Prognostic value of vestibular-evoked myogenic potentials for disease progression and treatment response in Ménière's disease and endolymphatic hydrops: a systematic review.

PURPOSE: To evaluate the prognostic and treatment-response value of vestibular-evoked myogenic potentials (VEMPs) in adults with Ménière's disease (MD).

METHODS

A systematic search of MEDLINE, EMBASE, Scopus, and Cochrane Central up to September 2025 was conducted. Longitudinal studies including adults with definite or probable MD, reporting baseline VEMP testing and clinical outcomes (hearing, vertigo, disease progression, or treatment response) were included. Both cervical (cVEMP) and ocular (oVEMP) modalities, including multifrequency protocols, were analyzed. Study quality was assessed using the French version of Newcastle-Ottawa Scale.

RESULTS

Among the initial 415 articles identified, 34 met our inclusion criteria, including 2,422 patients. Abnormal VEMP parameters, including elevated thresholds, increased interaural amplitude ratios, Inter-Frequency Amplitude Ratio, and absent responses, correlated with advanced disease stage, hearing deterioration, vertigo severity, and progression to definite or bilateral MD. VEMP changes were frequently observed following intratympanic gentamicin and select surgical interventions, reflecting treatment response. Multifrequency VEMPs enhanced detection of subclinical otolithic dysfunction and differentiation of active versus stable disease.

CONCLUSION

VEMPs provide a reliable functional biomarker of vestibular involvement, disease progression, and treatment response in MD.