Tests · Balance
Cervical VEMP: balance measured through a neck muscle
Cervical VEMP records a neck muscle contraction triggered by a loud sound. That response depends on the saccule, a structure of the inner ear, and on the inferior vestibular nerve — parts of the balance system the other tests do not reach. It is painless and takes about twenty minutes.
Medically reviewed by Prof. Aline Bittencourt, MD, PhD, CRM-MA 7562 · RQE 1832 Updated on
What is cervical VEMP?
VEMP stands for vestibular evoked myogenic potential. Put plainly: an electrical potential generated by a muscle, triggered by a stimulus that reaches the balance system.
The vestibular system has more parts than the semicircular canals. Among them is the saccule, which detects vertical acceleration and the position of the head relative to gravity. The saccule is sensitive to intense sound, and that sensitivity is what makes the test possible: a loud sound stimulates it, and the response travels along the inferior vestibular nerve to the neck musculature.
Why it matters
The more traditional balance tests do not cover everything. The caloric test in videonystagmography assesses mainly the lateral semicircular canal and the superior vestibular nerve. Cervical VEMP reaches precisely the part that is left out.
| Test | Structure assessed |
|---|---|
| Videonystagmography, caloric test | Lateral semicircular canal and superior vestibular nerve |
| vHIT | All six semicircular canals |
| Cervical VEMP | Saccule and inferior vestibular nerve |
This is why, in some presentations, they are requested together: each shows a different part of the system.
How is it carried out?
- The skin is cleaned and adhesive electrodes are placed on the neck, the forehead and near the collarbone.
- Headphones deliver short, intense sound stimuli, one ear at a time.
- During recording, you keep your head turned to one side or slightly lifted, to tense the neck muscle. This is done in short cycles, with rests in between.
- The equipment captures the variation in muscle activity and builds the response curve.
The test takes about twenty minutes. Neck fatigue is the discomfort most often reported.
When is it indicated?
- Investigation of dizziness where involvement of the saccule or inferior vestibular nerve is suspected.
- Suspected superior semicircular canal dehiscence, where loud sounds, exertion or pressure changes trigger dizziness.
- Supplementary assessment in Ménière’s disease.
- Follow-up of vestibular changes over time.
One practical note: conductive hearing loss in the ear being tested may prevent sound reaching sufficient intensity, making recording unfeasible on that side. This is why audiometry comes first.
Where it is carried out
At Clínica Rhinus, in the Renascença district of São Luís, as part of the neurotologic assessment. The result is read at the consultation, alongside the other balance tests.
This test is carried out on a self-pay basis only. The consultation and the other tests follow the rules of your health plan. Contact our team to arrange booking.
How should I prepare for this test?
- Bring the medical request: it is required.
- Wash the hair and the skin of the neck, with no cream, oil or make-up in the area.
- Do not use make-up, sunscreen or moisturiser on the face on the day of the test: they interfere with electrode contact.
- Tell us if you have neck pain, restricted movement or recent neck surgery.
- Tell us if you have conductive hearing loss: it may make the test unfeasible on that side.
- Bring your audiogram and any previous balance tests.
Sources: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.
Frequently asked questions
Questions about balance
Why does a balance test measure a neck muscle?
Because there is a reflex linking the saccule, in the inner ear, to the neck musculature. A loud sound stimulates the saccule and produces a minute variation in the contraction of the sternocleidomastoid muscle on the same side. The electrodes capture that variation, and it is what shows whether this pathway is working.
Does the test hurt?
It does not hurt. Adhesive electrodes are placed on the neck, the forehead and near the collarbone, and sound is delivered through headphones. What tends to be tiring is the part where you must keep your head turned or lifted to tense the muscle, in short cycles with rests in between.
Can the loud sound in the test damage my hearing?
The test uses high-intensity stimuli, but for very short periods and with control of the total dose, within the parameters described for the procedure. The duration of stimulation is recorded during the test, and it is not repeated without need.
When is it indicated?
In the investigation of dizziness where involvement of the saccule or the inferior vestibular nerve is suspected, in the assessment of superior semicircular canal dehiscence — where loud sounds or exertion provoke dizziness — and as part of the assessment of Ménière's disease, always alongside the other tests.