Safe use of acoustic vestibular-evoked myogenic potential stimuli: Protocol and patient-specific considerations

Cory D.F. Portnuff, Samantha Kleindienst, Jamie M. Bogle

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Vestibular-evoked myogenic potentials (VEMPs) are commonly used clinical assessments for patients with complaints of dizziness. However, relatively high air-conducted stimuli are required to elicit the VEMP, and ultimately may compromise safe noise exposure limits. Recently, research has reported the potential for noise-induced hearing loss (NIHL) from VEMP stimulus exposure through studies of reduced otoacoustic emission levels after VEMP testing, as well as a recent case study showing permanent sensorineural hearing loss associated with VEMP exposure. Purpose: The purpose of this report is to review the potential for hazardous noise exposure from VEMP stimuli and to suggest clinical parameters for safe VEMP testing. Research Design: Literature review with presentation of clinical guidelines and a clinical tool for estimating noise exposure. Results: The literature surrounding VEMP stimulus-induced hearing loss is reviewed, including several cases of overexposure. The article then presents a clinical calculation tool for the estimation of a patient's safe noise exposure from VEMP stimuli, considering stimulus parameters, and includes a discussion of how varying stimulus parameters affect a patient's noise exposure. Finally, recommendations are provided for recognizing and managing specific patient populations who may be at higher risk for NIHL from VEMP stimulus exposure. A sample protocol is provided that allows for safe noise exposure. Conclusions: VEMP stimuli have the potential to cause NIHL due to high sound exposure levels. However, with proper safety protocols in place, clinicians may reduce or eliminate this risk to their patients. Use of the tools provided, including the noise exposure calculation tool and sample protocols, may help clinicians to understand and ensure safe use of VEMP stimuli.

Original languageEnglish (US)
Pages (from-to)708-717
Number of pages10
JournalJournal of the American Academy of Audiology
Issue number8
StatePublished - Sep 2017


  • Noise-induced hearing loss
  • Otolith testing
  • Saccule
  • Utricle
  • VEMP protocol
  • VEMP safety
  • Vestibular-evoked myogenic potential

ASJC Scopus subject areas

  • Speech and Hearing


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