Cervical and Ocular VEMP Testing in Diagnosing Superior Semicircular Canal Dehiscence

• Published in: Otolaryngology-head and neck surgery 2017-05, Vol.156 (5), p.917-923
• Main Authors: Hunter, Jacob B., Patel, Neil S., O’Connell, Brendan P., Carlson, Matthew L., Shepard, Neil T., McCaslin, Devin L., Wanna, George B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cohort Studies; cranial base; Female; Humans; Male; Middle Aged; neurotology; Retrospective Studies; ROC Curve; Semicircular Canals - physiopathology; Sensitivity and Specificity; Severity of Illness Index; skull base; superior semicircular canal dehiscence; VEMP; vestibular; Vestibular Diseases - diagnosis; Vestibular Evoked Myogenic Potentials - physiology; Vestibular Function Tests - methods
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599817690720

Objective To determine the sensitivity and specificity of ocular and cervical vestibular evoked myogenic potentials (VEMPs) in the diagnosis of superior semicircular canal dehiscence (SCD) and to describe the VEMP response characteristics that are most sensitive to SCD and compare the findings to previous reports. Study Design Case series with chart review. Setting Two tertiary neurotologic referral centers. Subjects and Methods Cervical and ocular VEMP peak-to-peak amplitudes and thresholds from 39 adult patients older than 18 years with surgically confirmed SCD were compared with 84 age-matched controls. Results Using receiver operating characteristic (ROC) curves, cervical VEMP (cVEMP) amplitudes, cVEMP thresholds, and ocular VEMP (oVEMP) amplitudes had areas under the curve of 0.731, 0.912, and 0.856, respectively, all of which were statistically significant (P < .0001). For cVEMP thresholds, at the clinical equivalent ≤85-dB normalized hearing level (nHL) threshold, the sensitivity and specificity were 97.3% and 31.3%, respectively. At the ≤70-dB nHL threshold, the sensitivity and specificity were 73.0% and 94.0%, respectively. For oVEMP amplitudes >12.0 µV, the sensitivity and specificity were 78.6% and 81.7%, respectively. Conclusion Data from this multicenter study suggest that both cVEMP thresholds and oVEMP amplitudes remain good diagnostic tests for identifying SCD, with each test dependent on a number of factors. The sensitivity and specificity of these individual tests may vary slightly between centers depending on testing parameters used.