Deniz Uğur CENGİZ, Mehmet TAN, Tuba BAYINDIR, Sanem CAN ÇOLAK, Tuğba EMEKCİ, Sümeyye DEMİREL

Evaluation of utricular and saccular function in BPPV patients: The role of VEMP in diagnosis

Aim: The pathological cause of Benign Paroxysmal Positional Vertigo (BPPV) is the degeneration of the otolith organs (utricle and sacculus). Vestibular Evoked Myogenic Potentials (VEMP) assess the functions of the otolith organs. The objective of this research was to evaluate the otolith organ functions of patients with unilateral idiopathic BPPV (canalolithiasis of the posterior and lateral semicircular canals) by cVEMP and oVEMP tests. Material and Methods: The study prospectively included 35 patients with BPPV (canalolithiasis of the posterior and lateral semicircular canals) and 30 healthy individuals. Bilateral cVEMP and oVEMP tests were administered to all participants. Participants were divided into three groups: control, BPPV-affected ear, and unaffected ear.Results: In our study, cVEMP and oVEMP abnormalities were statistically significantly different both between the affected and unaffected ear groups and between the affected ear and control groups. There were statistically significant differences in the cVEMP and oVEMP amplitude values both between the affected and unaffected ear groups and between the affected ear and control groups. Also, the asymmetry ratios of the cVEMP and oVEMP tests were statistically significantly different between the case group and the control group. The cVEMP and oVEMP wave latencies (p1, n1, p1-n1) were not statistically significantly different among the BPPV-affected ear, unaffected ear, and control groups. The results of measurements were not statistically significantly different between the posterior and lateral canal involvement subgroups of BPPV patients.Conclusion: Abnormal cVEMP and oVEMP test results, which are observed more frequently in patients with BPPV compared to the control group, indicate utricular and saccular degeneration. Higher oVEMP abnormality ratios compared to those of cVEMP in BPPV patients suggest that utricular dysfunction may be more common than saccular dysfunction.

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1. You P, Instrum R, Parnes L. Benign paroxysmal positional vertigo. Laryngoscope Investigative Otolaryngology 2019;4:116-23.
2. Gu X, Dong F, Gu J. Analysis of effect of 1α-hydroxyvitamin D3 on benign paroxysmal positional vertigo and risk factors. Experimental and Therapeutic Med 2018;15:2321-26.
3. Fujimoto C, Kawahara T, Kinoshita M, et al. Aging is a risk factor for utricular dysfunction in idiopathic benign paroxysmal positional vertigo. Frontiers in Neurology 2018;9:1049.
4. Bhattacharyya N, Hollingsworth DB, Mahoney K, et al. Plain language summary: Benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2017;156:417-25.
5. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992;107:399-404.
6. Byun H, Chung JH, Lee SH, et al. Increased risk of benign paroxysmal positional vertigo in osteoporosis: a nationwide population-based cohort study. Sci Rep 2019;9:1-8.
7. Chen CC, Cho HS, Lee HH, et al. Efficacy of repositioning therapy in patients with benign paroxysmal positional vertigo and preexisting central neurologic disorders. Front Neurol 2018;9:486.
8. Von Breverna M, Bertholonb P, Brandt T, et al. Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res 2015;25:105-17.
9. Pérez-Vázquez P, Franco-Gutiérrez V. Treatment of benign paroxysmal positional vertigo. A clinical review. J Otol 2017;12:165-73.
10. Murofushi T. Vestibular evoked myogenic potential. World J Otorhinolaryngol 2014;4:6-112014;4:6-11.
11. Fife TD, Colebatch JG, Kerber KA, et al. 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 2017;89:2288-96.
12. Rosengren SM, Kingma H. New perspectives on vestibular evoked myogenic potentials. Curr Opin Neurol 2013;112:574-82.
13. Welgampola MS, Colebatch JG. Characteristics and clinical applications of vestibular-evoked myogenic potentials. Neurology 2005;64:1682-8.
14. Gacek RR. Pathology of benign paroxysmal positional vertigo revisited. Annals of Otology, Rhinology & Laryngology 2003;112:574-82.
15. Longo G, Onofri M, Pellicciari T, et al. Benign paroxysmal positional vertigo: is vestibular evoked myogenic potential testing useful? Acta Otolaryngol 2012;132:39-43.
16. Xu H, Liang F, Chen L, et al. Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients. Journal of Otolaryngology-Head & Neck Surgery 2016;45:1-6.
17. Korres S, Gkoritsa E, Giannakakou-Razelou D, et al. Vestibular evoked myogenic potentials in patients with BPPV. Medical Science Monitor: International Medical J Experimental and Clinical Research.2011;17:CR42-47.
18. Mujdeci B, Unal A. Vestıbular Evoked Myogenıc Potentıals ın Benıgn Paroxysmal Posıtıonal Vertıgo. West Indian Med J.
19. Faul F, Erdfelder E, Buchner A, et al. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behav Res Methods 2009;41:1149-60.
20. Alpar R. Spor, sağlık ve eğitim bilimlerinden örneklerle uygulamalı ve geçerlilik–güvenirlik (2. Baskı). Ankara: Detay, 2012.
21. Chiarovano E, Zamith F, Vidal PP, et al. Ocular and cervical VEMPs: a study of 74 patients suffering from peripheral vestibular disorders. Neurophysiol Clin 2011;122:1650-9.
22. Min Hong S, Geun Yeo S, Wan Kim S, et al. The results of vestibular evoked myogenic potentials, with consideration of age-related changes, in vestibular neuritis, benign paroxysmal positional vertigo, and Meniere's disease. Acta Otolaryngol 2008;128:861- 65.
23. Yang WS, Kim SH, Lee JD, et al. Clinical significance of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo. Otology & Neurotology. 2008;29:1162-6.
24. Boleas-Aguirre M, Sánchez-Ferrándiz N, Artieda J, et al. Vestibular evoked myogenic potentials and benign paroxysmal positional vertigo. Acta Otorrinolaringol Esp 2007;58:173-7.
25. Seo T, Saka N, Ohta S, et al. Detection of utricular dysfunction using ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo. Neurosci Lett 2013;550:12-6.
26. Kim EJ, Oh SY, Kim JS, et al. Persistent otolith dysfunction even after successful repositioning in benign paroxysmal positional vertigo. J Neurol Sci 2015;358:287-93.
27. Hong SM, Park DC, Yeo SG, et al. Vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo involving each semicircular canal. Am J Otolaryngol 2008;29:184-87.
28. Yetiser S, Ince D, Gul M. An analysis of vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo. Annals of Otology, Rhinology & Laryngology. 2014;123:686-95.
29. Martínez Pascual P, Amaro Merino P. Otolithic damage study in patients with benign paroxysmal positional vertigo with vestibular evoked myogenic potentials. Acta Otorrinolaringol Esp 2019;70:131-5.
30. Akkuzu G, Akkuzu B, Ozluoglu LN. Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere’s disease. Eur Arch Otorhinolaryngol 2006;263:510-7.
31. Yang WS, Kim SH, Lee JD, et al. Clinical significance of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo. Otol Neurotol 2008;29:1162-6.
32. Lee JD, Park MK, Lee BD. Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with recurrent benign paroxysmal postitional vertigo. Acta Otolaryngol 2013;133:150-3.
33. Karatas A, Yuce T, Cebi IT, et al. Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo. J Int Adv Otol 2016;12:316-20.
34. Krempaska S, Koval J. The role of vestibular evoked myogenic potentials (VEMPs) in vestibulopathy diagnostics. Bratisl Lek Listy 2012;113:301-6.