Search Results (75)

Peripheral vestibulopathy (PV) is a common disorder that causes dizziness and balance impairment, substantially affecting patients’ quality of life. When symptoms persist, they frequently lead to anxiety, depression, and an increased risk of social isolation. Although central vestibular compensation (CVC) often promotes functional recovery, current pharmacological options remain limited and are primarily aimed at symptom control. Consequently, they should be considered adjuncts rather than alternatives to rehabilitation-based strategies. Vestibular rehabilitation (VR) remains the cornerstone of treatment for promoting functional recovery in patients with PV. Based on the complementary mechanisms of adaptation, substitution, and habituation, VR enhances the central nervous system’s ability to compensate for vestibular deficits by optimizing the integration of visual, proprioceptive, and residual vestibular inputs. Robust evidence from both clinical and preclinical studies has demonstrated its efficacy in improving postural stability, dynamic balance, gaze stabilization, and overall functional performance. Experimental studies using animal models have further highlighted the critical role of active sensorimotor training in ecologically relevant environments for enhancing vestibular compensation. Pharmacological interventions may further facilitate these adaptive processes by modulating the neurobiological mechanisms underlying vestibular compensation, thereby improving responsiveness to rehabilitation. Likewise, emerging neuromodulation approaches, including galvanic vestibular stimulation, have shown promising potential to enhance neural plasticity and augment the effects of rehabilitation. Consequently, combining VR with targeted pharmacological therapies and/or vestibular stimulation techniques may provide synergistic benefits and maximize functional recovery. In conclusion, vestibular rehabilitation should remain the foundation of PV management and be integrated with pharmacological and neuromodulatory approaches within a multidisciplinary therapeutic framework. Further research is needed to optimize rehabilitation protocols, identify the biological determinants of successful vestibular compensation, and develop personalized therapeutic strategies aimed at maximizing functional recovery and improving patients’ quality of life. Full article

Temporohyoid osteoarthropathy is a disease affecting the temporohyoid joint in equids caused by local inflammation and/or degeneration, leading to neurological deficits ranging from mild signs that affect performance to significant, acute neurological deficits such as facial nerve paralysis or vestibular signs. Multiple surgical treatment options are available, and while treatment has historically been performed unilaterally on the side of the clinical signs, advances in diagnostic imaging have highlighted the occurrence of bilateral disease of the temporohyoid joints, warranting evaluation of bilateral surgical treatment. The objective of this study is to report the findings, surgical complications, and outcomes of both unilateral and bilateral ceratohyoidectomy in 33 equids diagnosed with THO. This study found that there was no significant difference in outcome based on which procedure was performed, but that increased age and longer duration of clinical signs were associated with decreased likelihood of horses returning to work or showing clinical improvement. Overall, this study reports 84% survival to long term; 86% cases showed improvement, with 38% showing complete resolution of signs, 62% returned to the previous level of exercise, and 77% returned to work at the same or lower level. Full article

Sport-related concussion (SRC) rehabilitation has advanced toward active, multidomain management, yet recovery may still be judged largely through symptom resolution and broad clinical indicators that may not fully capture persistent functional deficits. Emerging evidence suggests subtle disturbances in postural control, gait, and sensorimotor coordination may persist beyond apparent clinical recovery, raising the possibility that unresolved asymmetries represent an underrecognized dimension of dysfunction. This Viewpoint proposes symmetry restoration as a potential rehabilitative construct in SRC management and explores how biofeedback-guided approaches may provide a conceptual framework for identifying, monitoring, and retraining symmetry-related deficits. Drawing from concussion research, motor control theory, rehabilitation science, and biofeedback applications, this article discusses postural and movement asymmetries as possible markers of incomplete recovery, examines visual, wearable, neuromuscular, and auditory biofeedback strategies as potential mechanisms for symmetry-informed rehabilitation, and outlines clinical implications and future research priorities. Rather than proposing symmetry as a stand-alone determinant of recovery, this Viewpoint advances the conceptual proposition that symmetry-oriented approach may complement existing multidomain models by serving as an additional layer of functional assessment alongside symptom reporting, neurocognitive evaluation, vestibular and oculomotor examination, exertional testing, and routine clinical assessment. Within this framework, symmetry-related measures are envisioned not as independent clearance criteria, but as potentially informative indicators of residual sensorimotor function that may help guide rehabilitation progression and contribute to more functionally informed return-to-sport decision making through adjunctive measures such as center-of-pressure behavior, center-of-mass displacement, gait symmetry, stance and swing time asymmetry, limb-loading patterns, interlimb coordination, and muscle activation symmetry. Full article

Background: Caloric–vHIT (CalHiT) dissociation has been considered highly characteristic of Ménière’s disease (MD), but its occurrence in vestibular migraine (VM) remains incompletely characterized. Objective: The primary aim was to characterize, through detailed longitudinal analysis, the clinical and mechanistic heterogeneity underlying caloric-vHIT dissociation in seven patients with definite VM in a retrospective cohort. Study design: Observational, retrospective case series. Methods: From a standardized vestibular cohort of 100 consecutive patients with definite MD or VM evaluated between 2015 and 2018, seven patients with definite VM who exhibited caloric-vHIT dissociation were identified and followed up for approximately seven years. The frequency of dissociation patterns within the source cohort was recorded to contextualize case selection, and each case was characterized descriptively as follows: Patterns were classified as CalHiT-0 (CP < 22%, vHIT ≥ 0.80), CalHiT-A (CP ≥ 22%, vHIT ≥ 0.80), CalHiT-B (CP < 22%, vHIT < 0.80), and CalHiT-C (CP ≥ 22%, vHIT < 0.80). Results: At the cohort level, A-pattern dissociation occurred in 17.5% of patients with VM (7/40) and 56.7% of patients with MD (34/60), while B-pattern dissociation was rare (MD: 2/60, 3.3%; VM: 1/40, 2.5%). One patient with CalHiT-A VM was lost to follow-up and excluded from the longitudinal analysis. At the case level, the seven cases (six CalHiT-A and one CalHiT-B) suggested mechanistic heterogeneity, including compensated peripheral hypofunction, familial vulnerability, traumatic injury, and potential central modulation. VM was distinguished by the absence of fluctuating auditory symptoms, absence of progressive hearing loss characteristic of MD, and DHI-measured disability comparable to that of MD despite substantially lower objective vestibular deficits. No VM case with confirmed follow-up evolved toward MD. Conclusions: Caloric-vHIT dissociation occurred in approximately one-sixth of patients with definite VM and should not be regarded as a stand-alone sign of endolymphatic hydrops. The clinical heterogeneity across cases suggests that several mechanisms other than hydrops may produce a comparable pattern. These observations could support future studies exploring whether a distinct VM phenotype defined by this dissociation can be established and favor interpreting the dissociation alongside the auditory and longitudinal profiles rather than in isolation. Full article

Vertigo, dizziness, and oculomotor disturbances may occur as manifestations of immune-mediated disorders affecting the inner ear, central vestibular pathways, or multisystem autoimmune disease. Although uncommon, these conditions are clinically important because delayed recognition may lead to irreversible hearing loss, vestibular dysfunction, or neurological disability. This review summarizes the clinical presentation, diagnostic approach, and treatment of immune-mediated vestibular and oculomotor disorders. We suggest a practical classification into isolated immune-mediated inner ear disease, systemic autoimmune disorders with audio-vestibular involvement, and autoimmune disorders of the central or peripheral nervous system affecting balance and eye movements. Red flags for such conditions include bilateral or progressive symptoms, fluctuating audio-vestibular deficits, associated neurological signs, and accompanied autoimmune disease. Corticosteroids remain the main first-line treatment in many of these disorders, mainly due to missing data from controlled trials. Steroid-sparing immunosuppressants, biologics, and tumor-directed therapies are effective in many cases; however, because of the missing data, they are only used in selected entities without any other choice. A structured neuro-otological and immunological workup is essential to improve diagnostic accuracy and enable timely therapy. Full article

Background: The vestibular system has traditionally been interpreted within a reflex-based framework, mainly centered on gaze stabilization, vestibulo-ocular reflex pathways, and peripheral vestibular deficits. This model remains essential, but it is insufficient to explain the full spectrum of postural, perceptual, visual-motion, and self-motion complaints observed in contemporary clinical otoneurology. Objective: This conceptual narrative review examines selected representative works by Kathleen E. Cullen as landmarks in a broader transition from reflex physiology to predictive, multimodal, context-dependent, body-centered self-motion control. Methods: This is not a systematic or bibliometric review. Papers were selected because they mark distinct conceptual steps in Cullen’s work: neural encoding of self-motion, peripheral and central coding strategies, multimodal integration, active versus passive self-motion, reafference suppression, body-centered encoding, proprioceptive prediction, vestibular cerebellar internal models, sensory reweighting, and clinical translation. Synthesis: Angelaki and Cullen’s 2008 synthesis and Cullen’s subsequent work demonstrate that vestibular processing is inherently multimodal from the earliest central stages and that neural representations of self-motion depend on behavioral context. Vestibular nuclei, visual-vestibular networks, and vestibular cerebellar circuits integrate labyrinthine signals with optic flow, proprioceptive, oculomotor, motor, cerebellar, cortical, and contextual information. This architecture enables the brain to distinguish expected from unexpected motion, suppress predictable vestibular reafference during voluntary action, compute internal estimates of body motion, adapt to altered sensory reliability, and reweight sensory inputs according to task demands. Conclusions: The clinical relevance of this trajectory is substantial. Patients may show preserved high-acceleration vestibulo-ocular reflex responses while experiencing persistent instability, visually induced dizziness, defective self-motion perception, or abnormal sustained vestibular processing. Such dissociations are not paradoxical when the vestibular system is understood as a predictive, distributed, body-centered control system. Cullen’s long lesson offers a neurophysiological foundation for a modern vestibular grammar in which clinical findings are interpreted across the reflexive, perceptual, postural, visual-vestibular, sustained, and predictive domains. Full article

Background and Clinical Significance: Vestibular drop attacks are a rare but disabling manifestation of Ménière’s disease. This study aimed to demonstrate the value of multimodal audiovestibular assessment in documenting vestibular deficit after intratympanic gentamicin therapy. Case presentation: A 57-year-old woman with refractory Tumarkin crises underwent serial audiological and vestibular testing before and after intratympanic gentamicin treatment. Post-treatment testing demonstrated right-sided vestibular hypofunction with caloric areflexia, reduced vestibulo-ocular reflex gain, corrective saccades on video head impulse testing, and absent cervical vestibular-evoked myogenic potentials. Hearing thresholds showed transient deterioration with near-baseline recovery during follow-up. Vestibular drop attacks resolved completely. Conclusions: Multimodal audiovestibular assessment provides objective documentation of treatment-induced vestibular hypofunction after intratympanic gentamicin therapy in refractory Ménière’s disease. Full article

Background/Objectives: Hyperventilation-induced nystagmus (HVIN) has been described as a sensitive clinical sign in vestibular schwannoma (VS), potentially reflecting a reversible conduction block in partially demyelinated vestibular nerve fibers. However, its relationship with tumor size and instrumental vestibular deficits remains controversial. This study aimed to investigate the association between HVIN, tumor size, clinical presentation, and vestibular function assessed by the video Head Impulse Test (vHIT) and functional Head Impulse Test (fHIT). Methods: Eighty consecutive patients with unilateral VS were retrospectively evaluated. All underwent bedside vestibular examination, the vHIT, the fHIT, and the Hyperventilation Test (HVT). Tumors were classified according to the modified Koos–Sanna grading system. Associations between HVIN (presence and direction), demographic and clinical variables, vestibular deficits, and tumor size were analyzed using binary logistic regression, Fisher’s exact test, Welch’s independent samples t-test, and the Mann–Whitney U test. Results: HVIN was observed in 73% of patients. Among the patients with HVIN, ipsilesional horizontal nystagmus occurred in 57% of cases, 41% of the subjects showed contralesional nystagmus and one patient had downbeat nystagmus. vHIT abnormalities were identified in 54% of patients, while 30% of these also demonstrated fHIT deficits. No patient presented isolated fHIT abnormality. HVIN was detected even in patients with intracanalicular or small tumors and in some asymptomatic individuals. No statistically significant correlations were found between tumor size and HVIN presence, HVIN direction, or vestibular deficits in the vHIT/fHIT (all p > 0.05). Conclusions: HVIN is frequently observed in patients with VS, including those with small or asymptomatic lesions. However, neither its presence nor direction correlates with tumor size or objective vestibular deficit. The Hyperventilation Test should not be considered a prognostic tool but may serve as a simple and valuable adjunctive bedside examination in the early diagnostic suspicion of vestibular schwannoma. Full article

Post-traumatic auditory and vestibular complaints are frequent after traumatic brain injury (TBI) and temporal bone trauma. They create particular difficulty in medico-legal practice because the evaluator must distinguish diagnosis, functional impact, plausibility of traumatic causation, and the credibility of reported deficits and/or symptoms. This manuscript is a narrative expert review, not a systematic review or a validated forensic prediction rule. It aims to synthesize clinically relevant evidence and propose a practical cross-check framework for structured audio-vestibular assessment in post-traumatic and medico-legal contexts. Pure-tone audiometry remains the functional entry point, but it should be interpreted in conjunction with speech audiometry, tympanometry, acoustic reflexes, transient-evoked and distortion-product otoacoustic emissions, auditory brainstem responses, and auditory steady-state responses. Vestibular evaluation should combine videonystagmography, video head impulse testing, cervical and ocular vestibular evoked myogenic potentials, and computerized dynamic posturography, recognizing that each method interrogates different physiological domains and frequencies. Particular emphasis is placed on the separation between clinical diagnosis, physiological localization, functional impairment, and medico-legal attribution. The article also discusses safeguards against false-positive attribution of malingering, the time course after TBI, inter-rater variability, and the role of specialist expertise in medico-legal reporting. The proposed framework does not eliminate uncertainty; rather, it is intended to make expert reasoning transparent, cautious, internally consistent, and defensible. Full article

Objective: This study aims to analyze the characteristics of vestibular evoked myogenic potentials (VEMPs) and evaluate specific vestibular nerve pathway impairments in children with Attention Deficit Hyperactivity Disorder (ADHD) compared to typically developing (TD) children. Methods: Forty-five children with ADHD and 34 TD children were recruited. All participants underwent comprehensive acoustic (ACS) and galvanic (GVS) VEMP examinations. To account for within-subject correlation, statistical analyses were performed at the subject level. Results: Children with ADHD exhibited prolonged P13 and N23 latencies in both ACS-cVEMP and GVS-cVEMP compared to TD children. For oVEMP, the N1 latency of ACS-oVEMP was significantly shorter in the ADHD group, and the interval was prolonged. Additionally, the absolute amplitude of ACS-cVEMP was significantly and markedly higher in children with ADHD. Conclusions: Children with ADHD exhibit functional abnormalities in both the saccule inferior vestibular nerve pathway (reflected by cVEMP) and the utricle superior vestibular nerve pathway (reflected by oVEMP). These impairments are primarily characterized by altered neural conduction latencies and hyperactive amplitude responses, providing valuable electrophysiological insights into vestibular dysfunction in ADHD. Full article

Background/Objectives: Stroke frequently leads to balance deficits. Vestibular physical therapy (VPT) may enhance postural control through neuroplastic mechanisms. Virtual reality (VR) can provide ecologically valid environments for rehabilitation, increasing patient engagement. Methods: In this randomized feasibility study, nine individuals with chronic stroke were randomized to either a Real visuo–vestibular rehabilitation group (n = 6) or a Sham VR group (n = 3) to explore the feasibility of the protocol and randomization procedures rather than to compare clinical efficacy. Both groups were trained in immersive VR environments for 12 sessions. The Real group experienced visuo–vestibular stimuli requiring sensorimotor integration; the Sham group trained in the same environments without such stimuli. Feasibility was assessed through attendance, participation (Pittsburgh Rehabilitation Participation Scale, PRPS), and user satisfaction (USEQ). Safety and acceptability were monitored through adverse event reporting. Secondary exploratory outcomes included measures of balance—the Mini Balance Evaluation Systems Test (MiniBESTest), the Berg Balance Scale (BBS), and the Performance-Oriented Mobility Assessment (POMA)—as well as functional independence (Barthel Index), health-related quality of life (Stroke-Specific Quality of Life Scale, SSQoL), and a set of spatiotemporal and gait quality parameters derived from inertial measurement unit (IMU) data collected during the 10-Meter Walk Test and the Figure of 8 Walk Test. Results: All participants completed the protocol without adverse events. Participation, as measured by the PRPS, remained consistently high across sessions (mean ≥5.7/6), while USEQ scores indicated excellent user satisfaction (mean ≥28/30). Exploratory analyses revealed improvements in MiniBESTest and BBS scores for the Real group. Instrumental measures derived from IMUs demonstrated improvements across groups. Conclusions: Exploratory outcomes suggested positive trends in balance improvements, and the integration of clinical scales with wearable sensors proved feasible and informative. Full article

Anti-GQ1b antibody syndrome (AGABS) unifies triad-defined Miller Fisher syndrome (MFS), Bickerstaff brainstem encephalitis (BBE), and the ophthalmoplegic variant of Guillain–Barré syndrome (GBS-O) under a post-infectious immune mechanism centered on IgG to disialosyl gangliosides. The spectrum also encompasses triad-minus phenotypes—acute ophthalmoparesis without ataxia, acute vestibular syndrome, optic involvement, and acute sensory-ataxic neuropathy. A molecular-mimicry model with complement-mediated nodal/paranodal dysfunction explains severe early deficits despite bland limb nerve conduction studies (NCSs), the cranial/proprioceptive predilection, and generally favorable treatment responsiveness to immunotherapy. In practice, a serology-first strategy, complemented by targeted electrophysiology—blink and H-reflex testing, and, where feasible, paired SEP–ABR showing a literature-supported dissociation (normal ABR with impaired median-nerve cortical SEPs), which, in our series, was documented in one illustrative BBE case—and by structured neuro-otologic examination, mitigates the “normal-NCS trap” and enables timely treatment. Intravenous immunoglobulin (IVIg) is first-line; plasma exchange (PLEX) is an alternative in severe or IVIg-ineligible cases; and intravenous methylprednisolone (IVMP) may be added selectively for central/optic-weighted phenotypes without routine oral taper. We consolidate actionable diagnostic and therapeutic steps and examine them in an institutional series of 16 consecutive seropositive patients (2015–2025): all were anti-GQ1b-positive with frequent GT1a co-reactivity; most reported an antecedent infection—typically upper respiratory, less often gastrointestinal—within the two weeks before onset; limb NCSs were often nondiagnostic whereas reflex/evoked-potential studies were informative; two required intubation in addition to IVIg; outcomes were generally favorable with early immunotherapy. The practical message: order anti-GQ1b at first contact, pair targeted electrophysiology with neuro-otology, and treat early to exploit reversible nodal/paranodal dysfunction. Full article

NF2-related Schwannomatosis (NF2-SWN) remains a disorder with few effective treatment options. Patients develop vestibular schwannomas (VSs) on both auditory nerves, which gradually impair hearing and often result in significant communication difficulties, social withdrawal, and higher rates of depression. Progress in understanding NF2-SWN biology and translating discoveries into therapies has been slowed by the absence of robust animal models that faithfully reproduce both tumor behavior and the associated neurological deficits. In this review, we summarized the development of animal models that not only reproduce tumor growth in the peripheral nerve microenvironment but also reproduce tumor-induced neurological symptoms, such as hearing loss and ataxia. We further highlight the currently available organotypic models for NF2-SWN. Together, these systems provide an essential foundation for advancing mechanistic studies and accelerating the development of effective therapies for this devastating disorder. Full article

Background/Objectives: Tumors of the cerebellopontine angle (CPA) encompass a limited range of histologies, predominantly vestibular schwannomas (VSs), meningiomas, and paragangliomas (PGLs). Their growth region threatens the cranial nerves (V–XII), brainstem, and cerebellum, possibly causing functional deficits. This review aims to synthesize clinical features and multidisciplinary treatment strategies for CPA tumors with brainstem involvement, emphasizing functional preservation alongside tumor control. Methods: A systematic PubMed search identified studies on VSs, CPA meningiomas, and intradural PGLs. Eligibility criteria included studies reporting tumor management and cranial nerve outcomes. Data extraction focused on tumor size, neurological presentation, surgical approach, adjunctive therapies, and postoperative cranial nerve function. Multidisciplinary involvement and rehabilitation strategies were noted. Results: Twenty studies (3311 patients) analyzed large VSs, showing facial nerve dysfunction in 8–53%, trigeminal neuropathy in 20–77%, and cerebellar signs in up to 79%. Microsurgery (MS) achieved variable gross total resection, while stereotactic radiosurgery (SRS) preserved facial nerve function but carried trigeminal and hydrocephalus risks. CPA meningiomas demonstrated cranial nerve displacement patterns critical for surgical planning, with transient deficits common and recovery linked to baseline function. In 388 intradural PGL cases, staged surgery combined with preoperative embolization was standard; functional preservation of lower cranial nerves was often limited. Across all histologies, multidisciplinary management and targeted rehabilitation were essential. Conclusions: Optimal CPA tumor management balances tumor control with functional preservation. VSs benefit from individualized MS or SRS based on size and mass effect. Meningioma surgery prioritizes cranial nerve preservation over radical resection. Intradural PGLs require staged vascular-conscious approaches. Multidisciplinary care and structured rehabilitation are pivotal to improving outcomes and quality of life. Full article

This study examined the efficacy of a 12-week school-based program combining proprioceptive and plyometric training to enhance static and dynamic balance in children and adolescents with visual impairment. A total of 33 students were randomly assigned to either an experimental group (EG; n = 18), receiving a one-weekly session of integrative training alongside regular physical education, or a control group (CG; n = 15), following only the standard curriculum. Balance outcomes were assessed at baseline (T0) and post intervention (T1) using stabilometric measures under visual deprivation (eyes closed) and BOT-2 (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition) balance subtests. The EG demonstrated statistically significant reductions in ellipse surface area (p = 0.002, d = −1.29), center of pressure displacement (p < 0.001, d = −1.67), and sway velocity (p = 0.015, d = −1.06), indicating improved postural stability when vision was unavailable. BOT-2 Test 4 showed significant intra-group improvement (p = 0.006, d = 1.37), while BOT-2 Test 3 and between-group comparisons revealed medium-to-large effect sizes, though not always statistically significant. These findings suggest that augmenting somatosensory input through proprioceptive and plyometric training may partially compensate for visual deficits and improve postural control in individuals with visual impairments. This improvement likely reflects the activation of compensatory mechanisms that enhance proprioceptive and vestibular contributions to balance maintenance. Importantly, meaningful improvements occurred with just one weekly session, making this an accessible and scalable intervention for inclusive school settings. Full article