Ocular Vestibular Evoked Myogenic Potential Response Patterns for Characterizing Vestibular Dysfunction in Peripheral Vestibular Disorders

Ocular vestibular evoked myogenic potential (oVEMP) testing provides electrophysiological information on otolithic and superior vestibular pathway function, but its clinical interpretation often remains limited to a binary normal or abnormal judgment. This study developed and applied a structured oVEMP response-pattern protocol together with an exploratory, study-specific composite abnormality-burden grade for characterizing vestibular dysfunction in patients with peripheral vestibular disorders. From February 2024 to December 2025, 110 adults with Ménière’s disease, benign paroxysmal positional vertigo, sudden sensorineural hearing loss with vertigo, vestibular neuritis, or other peripheral vestibular injury underwent standardized clinical assessment and bilateral oVEMP testing. Parameters included N10 latency, P15 latency, N10–P15 amplitude, response threshold, interaural amplitude asymmetry ratio, 1000/500 Hz amplitude ratio, waveform absence, and the composite grade. Abnormal oVEMP responses were found in 62.7% of patients. Ménière’s disease showed a higher 1000/500 Hz amplitude ratio, while the small heterogeneous vestibular neuritis/other peripheral vestibular injury composite group showed more absent responses and higher composite grades. Across all four analytical groups, response-pattern and grade distributions differed; however, sensitivity analyses restricted to the three larger diagnostically homogeneous groups attenuated these between-group differences. At 4 weeks, abnormal oVEMP responses, marked interaural asymmetry, and higher exploratory grades were associated with residual dizziness. These findings support structured oVEMP response-pattern analysis as a functional descriptive framework, but they do not establish diagnostic accuracy or validate the proposed grade as a universal severity scale.