapt to pure tone audiometry. TEOAE results of 14 patients were bilateral (-), TEOAE results of 2 patients were (+). Bilateral type B tympanogram were obtained in 36 of 40 patients (%90), type C tympanogram was obtained in 4 (%10) patients. Tests were reapplied to patients postoperatively 3rd month. Pure tone audiometry that was performed to 24 patients was repeated postoperatively. Hearing loss wasn't seen in 23 patients as 1 patient had mild conductive hearing loss. Postoperative TEOAE results of 12 patients were bilateral (+), 91 postoperative TEOAE results of 4 patients were bilateral (-) Postoperative timpanometry wasn't performed because of patient's ventilation tubes. Biphasic VEMP waves were obtained in all patients.Average p13 value of control group was 11.7±4 (7.7-15.7) msn for right ear and 12.1±3.5 (8.6-15.6) msn for left ear. Average n23 value of control group was 19.5±4.2 (15.3-23.7) msn for right ear and 19.4±4.2 (15.2-23.6) msn for left ear. Preoperative average p13 value of patient group was 17.6±4.2 (13.4-21.8) msn for right ear and 17.1±3.9 (13.2-21) msn for left ear. Preoperative average n23 value of patient group was 24.2±4 (20.2-28.2) msn for right ear and 23.7±3.8 (19.9-27.5) msn for left ear. Postoperative 1st month average p13 value of patient group was 15.2±4.2 (10.8-19.2) msn for right ear and 14.6±3.8 (10.8-18.4) msn for left ear. Postoperative 1st month average n23 value of patient group was 21.5±4 (17.5-25.5) msn for right ear and 20.8±3.9 (16.9-24.7) msn for left ear. Postoperative 3rd month average p13 value of patient group was 13.2±4.5 (8.7-17.7) msn for right ear and 12.8±4.5 (8.3-17.2) msn for left ear. Postoperative 3rd month average n23 value of patient group was 20.4±4 (16.4-24.4) msn for right ear and 19.6±3.8 (15.8-23.4) msn for left ear. Statistically significant decrease was seen in p13 and n23 values of patient group (p<0.05). When compared average np13 and n23 values of control group and postoperative 3rd month patient group there was no statistically significant difference (p>0.05). Average p13-n23 amplitudes of control group were 92.5±49.6 μV for right ear and 90.4±47.8 μVfor left ear. Average preoperative p13-n23 amplitudes of patient group were 60.2±24.5 μV for right ear and 58±25 μV for left ear. Average postoperative 1st month p13-n23 amplitudes of patient group were 72±34 μV for right ear and 68.4±33.7 μV for left ear. Average postoperative 3rd month p13-n23 amplitudes of patient group were 80.6±40.5 μV for right ear and 75.4±35.3 μV for left ear. Statistically significant increase was seen in postoperative amplitudes of patient group (p<0.05). When compared average p13-n23 amplitudes of control group 92 and postoperative 3rd month patient group there was no statistically significant difference (p>0.05). On this basis it was determined that average VEMP values of children who were applied tube came close to values of healthy children. Decrease in p13 and n23 period and significant increase in amplitudes were seen up to 1st month and 3rd month datas following tube insertion. Conclusion: Increased VEMP responses in chronic otitis media with effusion patients have shown that dysfunction of middle ear caused vestibular dysfunction. It was observed that VEMP responses came near to values of healthy children with improvement of middle ear fuctions by applying tube. There was a rapid recovery as VEMP responses came to normal values.In line of these datas we think that VEMP test can be used to follow up COM with effusion patients as a test for showing improvement. Key words: Chronic otitis media with effusion, servical vestibular evoked myogenic potential, vestibular fuction failure.