Are test results from Subjective Visual Vertical and Ocular Vestibular Evoked Potentials correlated in a Danish Cohort of Patients admitted to a tertiary Dizziness Clinic?


 Objectives: To investigate if any concordance exists between oVEMP and SVV results in a heterogeneous group of patients admitted with first time monosymptomatic vertigo. Methods: The retrospective clinical study included 103 patients referred to a tertiary dizziness clinic due to first time monosymptomatic vertigo. All patients were examined with SVV and oVEMP. The tests were compared by means of stratification as well as Receiver Operation Characteristics (ROC) curves with area under the curve (AUC) computed. Results: ROC curves comparing SVV and oVEMP results, with the oVEMP system as the benchmark for pathological findings, showed an AUC [95%CI] of 0.83 for patients with symptom duration of less than one month. The entire study population as well as the patients with symptom duration more than one month showed ROC curves with AUC [95%CI] of < 0.5 indicating less accuracy than random outcome. Patients with Ménière, Vestibular Neuritis or BPPV were stratified based on which side the examining doctor noted as being pathological. Pooled together, the three diagnoses demonstrated an agreement between the examining doctor and oVEMP or SVV of respectively 27.5% and 24%. An agreement of 20% was found for BPPV in regard to both tests. Patients with only one measurable oVEMP, stratified on SVV classification showed a 34% agreement between the two tests, as well as 59% of patients with normal SVV, but pathological oVEMP. Conclusion: Among patients experiencing monosymptomatic vertigo the present study showed a correlation between oVEMP and SVV results in patients with a symptom duration of less than one month. Despite oVEMP and SVV both being part of the extensive test battery in vestibular diagnostics, clinicians should be conscious of avoiding the potential errors discussed in this study; both during testing and interpretation.