Ocular vs. Cervical Vestibular Evoked Myogenic Potentials in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis

Abstract

Objective: To compare utricular dysfunction with saccular dysfunction in benign paroxysmal positional vertigo (BPPV), based on ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP), respectively. Materials and Methods: We performed a literature search exploring utricular and saccular dysfunction in BPPV patients through June 2020 using oVEMP and cVEMP, respectively. The databases included Pubmed, Embase, CENTRAL, CNKI, Wan Fang Data, and CBM. The literatures were limited to Chinese and English. Inclusion criteria and exclusion criteria were defined. We adopted abnormal rate as the outcome. All statistical processes were conducted through software Review Manager. Considering the air-conducted sound (ACS) and bone conducted vibration (BCV) may have different mechanisms, and three types of diagnostic criteria for abnormal VEMP were available, subgroup analysis was performed simultaneously according to the sound stimuli and the diagnostic criteria of abnormal VEMP. Results: We retrieved 828 potentially relevant literatures, and finally 12 studies were included for meta-analysis of abnormal rate after duplication removal, titles and abstracts screening, and full-text reading. The abnormal rate of oVEMP was not significantly different from cVEMP (OR = 1.59, 95% CI = 0.99-2.57). But the abnormal rate was obviously different between the subgroups adopting ACS oVEMP and BCV oVEMP. In studies adopting ACS oVEMP, the abnormal rate of oVEMP was higher than cVEMP (OR = 1.85, 95% CI = 1.38-2.49). The abnormal rate of oVEMP was also higher than cVEMP when adopting asymmetry ratio (AR) and no response (NR) as diagnostic criteria (OR = 2.16, 95% CI = 1.61-2.89). Conclusion: The meta-analysis reveals that utricular dysfunction may be more predominant in BPPV compared with saccular dysfunction.

Cervical and ocular vestibular-evoked myogenic potentials test results and its relation to vestibular signs and symptoms in individuals with vestibular migraine

“…Makowiec et al [16] reported that patients with vestibular migraine may exhibit normal cVEMP responses in the presence of unilaterally abnormal oVEMP responses. The absence of oVEMP more than cVEMP has also been reported in individuals with severe to profound sensorineural hearing loss [17], patients with bilateral vestibulopathy due to aminoglycosides toxicity [18], and BPPV [19]. Thus, the absence of oVEMP more than cVEMP may not be a significant biomarker for the diagnosis of vestibular pathology in patients with vestibular migraine.…”

Patient-Reported Disability After Computerized Posturographic Vestibular Retraining for Stable Unilateral Vestibular Deficit

“…Benign paroxysmal positional vertigo is unlikely to cause persistent symptoms of imbalance as it is not associated with unilateral vestibular weakness during videonystagmogram testing, although some studies have described persistent VEMP abnormalities in patients with a history of BPPV. 42 Our study excluded patients with a diagnosis of Ménière disease or BPPV.…”

Clinical effect of vestibular rehabilitation on benign paroxysmal positional vertigo

“…[ 4 – 6 ] Of it, benign paroxysmal positional vertigo (BPPV) accounts for most common type of vertigo. [ 7 – 10 ] It occurs in the inner ear because of the changes in position. [ 9 – 12 ] Although standard treatment is applied to manage such disorder, its 1-year recurrence rate is about 20%, and its 4 to 5 year recurrence rate is between 40% and 50%.…”