Ocular VEMPs indicate repositioning of otoconia to the utricle after successful liberatory maneuvers in benign paroxysmal positioning vertigo

Abstract

Conclusions: This study showed a transient increase of ocular vestibular evoked myogenic potential (oVEMP) amplitudes in the affected ear after successful liberatory maneuvers and no changes in cervical VEMP (cVEMP) amplitudes. These findings support the hypothesis that successful liberatory maneuvers can lead to a repositioning of otoconia to the utricle. Objectives: To evaluate whether oVEMP amplitudes increase after successful liberatory maneuvers in patients with posterior semicircular canal benign paroxysmal positioning vertigo (pc-BPPV), while cVEMP amplitudes do not change. These findings may indicate a successful repositioning of dislodged otoconia to the utricular macula, but not to the saccular macula. Methods: Thirty patients with unilateral pc-BPPV were prospectively examined with bone-conducted oVEMP and air-conducted cVEMP at four time points: before, after, 1 week after, and 1 month after the liberatory maneuvers (Sémont maneuvers). Results: At the 1-week follow-up, 20 of 30 patients were asymptomatic (responders); BPPV could still be induced in the other 10 (non-responders). In responders the mean n10 amplitude on the affected side increased from 12 ± 6.5 µV at baseline (before the treatment) to 15.9 ± 7.1 µV at 1 week after treatment; this increase was significantly (p = 0.001) higher in responders than in non-responders. cVEMP did not differ significantly.

Keywords::

• Vestibular evoked myogenic potentials
• nystagmus
• Sémont maneuvers

Acknowledgments

We thank Ms J. Benson and Ms K. Ogston for copy editing the manuscript and Mr S. Krafczyk for technical support. This study was supported by a grant from the BMBF to the IFB (grant code 01 EO 0901).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.