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

Abstract

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. PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database. 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. 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; I2 = 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; I2 = 76.4%) and 0.8824 (95% CI: 0.7859, 0.9387; I2 = 92.8%), respectively. However, there was a high degree of heterogeneity (I2 ≥ 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. 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.