Usefulness of Cervical Vestibular-Evoked Myogenic Potentials for Diagnosing Patients With Superior Canal Dehiscence Syndrome: A Meta-Analysis

Objectives: To compare the diagnostic accuracy of cervical vestibular-evoked myogenic potential (cVEMP) for detecting superior canal dehiscence (SCD) syndrome to that of computed tomography (CT) and surgical findings. Databases Reviewed: PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database. Methods: Databases were searched up to July 2021. True positives, true negatives, false positives, and false negatives were extracted. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: Our search yielded nine studies with 721 patients. Including all cVEMP thresholds, the diagnostic odds ratio (DOR) was 32.8483 (95% confidence interval [CI]: 19.6577, 54.8900; I-2 = 49.9%). The area under the summary receiver operating characteristic curve (AUC) was 0.879. Sensitivity and specificity were 0.8278 (95% CI: 0.7517, 0.8842; I-2 = 76.4%) and 0.8824 (95% CI: 0.7859, 0.9387; I-2 = 92.8%), respectively. However, there was a high degree of heterogeneity (I-2 >= 70%) due to the different VEMP threshold values used among the studies. In subgroup analysis, higher cVEMP threshold values showed higher sensitivity (threshold <= 85: 0.9568; threshold <= 65: 0.7691) but lower specificity (threshold <= 85: 0.5879; threshold <= 65: 0.8913). The threshold <= 75 subgroup showed moderate sensitivity of 0.7455, high specificity of 0.9526, and the highest DOR of 38.9062. The AUC of this subgroup was 0.894. Conclusions: cVEMP is a reliable adjunctive tool for the clinical diagnosis of SCD. Taking the balance between sensitivity and specificity into consideration, a cVEMP threshold value of 75 showed good diagnostic accuracy.