Abstract
Bilateral vestibulopathy (BVP) is a chronic condition in which patients have a reduction or absence of vestibular function in both ears. BVP is characterized by bilateral reduction of horizontal canal responses; however, there is increasing evidence that otolith function can also be affected. Cervical and ocular vestibular-evoked myogenic potentials (cVEMPs/oVEMPs) are relatively new tests of otolith function that can be used to test the saccule and utricle of both ears independently. Studies to date show that cVEMPs and oVEMPs are often small or absent in BVP but are in the normal range in a significant proportion of patients. The variability in otolith function is partly due to the heterogeneous nature of BVP but is also due to false negative and positive responses that occur because of the large range of normal VEMP amplitudes. Due to their variability, VEMPs are not part of the diagnosis of BVP; however, they are helpful complementary tests that can provide information about the extent of disease within the labyrinth. This article is a review of the use of VEMPs in BVP, summarizing the available data on VEMP abnormalities in patients and discussing the limitations of VEMPs in diagnosing bilateral loss of otolith function.
Highlights
Specialty section: This article was submitted to Neuro-Otology, a section of the journal Frontiers in Neurology
Studies to date show that Cervical VEMPs (cVEMPs) and ocular VEMPs (oVEMPs) are often small or absent in Bilateral vestibulopathy (BVP) but are in the normal range in a significant proportion of patients
Vestibular-evoked myogenic potential studies have shown a range of otolith function in patients with BVP
Summary
Cervical VEMP abnormalities in BVP were first reported by Matsuzaki and Murofushi [17], who tested three patients who had absent ice water caloric responses bilaterally. They found that cVEMPs were absent in five of the six ears, suggesting that the saccule and inferior vestibular nerve were affected by the disease. In a subsequent article, Brantberg and Löfqvist [20] presented a series of five patients with symptoms of unsteadiness and oscillopsia and absent caloric responses who were diagnosed with idiopathic BVP They found that, one patient had asymmetric amplitudes, all five patients had well-formed cVEMPs bilaterally, suggesting that saccular function may be largely spared in BVP.
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