Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo

[Vestibular evoked myogenic potentials in patients with recurrent benign paroxysmal positional vertigo]

Registration of ocular and cervical vestibular evoked myogenic potentials (oVEMPs and cVEMPs) reflects the function of otolith receptors: sacculus and utriculus. Benign paroxysmal positional vertigo (BPPV) is a disease of the inner ear as a result of the utriculus disfunction and migration of otoliths into semicircular channels.

OBJECTIVE

To study the function of otolith receptors (sacculus and utriculus) with using VEMPs registration in patients with first-time and recurrent posterior semicircular canal BPPV before and after repositional maneuvers.

MATERIAL AND METHODS

Registration and comparison of the results of oVEMPs and cVEMPs were performed in 50 patients with first-time posterior semicircular canal idiopathic BPPV and 26 patients with recurrent posterior semicircular canal BPPV before and after repositional treatment.

RESULTS AND DISCUSSION

Clinically significant asymmetry of the amplitude of oVEMPs before treatment was recorded in 14 (38%) of patients with first-time BPPV and in 15 (57.7%) of patients with recurrent BPPV; cVEMPs - in 6 (12%) of patients with first-time BPPV and in 6 (23.1%) of patients with recurrent BPPV. Successful repositional treatment did not affect the amplitude of cVEMPs in any of the groups of patients, but led to a significant increase in the amplitude of oVEMPs on the affected side in patients with first-time BPPV. In patients with recurrent BPPV, despite the absence of symptoms of otolithiasis, the asymmetry of the amplitude of oVEMPs persisted during remission (p<0.05), which can be considered as a prognostically unfavorable factor of disease recurrence.

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

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, sub-group 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.

VEMP: An Objective Test for Diagnosing the Cases of BPPV

Vertigo is a medical condition where a person feels as if they or the objects around them are moving when they are not. Any disturbance in the functioning of vestibular organ may cause vertigo. This study aims to find the role of cervical Vestibular evoked myogenic potential in diagnosing BPPV. The study performed was a prospective study of 50 patients with the age distribution from 20 to 60 years of age, attending the OPD in ENT department of MY Hospital, Indore with complaints of Vertigo. c-VEMP test was performed. The results were evaluated to diagnose BPPV. Of all the patients with the complaints of vertigo maximum belonged to the 5th decade of life. Of all the patients, females were found to be affected more than males making the male female ratio to be 1:1.28. In our study Dix-Hallpike test was found to be positive in 38 (74%) patients. On performing cervical VEMP, 15 (30%) patients of 50 patients showed abnormal latencies and amplitudes suggesting abnormal saccular functioning on affected side. Of these 15 abnormal VEMPs, 13 patients were positive on performing Dix-Hallpike test i.e. were diagnosed to have BPPV. VEMP showed a positive correlation with Dix-Hallpike test in diagnosis of vertigo of postural origin and thus can be used as a diagnostic tool for BPPV as VEMP is found to have high specificity.