The vestibular-evoked myogenic potential (VEMP) is a short-latency potential evoked through activation of vestibular receptors using sound or vibration. It is generated by modulated electromyographic signals either from the sternocleidomastoid muscle for the cervical VEMP (cVEMP) or the inferior oblique muscle for the ocular VEMP (oVEMP). These reflexes appear to originate from the otolith organs and thus complement existing methods of vestibular assessment, which are mainly based upon canal function. This review considers the basis, methodology, and current applications of the cVEMP and oVEMP in the assessment and diagnosis of vestibular disorders, both peripheral and central.

Vestibular-evoked myogenic potentials.

OBJECTIVE This retrospective study assessed several clinical, case history and functional parameters to investigate benign paroxysmal positional vertigo (BPPV) in patients with migraine. METHODS Two groups of patients were compared: those affected by BPPV and migraine (group A), as defined by International Headache Society criteria, and those with BPPV without migraine or with another form of headache (group B). The following parameters were investigated: onset of BPPV, recovery time, residual dizziness, recurrence of BPPV, atypical eye movement patterns and Meniere-like vertigo in the inter-critical BPPV period. RESULTS Mean age at BPPV onset was 39 years +/- 9.2 in Group A and 53 years +/- 7.3 in Group B (p = 0.00). No significant difference emerged in the number of manoeuvres needed to achieve recovery (Group A: 1.7 +/- 0.94; Group B: 1.9 +/- 0.89; p > 0.05). Highly recurrent BPPV (at least 4 documented episodes) was observed in 15 patients from group A (19.4%) and in 8 patients from group B (7.3%). Atypical eyes movements and Meniere-like vertigo were more frequent in migraineurs with highly recurrent BPPV (Chi square = 5.76; p < 0.016). CONCLUSIONS A high prevalence of BPPV and earlier onset in migraine are the main findings of this study. There is a higher incidence of a range of neurotological patterns in the intervals between BPPV episodes in migraineurs with recurrent vertigo. No direct pathophysiological link between migraine and BPPV has yet been established; comorbidity seems to affect clinical features in a sub-population of patients and make BPPV more debilitating.

Benign paroxysmal positional vertigo and migraine: analysis of 186 cases.

As the pathological cause of benign paroxysmal positional vertigo (BPPV), the dislocation or degeneration of otoconia in the utricle and saccule is suggested. Vestibular evoked myogenic potential (VEMP) could reflect otolithic dysfunction due to these etiologies of BPPV. The aim of this study was to validate the clinical significance of cervical (c) and ocular (o) VEMP in BPPV by a meta-analysis of previous articles. Articles related to BPPV with data on cVEMP and oVEMP were collected. The following keywords were used to search PubMed and Scopus for English language articles: benign paroxysmal positional vertigo or BPPV and vestibular evoked myogenic potential or VEMP. The p13 latency in cVEMP and n1 latency in oVEMP were slightly but significantly prolonged in BPPV patients compared to control patients. AR in oVEMP of BPPV patients also showed higher value than that of control patients. However, the n23 latency and AR in cVEMP and p1 latency in oVEMP showed no significant difference between BPPV and control patients. Furthermore, latencies in VEMPs also showed no significant difference between an affected and a non-affected ear in BPPV patients. Our results indicated that otolith dysfunction of BPPVs was detected by latencies in VEMPs, and AR in oVEMP more sensitively reflects the difference between affected and non-affected ears in BPPV patients. The otolith dysfunction of BPPV might be induced by the systemic condition. However, the differences of latencies between BPPV patients and control patients were too small to use VEMPs as a prognostic predictor.

Clinical significance of cervical and ocular vestibular evoked myogenic potentials in benign paroxysmal positional vertigo: a meta-analysis.

Otolith function in 
subjects with vitamin D deficiency/insufficiency is investigated through vestibular-evoked myogenic potentials (VEMP) and subjective visual vertical (SVV) testing. The study group included 62 patients with vitamin D deficiency/insufficiency (30 females, 32 males), with age range 24–56 years (40.6 ± 9.1). The control group included 44 healthy volunteers of similar age and gender distribution. The entire study group had: (1) serum level of 25-hydroxyvitamin D −1; (3) normal middle ear function; (4) Age is ≤60 years. All subjects enrolled in the current study underwent audiovestibular evaluation consisting of pure-tone audiometry, immittancemetry, cervical VEMP (cVEMP), ocular VEMP (oVEMP), and SSV. The entire control group had normal cVEMP, two subjects had abnormal oVEMP. Thirty-three subjects (53 %) in the study group had abnormal oVEMP and 31 subjects (50 %) had abnormal cVEMP. Forty-one (66 %) had abnormal VEMP when abnormal VEMP was considered as either abnormal oVEMP or cVEMP. The entire control and study groups had normal SSV test results. Vitamin D deficiency may be associated with development of otolith dysfunction affecting both the utricle and saccule. This was suggested by the high prevalence of abnormal ocular vestibular-evoked myogenic potentials (oVEMP) and cervical vestibular-evoked myogenic potentials (cVEMP) in the study group.

Vestibular-evoked myogenic potentials and subjective visual vertical testing in patients with vitamin D deficiency/insufficiency

Objective: The objective of our study was to investigate the potential association between the occurrence of benign paroxysmal positional vertigo (BPPV) and saccular dysfunction using cervical vestibular evoked myogenic potentials (cVEMP) testing.

Methods: The databases including Pubmed, Embase, and CENTRAL were systemically searched for case-control literatures investigating saccular dysfunction using cVEMP testing in BPPV patients compared with healthy controls. The literatures were published up to 16 April 2019 and were limited to the English language. All statistical processes were carried out using software Review Manager, version 5.3. Subgroup analysis and sensitive analysis were performed simultaneously.

Results: Of the 12 case-control studies confirmed for meta-analysis, p13 latency of cVEMP was assessed in 8 studies, n23 latency in 6 studies, amplitude in 5 studies, asymmetry ratio (AR) in 3 studies, proportion of absent response in 9 studies, and abnormal cVEMP in 8 studies. Compared with healthy controls, the p13 mean latency of cVEMP was longer (MD = 0.88, 95% CI = 0.64–1.12, p < 0.00001), the mean amplitude was lower (SMD = −0.60, 95% CI = −0.80 to −0.41, p < 0.00001), and the proportions of absent response (OR = 8.76, 95% CI = 2.28–33.61, p = 0.002), and abnormal cVEMP (OR = 7.47, 95% CI = 4.65–12.01, p < 0.00001) were higher in BPPV patients. But there was no significant difference in the n23 mean latency (MD = 0.37, 95% CI = −0.23–0.98, p = 0.22) and the AR of cVEMP (MD = 3.95, 95% CI = −4.75–12.65, p = 0.37) between BPPV patients and healthy controls. In the sub-group analysis based on age, only the result of the proportion of absent response of cVEMP indicated a significant difference existed (p = 0.002) between the studies with age-matched controls (OR = 2.78, 95% CI = 1.09–7.10, p = 0.03) and the studies without age-matched controls (OR = 53.85, 95% CI = 10.09–287.13, p < 0.00001). In the sub-group analysis of the proportion of abnormal cVEMP according to the diagnostic criteria of abnormal cVEMP, the result indicated no significant difference existed between the four groups (p = 0.61, I2 = 0%). In the sensitivity analysis, we obtained the consistent results after removing each study sequentially.

Conclusion: The meta-analysis reveals that saccular dysfunction may be associated with BPPV occurrence, and neural degeneration in the saccular macula may be a potential pathogenesis for BPPV.

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

OBJECTIVE Recent studies show that benign paroxysmal positional vertigo (BPPV) may also affect the macula of the saccule. We investigated vestibular evoked myogenic potential (VEMP) results in patients with BPPV. MATERIALS AND METHODS The study group included 31 patients (31 ears) diagnosed with posterior canal BPPV and the control group included 23 healthy volunteers (46 ears) with no neurotologic symptoms. After VEMP recordings were performed, mean latency values for p13 of the study and control groups were compared. RESULTS VEMP responses were elicited in all controls (46 ears). In the study group, responses were normal in 19, delayed in 5, and absent in 7 ears. There was a significant difference between abnormal VEMP rates for patients versus controls (p < 0.001). Although VEMP responses were elicited in all non-affected ears of patients, there was a delayed response in 6 (19%) non-affected ears. This was statistically significant when compared with controls (p = 0.002). There was no correlation between abnormal VEMPs and the number of canalith reposition maneuvers required (p = 0.392). CONCLUSION Our findings suggest the prolongation of mean latency values for p13 of VEMP in patients with BPPV might signify neuronal degeneration in the macula of the saccule, and the absence of VEMP waves might represent the extent of damage. Also, high latency values for p13 in non-affected ears of patients might indicate bilateral neural degeneration in BPPV.

Evaluation of vestibular evoked myogenic potentials during benign paroxysmal positional vertigo attacks; neuroepithelial degeneration?

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Evaluation of vestibular evoked myogenic potentials during benign paroxysmal positional vertigo attacks; neuroepithelial degeneration?