S242 – Comparing the VEMP and ENG Tests in Vestibular Diagnosis

Abstract

Objectives 1) Compare the VEMP to the ENG test in the diagnosis of vestibular disease. 2) Learn clinical usefulness of the VEMP test. Methods We prospectively evaluated 166 patients complaining of dizziness with a complete neurotologic examination. VEMP and ENG testing were done on 160 patients. Brain scans were done when indicated. We compared the clinical diagnosis to the VEMP and ENG test results separately for 4 commonly seen vestibular conditions. Results 44 patients had no VEMP response and were excluded. Of the 116 patients there were 32 cases of Vestibular Neuronitis, 17 of Meniere's disease, 15 of BPPV, 12 of central vestibular dysfunction, 13 other vestibular diagnoses, and 27 with no vestibular diagnosis. Using a 2×2 contingency table and Fisher Exact Probability Test, there was a statistical difference between the VEMP and ENG tests only in diagnosis of Vestibular Neuronitis (p<0.001) when analyzed individually, and because this difference was so strong, there was a statistical difference with the diagnoses taken all together (p<0.001). Conclusions The ENG test remains the gold standard for diagnosis of vestibular disease. The VEMP test is useful in diagnosis of several vestibular disorders, including the 4 considered in this study. There is a strong bias toward the ENG test mainly because the diagnosis of vestibular neuronitis relies heavily on an abnormal caloric response. The VEMP test is administered in a much shorter time than the ENG test and provides valuable information regarding the inferior vestibular nerve and it has a lower false positive rate than the ENG test.