Figure 4. Flowchart illustrating in which order the stimulations (ACS and BCV) should be done to test predominantly the function of the superior and mostly of the utricular nerve using oVEMPs.

IVN: inferior vestibular nerve - SVN: superior vestibular nerve. ACS stimulation may be performed first in patients suffering from vertigo. If ACS induced normal oVEMPs, BCV was not required. If ACS gave abnormal oVEMPs, bone stimulation should be done. We suggest beginning with AFz BCV stimulation: this mode stimulates both labyrinths equally and is easier to perform than mastoid stimulation in a routine clinical setting. When no response was observed on either side to ACS and to AFz stimulation, mastoid BCV stimulation is necessary to appreciate the residual function of the superior vestibular nerve.