Journal of Vestibular Research

Kim, Hyun-Jae; Kim, Ji-Soo; Büki, Bela

doi: 10.1177/09574271261454144pmid: 42167812

Since the diagnostic criteria of benign paroxysmal positional vertigo (BPPV) were published in 2015 by the Bárány Society, many new ideas and observations have been introduced concerning the diagnostic methods, classification and related theories of pathomechanisms of this most frequent vestibular disease. The aim of the authors was to review new diagnostic methods, classification, hypothetical pathomechanisms of the recently introduced BPPV variants. To look for answers to the “Questions for the Future” published in the Consensus Document (2015) of the Committee for Classification of Vestibular Disorders of the Bárány Society, the authors reviewed the publications listed in PUBMED since 2015 on “diagnosis,” “classification,” “pathomechanism,” of BPPV in the light of their own studies. The questions were:1. The possible role of loose otoconia within the short arm of the semicircular canals.2. Coexistence of canalithiasis and cupulolithiasis.3. Mechanism of “pseudospontaneous” nystagmus and the theory of “canalith jam”.4. Mechanism of persistent geotropic direction-changing positional nystagmus and the theory of light cupula.5. Anterior canalithiasis and the posterior cupulolithiasis.New research results contribute to our understanding of previously unclassified symptoms and examination results. As a conclusion it can be stated that the newly defined entities are important for topodiagnosis and successful treatments by physiotherapy.

Yusta-Ceacero, Aitor; Serrada-Tejeda, Sergio; Sánchez-Herrera Baeza, Patricia; Máximo-Bocanegra, Nuria; Obeso-Benítez, Paula; Horna-Schlincker, Joaquín; Cohen, Helen S.; Martínez-Piédrola, Rosa M; Pérez-de-Heredia-Torres, Marta

doi: 10.1177/09574271261455219

Oh, Eun Hye; Kim, Hyun Sung; Lee, Jin-Ok; Choi, Seo Young; Choi, Kwang-Dong; Choi, Jae-Hwan

doi: 10.1177/09574271261418550pmid: 41549609

ObjectiveThe present study aimed to identify blood-based inflammatory biomarkers that would help investigate the underlying pathogenesis in vestibular neuritis (VN) using a proximity extension assay (PEA).MethodsIn this single-center prospective study, we enrolled both a cross-sectional (acute VN vs normal controls) and a longitudinal (acute phase vs recovery phase) cohorts. We quantified 92 plasma inflammatory proteins using the Olink PEA and identified differentially expressed proteins (DEPs) in each cohort using t-tests. The clinical utility and predictive value of each DEP were evaluated using the Pearson correlation test and receiver operating characteristic (ROC) curve analysis, respectively.ResultsIn the cross-sectional cohort, there were 17 DEPs identified between acute VN (n = 35) and normal controls (n = 35), of which Flt3L was the only downregulated DEP that showed longitudinal changes congruent with clinical disease activity in the longitudinal cohort (n = 18). The correlation analysis revealed that the expression level of CXCL5 was significantly related to the absolute gain and gain asymmetry of the horizontal vestibulo-ocular reflex, while five DEPs (OSM, Flt3L, IFN-γ, MCP-1, and uPA) were negatively correlated with the hospitalization period. ROC curves showed that CXCL1 and Flt3L were upregulated and downregulated DEPs with high predictive values, respectively.ConclusionsThis study shows that the high-throughput PEA technology can be used to identify blood-based inflammatory biomarkers for VN. Our findings highlight the potential value of Flt3L and CXCL1/CXCL5 as objective VN markers that may correlate with disease activity.

Vassard-Yu, Gabrielle; Van Laer, Lien; Hallemans, Ann; Vereeck, Luc; Van Rompaey, Vincent

doi: 10.1177/09574271261448955pmid: 42095575

ObjectivesThis study aims to develop a prognostic model, based on the video Head Impulse Test (vHIT)-Vestibulo-Ocular Reflex (VOR) gain, of vestibular loss after an acute Unilateral Vestibulopathy (aUVP) predicting the probability of an objective and significant recovery.DesignData gathered prospectively in patients with aUVP were re-analyzed. After an exploratory cluster analysis, a multivariate PROBIT regression model was used to objectively pinpoint the value of vHIT-VOR gain at baseline that predicts a significant recovery after 10 weeks. Significant recovery was defined as a vHIT-VOR gain superior or equal to 0.70 after 10 weeks.ResultsA total of 48 subjects were included. The final model identified 2 thresholds, respectively, at 0.53 and 0.74, to classify severe (vHIT-VOR gain ≤0.53), moderate (0.53 < vHIT-VOR gain ≤0.74), and non-significant (0.74 < vHIT-VOR gain) vestibular loss. The probability of a significant recovery was 20% ((Prediction Interval 95% (PI) [0%–43%]) for a gain of 0.50 at baseline, while it doubles (45% (PI [0%–63%]) for an initial gain of 0.60. Our final model demonstrated a good area under the curve (AUC) of 0.85. The corrected AUC after bootstrap resampling was 0.81 (CI 95% [0.74, 0.89]). A good Brier score of the predicted probabilities was also obtained, at 0.15.Conclusions and relevanceFor the first time, this paper proposes a model that objectively defines the severity of vestibular loss at baseline after an aUVP. This research lays the groundwork for future studies to validate our prognostic model and perform more precise analyses of vestibular compensation patterns.

Gargula, Stéphane; Ebode, Dario; Maniaci, Antonino; Radulesco, Thomas; Iannella, Giannicola; Tuset, Maria-Pia; Haddad, Ralph; Michel, Justin

doi: 10.1177/09574271261446228pmid: 42008696

Introduction: Third-window syndromes (TWS), including superior semicircular canal dehiscence (SSCD) and enlarged vestibular aqueduct (EVA), cause paradoxical auditory and vestibular symptoms such as apparent conductive loss, bone-conduction hyperacusis, and sound- or pressure-induced vertigo. Numerical modeling provides a unique means to explore the mechanical consequences of lesion size, geometry, and location.Methods: A structured search of PubMed, Scopus, and Google Scholar (July 2025) identified nine studies applying lumped-element, finite-element (FE), or computational fluid dynamics (CFD) models to SSCD or EVA, which were analyzed qualitatively.Results: Lumped-element models reproduced air–bone gaps and bone-conduction hypersensitivity, showing that lesion size and location modulate functional severity. FE and CFD simulations offered anatomically detailed insights, revealing that dehiscence geometry strongly shapes basilar membrane motion, that sound-induced endolymphatic streaming can account for the Tullio phenomenon, and that large vestibular aqueducts transmit intracranial pressure fluctuations. Validation across studies remained limited.Conclusion: Numerical models provide complementary insights into TWS. Lumped-element approaches are rapid and clinically interpretable, while FE and CFD enable detailed exploration of fluid–structure interactions. Patient-specific simulations may eventually support individualized diagnosis and surgical planning but remain speculative.

Piatti, Diego; Paolocci, Gianluca; Verdecchia, Daniel Hector; Grasso, Maria Grazia; Bosco, Gianfranco; Indovina, Iole; Tramontano, Marco

doi: 10.1177/09574271261444952pmid: 42084487

Multiple Sclerosis (MS) is a chronic, inflammatory, and degenerative disease of the central nervous system. Balance impairments are very common symptoms among people with MS (PwMS). Vestibular physical therapy (VPT) is an evidence-based approach aimed at managing and improving gaze and balance stability, which could be used to mitigate balance disorders in MS. The objective of this systematic review with meta-analysis is to evaluate the effects of VPT in managing balance and dizziness in PwMS.Electronic databases were searched in February 2025 (PubMed, Scopus and Cochrane) and screened by two blind reviewers. Risk of Bias was assessed using PEDro Scale. A meta-analysis was conducted to evaluate, across multiple studies, the effect sizes for two clinical outcomes: the Dizziness Handicap Inventory (DHI) and the Activities-specific Balance Confidence Scale (ABC).After screening, 16 articles were included in the review, mostly comparing VPT with other conventional approaches. Analysis of the Risk of bias showed quality deficiencies in these studied with respect to the blinding of participants, assessor and physiotherapist. The meta-analysis showed significant efficacy of VPT against control using the DHI as outcome measure (Hedges’ g = 1.451, CI [0.190, 2.713]).In conclusion, VPT is a safe approach in reducing dizziness-related disability of PwMS. Further studies are needed to refine assessment methods and explore individualized approaches.

Pan, Qingchun; Wang, Lei; Li, Bei; Zou, Kai

doi: 10.1177/09574271261426885pmid: 41698169

BackgroundVestibular migraine (VM) is frequently complicated by sleep disorders, potentially involving abnormalities in vestibular-brainstem neural pathways. This study aimed to analyze sleep characteristics and influencing factors in VM patients through a multicenter cross-sectional survey, explore associations with symptoms like vertigo and headache, and provide a basis for precise interventions.ObjectiveTo profile the sleep characteristics and clinical features of patients with vestibular migraine (VM), and to explore the influencing factors of sleep disturbance in VM patients.MethodsIn this multi-center cross-sectional study, we recruited VM patients who were treated in otolaryngology department and neurology department of 5 hospitals in Sichuan Province from June 2022 to June 2024 as experimental group (including two subgroups divided based on PSQI score: poor sleep quality (PSQI > 5) and good sleep quality (PSQI ≤ 5)), Meanwhile, the control group was composed of non-VM volunteers matching clinical characteristics of experimental group. After clinical data organization, participants were subjected to sleep quality assessment using the Pittsburgh Sleep Quality Index (PSQI). A multivariate Logistic regression was employed to outline factors influencing sleep disturbance in VM patients. In addition, Spearman correlation coefficient was used as a criterion to identify the correlation of sleep disturbance with headache, vertigo and hearing and other clinical features in VM patients.ResultsWith 530 VM patients included, 332 patients had poor sleep quality (PSQI > 5) (62.64%), 198 patients had good sleep quality (PSQI ≤ 5) (37.36%), and 50 patients were selected as the control. VM group had higher total and individual scores of PSQI (p < 0.05). PSQI in VM patients was correlated with VAS and DHI positively (r = 0.797, p < 0.05; r = 0.834, p < 0.05), but PSQI had no correlation with pure tone hearing (r = 0.324, p = 0.167). Moreover, female, age ≥60 years, living alone, duration of disease ≥3 months, motion sickness history, and HADS-A were independent influencing factors for VM patients with poor sleep quality (p < 0.05).ConclusionSleep disturbance is a major interfering factor in VM patients, and patients may experience more severe headache and vertigo when sleep disorder aggravates. VM patients who are female, ≥60 years old, live alone, have a disease course ≥3 months, have a history of motion sickness, and have anxiety should undergo sleep assessment to determine whether there is poor sleep quality, so as to provide a theoretical basis for VM intervention precisely.

Can, Mehmet; Türüdü, Soner; Aydoğan, Zehra; Özgürsoy, Ozan Bağış

doi: 10.1177/09574271261418549pmid: 41553343

BackgroundMénière’s disease (MD) impairs cognitive function, yet the dynamics of cognitive-motor interference are not well understood. This study investigated dual-task performance in MD, hypothesizing a greater performance cost for patients compared to healthy controls under combined cognitive and postural loads.MethodTwenty-nine patients with MD and 29 healthy controls participated in a dual-task paradigm that combined computerized dynamic posturography (CDP) with a cognitive battery assessing visuospatial, executive, and working memory functions. Performance was measured across Sensory Organization Test (SOT) conditions of increasing difficulty and analyzed using mixed-effects models.ResultsSignificant dual-task interference was found in the MD group only for reaction times on two cognitive tasks (Mental Rotation and Shifting Attention), where increasing postural difficulty disproportionately slowed performance relative to controls. No dual-task effects were found in the other four cognitive tasks (Visual Stroop Task, Backward Digit Span Task, Corsi Block Task, and Symbol Digit Coding Task). Importantly, concurrent cognitive tasks did not significantly impair postural stability in either group. Patients also exhibited baseline deficits specifically on visuospatial working memory tasks.ConclusionIndividuals with MD demonstrate selective cognitive-motor interference in demanding visuospatial and executive tasks, without concomitant deterioration in postural control under dual-task conditions. This suggests a posture first strategy and highlights a quantifiable, task-specific cognitive burden that is a clinically relevant feature of the disorder. Dual-task paradigms provide a sensitive method for assessing this impact, with clear implications for comprehensive patient evaluation and management.

Jiang, Xiaoge; Liu, Dong; Qian, Fuping

doi: 10.1177/09574271261417617pmid: 41525677

The vestibular disorders, which generally manifest themselves as nausea, vomiting, and dizziness or vertigo, have troubled many people. Increasing evidence suggests that certain vestibular disorders are hereditary, and gene variants contribute to the onset and susceptibility of these disorders. This review summarizes the latest research progress, especially the molecular and genetic aspects of several common vestibular disorders, including Meniere’s disease, vestibular migraine, benign paroxysmal positional vertigo, and motion sickness, with the aim of encouraging more fundamental research and enhancing our understanding of the molecular and genetic mechanisms underlying vestibular disorders.

Hoppes, Carrie W.; Dunlap, Pamela M.; Sparto, Patrick J.; Alshebber, Kefah M.; Klatt, Brooke N.; Lambert, Karen H.; Furman, Joseph M.; Huppert, Theodore J.; Whitney, Susan L.

doi: 10.1177/09574271261435448pmid: 41834406