Absent cervical VEMP responses in iron deficiency anaemia: saccular hypofunction or insufficient sternocleidomastoid activation?

Dear Editor,

We read with great interest the article by Atalay et al. reporting cervical vestibular evoked myogenic potential (cVEMP) findings in 34 patients with iron deficiency anaemia (IDA) and 34 healthy controls¹. The authors are to be commended for addressing a question that, to our knowledge, had not previously been examined, and for the clarity of their laboratory-based case definition. The central observation, that cVEMP responses were absent in 30.8% of IDA ears compared with 5.8% of control ears, is striking. Precisely because the finding is novel and may enter the literature as evidence of "peripheral vestibular hypofunction" in IDA, we would like to raise four methodological points that, in our view, limit this interpretation and that the authors may be able to resolve with their existing data.