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

  • Ryohei OyaEmail author
  • Takao Imai
  • Yukinori Takenaka
  • Takashi Sato
  • Kazuo Oshima
  • Yumi Ohta
  • Hidenori Inohara
Review Article



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.


Benign paroxysmal positional vertigo Vestibular evoked myogenic potential Meta-analysis 



The authors would like to thank Enago ( for the English language review.

Author contributions

RO conceived and designed the study and wrote the paper. RO, TI, and YT collected and analyzed the data. TS, KO, YO, and HI reviewed and revised the manuscript.



Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.


  1. 1.
    Imai T, Takeda N (2017) Committee for standards in diagnosis of Japan Society for equilibrium research. Classification, diagnostic criteria and management of benign paroxysmal positional vertigo. Auris Nasus Larynx 44:1–6CrossRefGoogle Scholar
  2. 2.
    Parnes LS, McClure JA (1992) Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 102:988–992CrossRefGoogle Scholar
  3. 3.
    Akkuzu G, Akkuzu B, Ozluoglu LN (2006) Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere's disease. Eur Arch Otorhinolaryngol 263:510–517CrossRefGoogle Scholar
  4. 4.
    Gacek RR (2003) Pathology of benign paroxysmal positional vertigo revisited. Ann Otol Rhinol Laryngol 112:574–582CrossRefGoogle Scholar
  5. 5.
    Murofushi T, Curthoys IS (1997) Physiological and anatomical study of click-sensitive primary vestibular afferents in the guinea pig. Acta Otolaryngol 117:66–72CrossRefGoogle Scholar
  6. 6.
    Murofushi T, Curthoys IS, Topple AN, Colebatch JG, Halmagyi GM (1995) Responses of guinea pig primary vestibular neurons to clicks. Exp Brain Res 103:174–178CrossRefGoogle Scholar
  7. 7.
    Singh NK, Barman A (2015) Efficacy of ocular vestibular-evoked myogenic potential in identifying posterior semicircular canal benign paroxysmal positional vertigo. Ear Hear 36:261–268CrossRefGoogle Scholar
  8. 8.
    Rosengren SM, Welgampola MS, Colebatch JG (2010) Vestibular evoked myogenic potentials: past, present and future. Clin Neurophysiol 121:636–651CrossRefGoogle Scholar
  9. 9.
    Colebatch JG, Halmagyi GM, Skuse NF (1994) Myogenic potentials generated by a click-evoked vestibulocollic reflex. J Neurol Neurosurg Psychiatry 57:190–197CrossRefGoogle Scholar
  10. 10.
    Murofushi T, Halmagyi GM, Yavor RA, Colebatch JG (1996) Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis. An indicator of inferior vestibular nerve involvement? Arch Otolaryngol Head Neck Surg 122:845–848CrossRefGoogle Scholar
  11. 11.
    Fife TD, Colebatch JG, Kerber KA, Brantberg K, Strupp M, Lee H, Walker MF, Ashman E, Fletcher J, Callaghan B, Gloss DS 2nd (2017) Practice guideline: cervical and ocular vestibular evoked myogenic potential testing: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology. Neurology 89:2288–2296CrossRefGoogle Scholar
  12. 12.
    Node M, Seo T, Miyamoto A, Adachi A, Hashimoto M, Sakagami M (2005) Frequency dynamics shift of vestibular evoked myogenic potentials in patients with endolymphatic hydrops. Otol Neurotol 26:1208–1213CrossRefGoogle Scholar
  13. 13.
    Rauch SD (2006) Vestibular evoked myogenic potentials. Curr Opin Otolaryngol Head Neck Surg 14:299–304CrossRefGoogle Scholar
  14. 14.
    Murofushi T, Shimizu K, Takegoshi H, Cheng PW (2001) Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg 127:1069–1072CrossRefGoogle Scholar
  15. 15.
    Seo T, Saka N, Ohta S, Sakagami M (2013) Detection of utricular dysfunction using ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo. Neurosci Lett 550:12–16CrossRefGoogle Scholar
  16. 16.
    Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P (2009) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
  17. 17.
    Yang WS, Kim SH, Lee JD, Lee WS (2008) Clinical significance of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo. Otol Neurotol 29:1162–1166CrossRefGoogle Scholar
  18. 18.
    Korres S, Gkoritsa E, Giannakakou-Razelou D, Yiotakis I, Riga M, Nikolpoulos TP (2011) Vestibular evoked myogenic potentials in patients with BPPV. Med Sci Monit 17:CR42–CR47CrossRefGoogle Scholar
  19. 19.
    Eryaman E, Oz ID, Ozker BY, Erbek S, Erbek SS (2012) Evaluation of vestibular evoked myogenic potentials during benign paroxysmal positional vertigo attacks; neuroepithelial degeneration? B-ENT 8:247–250PubMedGoogle Scholar
  20. 20.
    Longo G, Onofri M, Pellicciari T, Quaranta N (2012) Benign paroxysmal positional vertigo: Is vestibular evoked myogenic potential testing useful? Acta Otolaryngol 132:39–43CrossRefGoogle Scholar
  21. 21.
    Singh NK, Sinha SK, Rajeshwari G, Kumari A (2014) Are cervical vestibular evoked myogenic potentials sensitive to changes in vestibular system associated with benign paroxysmal positional vertigo? Hear Balance Commun 12:20–26CrossRefGoogle Scholar
  22. 22.
    Yetiser S, Ince D, Gul M (2014) An analysis of vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 123:686–695CrossRefGoogle Scholar
  23. 23.
    Kim EJ, Oh SY, Kim JS, Yang TH, Yang SY (2015) Persistent otolith dysfunction even after successful repositioning in benign paroxysmal positional vertigo. J Neurol Sci 358:287–293CrossRefGoogle Scholar
  24. 24.
    Sreenivasan A, Sivaraman G, Parida PK, Alexander A, Saxena SK, Suria G (2015) The clinical utility of vestibular evoked myogenic potentials in patients of benign paroxysmal positional vertigo. J Clin Diagn Res 9:MC01–MC3.Google Scholar
  25. 25.
    Karata A, Yüce T, Çebi IT, Acar Yüceant G, Hacı C, Salviz M (2016) Evaluation of cervical vestibular-evoked myogenic potential findings in benign paroxysmal positional vertigo. J Int Adv Otol 12:316–320CrossRefGoogle Scholar
  26. 26.
    Singh NK, Apeksha K (2016) Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal. Eur Arch Otorhinolaryngol 273:2523–2532CrossRefGoogle Scholar
  27. 27.
    Dabbous AO, El-Shennawy AM, Medhat MM, Kandil MT (2019) Assessment of the utricular function in posterior canal benign paroxysmal positional vertigo patients before and after canalith repositioning maneuvre and its relation to residual dizziness. Hearing Balance Commun 17:91–106CrossRefGoogle Scholar
  28. 28.
    Li MW, Houlden D, Tomlinson RD (1999) Click evoked EMG responses in sternocleidomastoid muscles: characteristics in normal subjects. J Vestib Res 9:327–334PubMedGoogle Scholar
  29. 29.
    Nakayama M, Epley JM (2005) BPPV and variants: improved treatment results with automated, nystagmus-based repositioning. Otolaryngol Head Neck Surg 133:107–112CrossRefGoogle Scholar
  30. 30.
    Imai T, Takeda N, Uno A, Morita M, Koizuka I, Kubo T (2002) Three-dimensional eye rotation axis analysis of benign paroxysmal positioning nystagmus. ORL J Otorhinolaryngol Relat Spec 64:417–423CrossRefGoogle Scholar
  31. 31.
    Gacek RR, Gacek MR (1998) Update on the pathology and management of benign paroxysmal positional vertigo. Otorhinolaryngol Nova 8:235–244CrossRefGoogle Scholar
  32. 32.
    Curthoys IS, Iwasaki S, Chihara Y, Ushio M, McGarvie LA, Burgess AM (2011) The ocular vestibular-evoked myogenic potential to air-conducted sound; probable superior vestibular nerve origin. Clin Neurophysiol 122:611–616CrossRefGoogle Scholar
  33. 33.
    Dix MR, Hallpike CS (1952) The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 61:987–1016CrossRefGoogle Scholar
  34. 34.
    Takeda N, Nishiike S, Kitahara T, Kubo T, Ogino H, Koizuka I (1997) Clinical features and utricular dysfunction in patients with benign paroxysmal positional vertigo. Nihon Jibiinkoka Gakkai Kaiho 100:449–456CrossRefGoogle Scholar
  35. 35.
    Hughes I, Thalmann I, Thalmann R, Ornitz DM (2006) Mixing model systems: using zebrafish and mouse inner ear mutants and other organ systems to unravel the mystery of otoconial development. Brain Res 1091:58–74CrossRefGoogle Scholar
  36. 36.
    Kahraman SS, Ozcan O, Arli C, Ustun I, Erduran R, Akoglu E, Gokce C (2016) Calcium homeostasis during attack and remission in patients with idiopathic benign paroxysmal positional vertigo. Otol Neurotol 37:1388–1392CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology Head and Neck SurgeryOsaka University Graduate School of MedicineSuitaJapan
  2. 2.Department of Otorhinolaryngology Head and Neck SurgeryKansai Medical HospitalToyonakaJapan

Personalised recommendations