Usefulness of Cervical Vestibular-Evoked Myogenic Potentials for Diagnosing Patients With Superior Canal Dehiscence Syndrome: A Meta-Analysis

Abstract

Objectives: To compare the diagnostic accuracy of cervical vestibular-evoked myogenic potential (cVEMP) for detecting superior canal dehiscence (SCD) syndrome to that of computed tomography (CT) and surgical findings. Databases Reviewed: PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database. Methods: Databases were searched up to July 2021. True positives, true negatives, false positives, and false negatives were extracted. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: Our search yielded nine studies with 721 patients. Including all cVEMP thresholds, the diagnostic odds ratio (DOR) was 32.8483 (95% confidence interval [CI]: 19.6577, 54.8900; I 2 ¼ 49.9%). The area under the summary receiver operating characteristic curve (AUC) was 0.879. Sensitivity and specificity were 0.8278 (95% CI: 0.7517, 0.8842; I 2 ¼ 76.4%) and 0.8824 (95% CI: 0.7859, 0.9387; I 2 ¼ 92.8%), respectively. However, there was a high degree of heterogeneity (I 2 ! 70%) due to the different VEMP threshold values used among the studies. In subgroup analysis, higher cVEMP threshold values showed higher sensitivity (threshold 85: 0.9568; threshold 65: 0.7691) but lower specificity (threshold 85: 0.5879; threshold 65: 0.8913). The threshold 75 subgroup showed moderate sensitivity of 0.7455, high specificity of 0.9526, and the highest DOR of 38.9062. The AUC of this subgroup was 0.894. Conclusions: cVEMP is a reliable adjunctive tool for the clinical diagnosis of SCD. Taking the balance between sensitivity and specificity into consideration, a cVEMP threshold value of 75 showed good diagnostic accuracy.

An evidenced-based diagnostic tool for superior semicircular canal dehiscence syndrome

“…This may be due to inconsistent reporting of thresholds at 250 Hz in routine audiograms. Moreover, abnormalities in oVEMPs and cVEMPs in the setting of SSCD are well-described in the literature ( Kim et al., 2022 ; Zuniga et al., 2013 ). Unfortunately, VEMP data was not collected in most patients without radiologic-confirmed superior canal dehiscence, which is an issue that has been raised in previous reports ( Welgampola et al., 2008 ; Janky et al., 2013 ; Hunter et al., 2017 ; Roditi et al., 2009 ; Lin et al., 2019 , 2021 ).…”

“…Published evidence has identified factors that may be predictive of a diagnosis of SSCD, including cochlear symptoms ( Benamira et al., 2014 ), decreased thresholds on cVEMP ( Kim et al., 2022 ), increased oVEMP amplitudes ( Zhang et al., 2021 ), and low frequency CHL ( Zhang et al., 2021 ). While such clinical factors may be used to verify suspicion for SSCD independently, it again remains challenging to interpret in practice as patients often present with a quite varied combination of symptoms and objective findings ( Naert et al., 2018 ; Zhou et al., 2007 ).…”

Diagnostic Yield of Patients Undergoing Evaluation of Possible Superior Canal Dehiscence

“…7 Thus, radiographic imaging abnormalities alone do not indicate symptomatic SCD. Audiometric and vestibular testing, including supranormal bone conduction threshold testing and cervical or ocular vestibular evoked myogenic potential (VEMP) testing, 8 can clarify ambiguous cases. These can include patients with plausible alternative diagnoses and those with indeterminate radiographic dehiscence but convincing third window symptoms ("near dehiscence syndrome" 9,10 ).…”

Cervical vestibular evoked myogenic potentials in 3-month-old infants: Comparative characteristics and feasibility for infant vestibular screening

“…Cervical vestibular evoked myogenic potential (cVEMP) recorded from the contracted sternocleidomastoid muscle (SCMM) is an objective, non-invasive, timesaving, reproducible and well-tolerated evaluation method, which can be selected as a screening test to evaluate the otolith function in young children ( 22 , 23 ). In terms of its evoked stimuli, air conducted sound (ACS), the most commonly used stimulus, is frequently used to elicit cVEMP.…”

“…However, ACS-cVEMP is not suitable for subjects with conductive hearing loss. In contrast, bone conducted vibration cVEMP (BCV-cVEMP) can bypass the middle ear, allowing to evaluate the saccule and inferior vestibular nerve pathway for subjects with middle ear pathology ( 10 , 23 , 26 ). Verrecchia et al ( 15 ) implemented BCV-cVEMP in infants aged 1–6 months who referred for the 2nd hearing screening due to the failure of the 1st hearing screening or had high risk factors of hearing loss, and those who came for diagnostic hearing assessment.…”