A 40-year-old woman has recurrent episodes of vertigo lasting 30–60 minutes with ipsilateral low-frequency sensorineural hearing loss and aural fullness. Cervical VEMP (cVEMP) shows absent responses on the left side. The most likely diagnosis and significance of the VEMP finding are:

• A Benign paroxysmal positional vertigo — normal variant
• B Superior semicircular canal dehiscence — enhanced VEMP amplitudes
• C Meniere's disease — saccular dysfunction confirming endolymphatic hydrops ✓
• D Vestibular neuritis — absent caloric responses on the left

Explanation

The clinical picture is classic Meniere's disease (endolymphatic hydrops). Cervical VEMPs assess saccular function via the inferior vestibular nerve and sacculo-collic reflex. In Meniere's disease, the saccule is preferentially dilated due to endolymphatic hydrops, leading to absent or diminished cVEMP responses. This is a useful objective marker of saccular dysfunction. In SSCD, cVEMP thresholds are paradoxically reduced (enhanced). Vestibular neuritis affects caloric responses more than VEMP.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.