The role of vestibular evoked myogenic potential (VEMP) testing in sudden sensorineural hearing loss: a contemporary review

Abstract Background Sudden sensorineural hearing loss (SSNHL) represents an acute otologic emergency that may compromise not only auditory capacity but also vestibular function. Given the multifactorial and incompletely understood pathophysiology of SSNHL, reliable diagnostic and prognostic biomarkers remain an area of significant clinical interest. Vestibular evoked myogenic potential (VEMP) testing provides an objective means of assessing otolithic organ function and has been increasingly investigated in the context of SSNHL. Aims The objective of this review is to critically evaluate the role of VEMP in the diagnostic workup, therapeutic monitoring, and prognostic stratification of SSNHL. Material and methods A systematic literature search was conducted using Google Scholar, PubMed, ScienceDirect, and Scopus databases, following PRISMA 2020 guidelines. Thirty-two studies met the inclusion criteria and were included in the qualitative synthesis. Results The included studies investigated the association between abnormal VEMP responses, vestibular involvement, and hearing prognosis in patients with SSNHL. The reported prevalence of abnormal cVEMP and/or oVEMP responses varied widely across individual studies, and no pooled prevalence or summary percentage was calculated due to substantial methodological heterogeneity. Overall, abnormal VEMP findings were more frequently reported in patients with poorer hearing recovery, whereas preserved responses tended to be associated with more favorable outcomes. Conclusion Despite low certainty of evidence, VEMP testing may warrant further investigation as a potential adjunct. The major limitation of this review is the heterogeneity and methodological variability among included studies, which restricts generalizability. Nonetheless, further large-scale, prospective investigations are warranted to establish its definitive role in routine clinical practice.