Diagnostic Performance of Vestibular-Evoked Myogenic Potentials for Acute Unilateral Vestibulopathy: A Systematic Review and Meta-analysis.

OBJECTIVE: The goal of this study is to evaluate the pooled diagnostic performance of cervical (cVEMP) and ocular (oVEMP) vestibular-evoked myogenic potentials for Acute Unilateral Vestibulopathy. DATA SOURCES: MEDLINE, EMBASE, Scopus, and Cochrane Central were searched for relevant articles from inception to October 2025. REVIEW METHODS: We included prospective, retrospective, and cross-sectional studies evaluating the performance of cVEMP and oVEMP for the diagnosis of acute unilateral vestibulopathy in adult patients. The pooled estimates of the sensitivity and specificity of cVEMP and oVEMP in the diagnosis of acute unilateral vestibulopathy were calculated using a random-effects analysis that accounts for heterogeneity if present. Forest plots were constructed to combine the evidence identified during the systematic review. RESULTS: Forty-one studies were included; 15 contributed to diagnostic accuracy meta-analyses (519 patients, 577 controls). Pooled cVEMP sensitivity was 40% (95% CI, 0.30-0.50; I2 = 64.2%) and specificity 100% (95% CI, 0.00-1.00; I2 = 0%). Pooled oVEMP sensitivity was 74% (95% CI, 0.57-0.86; I2 = 55.9%) and specificity 99% (95% CI, 0.88-1.00; I2 = 0%). Abnormality rates were 40% for cVEMP (633/1540; I2 = 85.2%) and 67% for oVEMP (679/1135; I2 = 92.7%). Subgroup analyses revealed enhanced oVEMP sensitivity with air-conducted sound (76%) and tone-burst stimuli (82%), while cVEMP achieved superior sensitivity when elicited by bone-conducted vibration (49% vs 37% with air-conducted sound). CONCLUSION: VEMPs show high specificity but moderate sensitivity for diagnosing acute unilateral vestibulopathy, with oVEMP outperforming cVEMP because superior vestibular nerve involvement is more common. Therefore, VEMPs should be used as complementary rather than standalone tests alongside clinical and canal-based tests.