A New Insight into Vestibular Exploration

Dear Colleagues,

Acute and chronic balance disorders are one of the main reasons for seeking consultation with the general practitioner and the audiologist or ENT specialist. Etiologies are broadly categorized into peripheral and central causes, and since symptoms can overlap, a comprehensive physical examination can often help differentiate the two. Clinical history, bedside examination and instrumental tests represent the fundamental tools for diagnosis.

The strategy is very different depending on whether the patient is in the acute or chronic phase. In the first case, bedside diagnostics alone are often sufficient, as is the case with patients with central lesions. The chronic patient is much more complex, and this is due to a number of reasons. Vestibular compensation may have modified or eliminated spontaneous signs or those generated by clinical maneuvers, but not necessarily the symptoms. The apparent normality of instrumental tests does not guarantee that the vestibular system continues to provide correct information from a perceptive point of view. Finally, the inevitable emotional and cognitive consequences of the chronic disorder pollute and worsen the clinical picture.

For these reasons, we want to critically reconsider the diagnostic strategy and focus on the often overlooked perceptive, emotional and cognitive aspects, which play a decisive role in the diagnosis as well as the pharmacological and especially re-educational treatment.

Dr. Vincenzo Marcelli
Guest Editor

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• vertigo
• unsteadiness
• dizziness
• nystagmus
• bedside vestibular examination
• video-HIT
• VEMPs
• subjective visual vertical
• dynamic visual acuity