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Audiology Research
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Episodic Vertigo: Differences, Overlappings, Opinion and Treatment
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Episodic Vertigo: Differences, Overlappings, Opinion and Treatment

A special issue of Audiology Research (ISSN 2039-4349).

Deadline for manuscript submissions: 30 April 2025 | Viewed by 15701

Special Issue Editors

Dr. Roberto Teggi

E-Mail Website
Guest Editor
ENT Department, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
Interests: tinnitus; vertigo; vestibular diseases; Meniere disease; otoneurology
Special Issues, Collections and Topics in MDPI journals
Dr. Alexandre Bisdorff

E-Mail Website
Guest Editor
Ctr Hosp Emile Mayrisch, Clinique du Vertige, Rue Emile Mayrisch, L-4240 Esch Sur Alzette, Luxembourg
Interests: vertigo; migraine; oculomotor; classification

Special Issue Information

Dear Colleagues,

episodic vertigo is a major clinical problem; the most common long lasting (more than 20 minutes) forms are Menière’s Disease and Vestibular Migraine. Diagnostic criteria for both disorders mainly rely on clinical history and for the differential diagnosis between them on an audiometric exam. Since in some cases tinnitus, hearing loss and fullness may be concomitant symptoms also in VM, in early stages a differential diagnosis may be a puzzling dilemma. MRI with delayed images in MD may be useful in demonstrating hydrops, nonetheless hydrops has been found in some VM patients. Some patients with episodic vertigo do not fulfill the criteria for MD or VM; they are currently called NOS (Not Otherwise Specified). It is under debate if they represent a specific disorder. Finally, people with episodic vertigo may develop a chronic instability without vertigo, actually named PPPD (Persistent Postural Perceptual Dizziness).

A part of recent literature has focused on the relationship between the above mentioned disorders and on the possibility of characterizing subgroups of subjects for these disorders with specific features in order to develop a more tailored therapy. For one of them, MD, some papers have been already published on the topic.

The purpose of this special number should be to collect papers on these 4 conditions. Original papers as well as reviews on these disorders will be accepted, with a focus on:

  • Proposed exams helpful to differentiate\characterize subgroups of patients for each disorder
  • Etiology and pathophysiology
  • Therapy

Dr. Roberto Teggi
Dr. Alexandre Bisdorff
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Audiology Research is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • episodic vertigo
  • menière’s disease
  • vestibular migraine
  • PPPD
  • NOS
  • therapy of episodic vertigo

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Published Papers (7 papers)

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Research

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13 pages, 1216 KiB  
Article
Clinical Profile, Trends, and Management in Pediatric Patients with Audiovestibular Disorders: Can We Predict Emotional Disability in Pediatric Patients with Episodes of Vertigo and Dizziness?
by Joan Lorente-Piera, Nicolás Pérez-Fernández, Melissa Blanco-Pareja, Raquel Manrique-Huarte, Pia Michael Larenas, Valeria Serra and Manuel Manrique
Audiol. Res. 2024, 14(4), 701-713; https://doi.org/10.3390/audiolres14040059 - 14 Aug 2024
Viewed by 983
Abstract
Background: Audiovestibular disorders in childhood occur with considerable frequency. However, the difficulty of obtaining medical history, the nonspecificity of symptoms, and the lack of cooperation during complementary tests often contribute significantly to diagnostic biases, attributing clinical presentations to psychosomatic disorders. The objectives of [...] Read more.
Background: Audiovestibular disorders in childhood occur with considerable frequency. However, the difficulty of obtaining medical history, the nonspecificity of symptoms, and the lack of cooperation during complementary tests often contribute significantly to diagnostic biases, attributing clinical presentations to psychosomatic disorders. The objectives of this work are, firstly, to characterize, from an auditory and vestibular perspective, the most frequent causes of vertigo in childhood and a possible relationship with emotional symptoms. On the other hand, to propose the usefulness of the MSSQ-Short questionnaire as a predictive variable in the evolution of children diagnosed with recurrent vertigo of childhood (RVC). Methods: An observational cross-sectional study was designed with retrospective data collection at three tertiary hospitals. Results: Among the 117 patients recruited between 2016 and 2024, 32 patients (27.35%) were diagnosed with an anxious-depressive syndrome prior to audiovestibular testing. The mean age was 11.19 ± 5.61 years and the most frequent final diagnoses were vestibular migraine (VM) with 41.03% and RVC with 23.93%. Patients with VM, compared with RVC, are approximately 1.12 times more likely to have psychosomatic pathology (CI 0.39 to 3.25). The most sensitive and frequently altered test was VEMPS (39.32%), with statistical significance in VM and otic capsule dehiscence, while regarding the MSSQ-Short questionnaire, the linear regression of 0.28 indicates an increase in clinical duration with high questionnaire scores. Conclusions: Vestibular disorders causing dizziness and vertigo are challenging to diagnose, often due to lack of cooperation and/or symptom nonspecificity. A thorough medical history and complementary tests, including audiovestibular and imaging studies, are advisable, thus avoiding systematically attributing children’s complaints to other psychosomatic disorders. Full article
(This article belongs to the Special Issue Episodic Vertigo: Differences, Overlappings, Opinion and Treatment)
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14 pages, 2185 KiB  
Article
Episodic Vertigo: A Narrative Review Based on a Single-Center Clinical Experience
by Augusto Pietro Casani, Mauro Gufoni and Nicola Ducci
Audiol. Res. 2023, 13(6), 845-858; https://doi.org/10.3390/audiolres13060074 - 1 Nov 2023
Cited by 1 | Viewed by 1968
Abstract
(1) Background: Usually, the majority of patients suffering from vertigo and dizziness can be identified in four major categories: acute spontaneous vertigo, episodic (recurrent) vertigo, recurrent positional vertigo, and chronic imbalance. Our purpose is to retrospectively evaluate the main causes of episodic vertigo [...] Read more.
(1) Background: Usually, the majority of patients suffering from vertigo and dizziness can be identified in four major categories: acute spontaneous vertigo, episodic (recurrent) vertigo, recurrent positional vertigo, and chronic imbalance. Our purpose is to retrospectively evaluate the main causes of episodic vertigo and to find indications for a reliable clinical suspicion useful for a definitive diagnosis, comparing patients affected by different presenting symptomatology (acute vertigo, recurrent episodic vertigo, and imbalance). (2) Methods: we retrospectively evaluated the clinical records in a population of 249 consecutive patients observed for vertigo in our tertiary referral center in the period 1 January 2019–31 January 2020. On the basis of the reported clinical history, patients were divided into three groups: patients with their first ever attack of vertigo, patients with recurrent vertigo and dizziness, and patients with chronic imbalance. (3) Results: On the basis of the results of the instrumental examination, we arbitrarily divided (for each type of symptoms) the patients in a group with a normal vestibular instrumental examination and a group of patients in which the clinical–instrumental evaluation showed some pathological results; a highly significant difference (p: 0.157) was found between recurrent and acute vertigo and between recurrent vertigo and imbalance. (4) Conclusions: Patients with recurrent vertigo more frequently exhibit a negative otoneurological examination since they are often examined in the intercritical phase. A precise and in-depth research of the patient’s clinical history is the key to suspect or make a diagnosis together with the search for some instrumental or clinical hallmark, especially in cases where the clinical picture does not fully meet the international diagnostic criteria. Full article
(This article belongs to the Special Issue Episodic Vertigo: Differences, Overlappings, Opinion and Treatment)
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6 pages, 568 KiB  
Communication
Vestibular Migraine Therapy: Update and Recent Literature Review
by Laura Zanandrea, Bruno Colombo and Massimo Filippi
Audiol. Res. 2023, 13(5), 724-729; https://doi.org/10.3390/audiolres13050064 - 27 Sep 2023
Viewed by 2824
Abstract
Vestibular migraine (VM) is a neurological condition that causes vertigo and headache. It is considered the most common cause of episodic vertigo. However, specific treatments are missing, and medications currently used in VM are borrowed from migraine therapy. A comprehensive practical review of [...] Read more.
Vestibular migraine (VM) is a neurological condition that causes vertigo and headache. It is considered the most common cause of episodic vertigo. However, specific treatments are missing, and medications currently used in VM are borrowed from migraine therapy. A comprehensive practical review of the literature assessing the evidence for abortive and preventive interventions in adults with VM was published in 2022, providing practical recommendations about VM treatment. The aim of our paper is to provide an updated overview of the current state of the art of VM treatment, illustrating new evidence available in this field. Along with traditional pharmacological preventive therapies, medications targeting the CGRP pathways have recently been investigated in terms of treatment effect in VM patients, with encouraging results. Also, there is new evidence of the efficacy of non-pharmacological interventions. However, the overall evidence base for VM treatment remains sparse. Full article
(This article belongs to the Special Issue Episodic Vertigo: Differences, Overlappings, Opinion and Treatment)
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12 pages, 1393 KiB  
Article
Vestibular and Oculomotor Findings in Vestibular Migraine Patients
by Sofia Waissbluth, Valeria Sepúlveda, Jai-Sen Leung and Javier Oyarzún
Audiol. Res. 2023, 13(4), 615-626; https://doi.org/10.3390/audiolres13040053 - 8 Aug 2023
Cited by 1 | Viewed by 3257
Abstract
Background: Vestibular migraine (VM) is the most frequent etiology of recurrent spontaneous episodic vertigo. Vestibular and oculomotor abnormalities have been described in VM; however, the diagnosis is currently based on symptoms. The objective of this study was to determine the most frequent abnormalities [...] Read more.
Background: Vestibular migraine (VM) is the most frequent etiology of recurrent spontaneous episodic vertigo. Vestibular and oculomotor abnormalities have been described in VM; however, the diagnosis is currently based on symptoms. The objective of this study was to determine the most frequent abnormalities in videonystagmography (VNG), caloric testing (Cal) and video head impulse test (vHIT) in patients with VM. Methods: A retrospective cohort study was conducted, including all VM and probable VM patients seen from January 2021 to July 2022. Demographics, auditory symptoms and results via VNG, Cal and vHIT were evaluated. VNG results were compared with a control group. Results: Sixty patients, 81.7% with VM and 18.3% with probable vestibular migraine, were included. VNG revealed the following abnormalities: 21.7% spontaneous nystagmus; 33.3% positional nystagmus, mostly central; 26.7% optokinetic nystagmus; 56.7% smooth pursuit abnormalities and 70% saccade test abnormalities, mostly velocity and latency. An abnormal unilateral caloric response was seen in 22.9%, while vHIT revealed a low gain in at least one canal in 21.7%, and saccades were seen in at least one canal with normal gains in 18.3%. Concordant results between Cal and lateral vHIT were seen in 77.1% of cases. Conclusions: Although VM is a clinical diagnosis, vestibular and oculomotor abnormalities are commonly seen. The most frequent oculomotor findings were an abnormal saccade test, abnormal smooth pursuit and central positional nystagmus. Full article
(This article belongs to the Special Issue Episodic Vertigo: Differences, Overlappings, Opinion and Treatment)
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Review

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10 pages, 832 KiB  
Review
Instrumental Assessment and Pharmacological Treatment of Migraine-Related Vertigo in Pediatric Age
by Pasquale Viola, Alfonso Scarpa, Giuseppe Chiarella, Davide Pisani, Alessia Astorina, Filippo Ricciardiello, Pietro De Luca, Massimo Re and Federico Maria Gioacchini
Audiol. Res. 2024, 14(1), 129-138; https://doi.org/10.3390/audiolres14010011 - 29 Jan 2024
Viewed by 1427
Abstract
Background: The most frequent form of vertigo in pediatric age is represented by vertigo linked to migraine, with a prevalence of 32.7%. This group of pathologies has received a redefinition of the diagnostic criteria to adapt them to the pediatric age with a [...] Read more.
Background: The most frequent form of vertigo in pediatric age is represented by vertigo linked to migraine, with a prevalence of 32.7%. This group of pathologies has received a redefinition of the diagnostic criteria to adapt them to the pediatric age with a new classification of the clinical pictures. We have several kinds of problems with these conditions that often have a significant impact on patients’ and parents’ quality of life: the diagnostic approach involves different tools for the different age groups contained in the pediatric range; the treatment of this type of vertigo is not consolidated due to the limited availability of trials carried out on pediatric patients. Focusing on this topic, the aim of this review was to provide an update on the more recent clinical advances in the diagnosis and treatment of Vestibular Migraine (VM) in children. Methods: We searched the PubMed, Embase, and Cochrane library databases for articles published in English from January 2015 to April 2023. The secondary search included articles from reference lists, identified by the primary search. Records were first screened by title/abstract, and then full-text articles were retrieved for eligibility evaluation. The searches combined a range of key terms (“Pediatric” AND “Childhood” AND “dizziness” OR “vertigo” AND “vestibular”). Results: Migraine-related vertigo, in its most recent definitions and classifications, is the most frequent group of balance pathologies in pediatric age. The results from the various experiences present in the literature suggest a clinical approach to be integrated with the use of instrumental tests selected according to the age of the patient and the reliability of the results. Conclusion: Knowing the timeline of the applicability of vestibular tests and the information that can be obtained from them is fundamental for diagnostic accuracy. Therapy is strongly conditioned by the limited availability of pediatric trials and by the wide range it includes, from very young children to adolescents. Full article
(This article belongs to the Special Issue Episodic Vertigo: Differences, Overlappings, Opinion and Treatment)
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Other

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7 pages, 246 KiB  
Brief Report
Similarities and Differences between Vestibular Migraine and Recurrent Vestibular Symptoms—Not Otherwise Specified (RVS-NOS)
by Roberto Teggi, Bruno Colombo, Iacopo Cangiano, Omar Gatti, Mario Bussi and Massimo Filippi
Audiol. Res. 2023, 13(3), 466-472; https://doi.org/10.3390/audiolres13030041 - 8 Jun 2023
Cited by 2 | Viewed by 1744
Abstract
Menière’s disease and vestibular migraine (VM) are two common inner ear disorders whose diagnoses are based on clinical history and audiometric exams. In some cases, patients have been reporting different episodes of vertigo for years but not fulfilling the Bárány Society criteria for [...] Read more.
Menière’s disease and vestibular migraine (VM) are two common inner ear disorders whose diagnoses are based on clinical history and audiometric exams. In some cases, patients have been reporting different episodes of vertigo for years but not fulfilling the Bárány Society criteria for either. These are called Recurrent Vestibular Symptoms—Not Otherwise Specified (RVS-NOS). It is still under debate if this is a single disease entity or a part of the spectrum of already established disorders. The purpose of our work was to establish similarities and differences with VM in terms of clinical history, bedside examination, and family history. We enrolled 28 patients with RVS-NOS who were followed for at least 3 years with stable diagnosis; results were compared with those of 34 subjects having a diagnosis of definite VM. The age of onset of vertigo was lower in VM than in RVS-NOS (31.2 vs. 38.4 years). As for the duration of attacks and symptoms, we detected no differences other than subjects with RVS-NOS reporting milder attacks. Cochlear accompanying symptoms were more frequently reported by VM subjects (one subject reporting tinnitus and another one reported tinnitus and fullness). Motion sickness was equally reported by subjects across two samples (around 50% for both). Bipositional long-lasting, non-paroxysmal nystagmus was the most common finding in the two groups, with no significant difference. Finally, the percentage of familial cases of migrainous headache and episodic vertigo did not differ between the two samples. In conclusion, RVS-NOS shares some common aspects with VM, including the temporal profile of attacks, motion sickness (commonly considered a migraine precursor), bedside examination, and family history. Our results are not inconsistent with the possibility that RVS-NOS may be a heterogeneous disorder, even if some of these subjects may share common pathophysiological mechanisms with VM. Full article
(This article belongs to the Special Issue Episodic Vertigo: Differences, Overlappings, Opinion and Treatment)
12 pages, 784 KiB  
Brief Report
Balance Rehabilitation with Peripheral Visual Stimulation in Patients with Panic Disorder and Agoraphobia: An Open-Pilot Intervention Study
by Daniela Caldirola, Claudia Carminati, Silvia Daccò, Massimiliano Grassi, Giampaolo Perna and Roberto Teggi
Audiol. Res. 2023, 13(3), 314-325; https://doi.org/10.3390/audiolres13030027 - 28 Apr 2023
Viewed by 2297
Abstract
Given the involvement of balance system abnormalities in the pathophysiology of panic disorder and agoraphobia (PD-AG), we evaluated initial evidence for feasibility, acceptability, and potential clinical usefulness of 10 sessions of balance rehabilitation with peripheral visual stimulation (BR-PVS) in an open-pilot 5-week intervention [...] Read more.
Given the involvement of balance system abnormalities in the pathophysiology of panic disorder and agoraphobia (PD-AG), we evaluated initial evidence for feasibility, acceptability, and potential clinical usefulness of 10 sessions of balance rehabilitation with peripheral visual stimulation (BR-PVS) in an open-pilot 5-week intervention study including six outpatients with PD-AG who presented residual agoraphobia after selective serotonin reuptake inhibitor (SSRI) treatment and cognitive–behavioral therapy, dizziness in daily life, and peripheral visual hypersensitivity measured by posturography. Before and after BR-PVS, patients underwent posturography, otovestibular examination (no patients presented peripheral vestibular abnormalities), and panic-agoraphobic symptom and dizziness evaluation with psychometric tools. After BR-PVS, four patients achieved postural control normalization measured by posturography, and one patient exhibited a favorable trend of improvement. Overall, panic-agoraphobic symptoms and dizziness decreased, even though to a lesser extent in one patient who had not completed the rehabilitation sessions. The study presented reasonable levels of feasibility and acceptability. These findings suggest that balance evaluation should be considered in patients with PD-AGO presenting residual agoraphobia and that BR-PVS might be an adjunctive therapeutic option worth being tested in larger randomized controlled studies. Full article
(This article belongs to the Special Issue Episodic Vertigo: Differences, Overlappings, Opinion and Treatment)
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