Search Results (264)

Ototoxicity represents a clinically significant complication of anticancer therapy in pediatric patients. Cytotoxic agents used in oncology, particularly platinum-based chemotherapy, may induce damage to the auditory and vestibular systems, resulting in hearing loss, tinnitus, and balance disturbances. Even mild hearing impairment during childhood may negatively affect speech perception, language development, communication abilities, and subsequent educational and psychosocial functioning. This narrative review aims to synthesize current evidence on treatment-related ototoxicity in children, with particular focus on commonly implicated therapies, clinical consequences, diagnostic approaches, and potential preventive strategies. A focused literature search was conducted in PubMed for publications from 2019 to 2025 addressing ototoxicity associated with pediatric anticancer treatment and audiological monitoring methods. The analysis indicates that platinum-based compounds, especially cisplatin and carboplatin, remain the primary agents associated with ototoxicity, with reported incidence ranging from approximately 20–70% for cisplatin and 10–30% for carboplatin. Additional risk factors include young age, baseline hearing status, renal function, and exposure to other ototoxic agents such as aminoglycoside antibiotics. Early detection relies on comprehensive audiological monitoring combining behavioral and objective methods, including pure-tone audiometry, extended high-frequency audiometry, otoacoustic emissions, and auditory brainstem response testing. Standardized grading systems such as ASHA, Brock, Chang, and SIOP Boston criteria play a key role in identifying and classifying ototoxic changes. Emerging research focuses on improved monitoring protocols, biomarker identification, and the development of otoprotective strategies, including sodium thiosulfate and experimental molecular therapies. Implementing systematic hearing monitoring and preventive strategies is essential to reduce long-term auditory complications and improve quality of life in pediatric cancer survivors. Full article

Background: Vestibular symptoms and objective vestibular dysfunction have been reported in patients with autoimmune and rheumatologic diseases, but available evidence remains fragmented and methodologically heterogeneous. Previous studies have often addressed audiovestibular involvement as a combined entity, limiting disease-specific interpretation of vestibular outcomes. Methods: A PRISMA 2020-based systematic review was conducted using predefined eligibility criteria targeting vestibular outcomes in autoimmune and systemic rheumatologic diseases. Observational studies reporting vestibular symptoms and/or objective vestibular test results were included. Vestibular data were extracted even when studies reported combined audiovestibular outcomes. Certainty of evidence was assessed using the GRADE approach. Results: Twenty-seven studies were included in the qualitative synthesis, comprising 14 primary observational studies and 13 reviews. Vestibular involvement was reported across multiple diseases, including systemic sclerosis, giant cell arteritis, ankylosing spondylitis, psoriatic arthritis, Behçet disease, primary Sjögren syndrome, rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and vasculitic disorders. Objective vestibular abnormalities were most frequently identified using caloric testing, balance integration measures, videonystagmography, and video head impulse testing. Systemic sclerosis and giant cell arteritis showed more consistently reported vestibular findings, although heterogeneity in assessment methods precluded quantitative synthesis. Conclusions: Vestibular involvement occurs across autoimmune and systemic inflammatory diseases, but overall certainty of evidence remains limited. Standardized vestibular assessment and longitudinal studies are needed to better define disease-specific vestibular phenotypes. Full article

Background/Objectives: This systematic review synthesizes MRI evidence to characterize neuromorphological alterations in somatosensory and vestibular brain regions among adolescents with idiopathic scoliosis (AIS). Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines. We systematically searched five databases from inception to January 2026 for case–control MRI studies comparing AIS patients (10–18 years) with healthy controls. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Newcastle–Ottawa Scale. Results: Across 15 studies (1270 participants), AIS patients demonstrated consistent neuromorphological alterations: (1) lower cerebellar tonsil position (0.9–2.8 mm below baseline), with ectopia incidence correlating with curve severity; (2) cortical thickening in bilateral medial regions but thinning in left paracentral areas; (3) left-dominant white matter volume increases and impaired microstructure in the corpus callosum; and (4) left-sided vestibular morphological changes, including a more vertical semicircular canal. Conclusions: AIS is associated with consistent neuromorphological alterations in key somatosensory and vestibular regions, supporting a potential neuroanatomical basis for impaired sensorimotor integration in its pathogenesis. It should be noted that substantial heterogeneity among the included studies prevented a meta-analysis, and the cross-sectional design limits causal interpretations Registration: This systematic review was registered in PROSPERO (CRD42024577195). Full article

Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease characterized by immune dysregulation, microvascular damage, and progressive fibrosis affecting multiple organs. While cardiopulmonary, renal, and gastrointestinal manifestations have been extensively investigated, involvement of the vestibular system remains insufficiently explored and is likely underrecognized in clinical practice. Vestibular symptoms such as dizziness, vertigo, imbalance, and postural instability may significantly affect quality of life and functional independence in patients with SSc. The pathophysiology of vestibular involvement in SSc is presumed to be multifactorial, involving microangiopathy of the inner ear, immune-mediated damage to vestibular end organs, fibrotic changes affecting inner ear homeostasis, and, in some cases, central nervous system involvement. This narrative review provides a comprehensive and critical synthesis of the current literature on vestibular alterations in systemic sclerosis. We discuss underlying mechanisms, clinical manifestations, diagnostic strategies, associations with common vestibular disorders, and the role of vestibular rehabilitation. By consolidating existing evidence and identifying knowledge gaps, this review aims to promote a more systematic and multidisciplinary approach to the evaluation and management of vestibular dysfunction in SSc. Full article

Postural control relies on the integration of visual, vestibular, and somatosensory inputs under biomechanical constraints. Conventional Romberg testing provides limited quantitative insight, particularly regarding directional control and sensory dependence. Wearable inertial measurement units (IMUs) enable portable, multidimensional assessment of postural sway. Thirty healthy adults (15 females, 15 males) completed a modified Romberg protocol with systematic manipulation of stance (normal, tandem), visual condition (eyes open, eyes closed), and arm position (arms at sides, arms forward), including both left and right leading foot during tandem stance. Whole-body kinematics were recorded using a full-body IMU system comprising 17 wireless sensors. Center-of-mass (CoM) trajectories were derived from a 23-segment biomechanical model, and linear, spatial, and nonlinear sway metrics were computed. Statistical analyses were conducted using repeated-measures ANOVA, with significance set at p < 0.05. Visual deprivation significantly increased sway path length, mean sway velocity, and sway area across all stance conditions (p < 0.001). Tandem stance elicited greater mediolateral sway than normal stance (p < 0.001). Romberg ratios exceeded unity for all metrics and were significantly higher in tandem stance (p < 0.01). Arm position effects were negligible in normal stance but showed significant Vision × Arm interactions during tandem stance (p < 0.05). Leading foot position had no significant main effects. Combining a modified Romberg protocol with full-body IMU-based CoM analysis enables sensitive characterization of sensory dependence and directional postural control. Tandem stance with visual deprivation increases mediolateral postural demands under reduced base-of-support conditions, providing a more challenging context for evaluating directional postural control. Full article

Background: Turner syndrome is a genotypic disorder in females characterized by the total or partial absence of an X chromosome. While cardiovascular issues and sensorineural hearing loss are well-documented, vestibular system involvement remains understudied. This study aims to examine vestibular system involvement in patients with Turner syndrome and assess if they exhibit a higher prevalence of peripheral vestibular pathology compared to the general population. Methods: A retrospective longitudinal study was conducted with 21 Turner syndrome patients and 21 age-matched controls. Evaluations included clinical history, otoscopy, pure tone audiometry, the Video Head Impulse Test (vHIT) to measure vestibulo-ocular reflex gain, and computerized dynamic posturography, specifically the Sensory Organization Test (SOT) and Stability Limits Analysis. Results: Turner syndrome patients showed significantly higher hearing thresholds across all frequencies compared to controls (p < 0.001). In the vHIT, 30% of the Turner group presented pathological results, with significant gain reductions in the right horizontal and left posterior semicircular canals. Posturography revealed a significant reduction in overall stability (p = 0.006) and a significantly lower vestibular index (p = 0.011) in the Turner group. Additionally, patients with Turner syndrome demonstrated significant impairments in directional control, reaction time, and excursion points during Stability Limits Analysis. Conclusions: Patients with Turner syndrome are more likely to experience vestibular disorders, a finding likely associated with estrogen deficiency and the loss of its protective effect on the inner ear. These results highlight the necessity of including vestibular and posturographic assessments in the routine clinical follow-up of these patients to facilitate early detection and rehabilitation, even in the absence of overt symptoms like vertigo. Full article

Background: Objective assessment of postural control is central to the clinical evaluation of vestibular disorders. Although force-platform-based posturography is considered the gold standard, its use may be limited by cost and infrastructural requirements. Wearable inertial measurement units (IMUs) represent a promising alternative; however, their clinical validation should account for intrinsic differences in measurement paradigms rather than strict metric equivalence. Objective: To preliminarily evaluate the within-session reliability of a wearable IMU-based medical device for balance assessment (Gravity), and its agreement with established static (SBP) and computerised dynamic posturographic systems (CDP) in healthy subjects. Methods: Sixty-three healthy adults were enrolled in two independent method comparison studies: a wearable IMU-based balance system versus a static stabilometric platform (GRAVITY vs. SVEP; n = 42) and a wearable IMU-based balance system versus computerised dynamic posturography (Gravity vs. EquiTest; n = 21). Gravity measurements were obtained simultaneously with reference systems across standardised sensory conditions. Within-session reliability and method agreement were assessed. Results: Within-session reliability of Gravity was outcome-dependent. Length-based components demonstrated higher repeatability (ICC (single) = 0.25–0.35; ICC (average) = 0.41–0.52), with narrower limits of agreement (LoA = ±9–12%) and lower measurement error (SEM = 3.3–4.3%). In comparison with SBP, length-based measures exhibited narrower limits (LoA = ±12–17) and more consistent relationships. Comparison with CDP revealed moderate agreement for composite and preferential scores (LoA: −2.20–7.07; −5.54–8.12). Conclusions: Gravity sensor may represent a clinically meaningful, outcome-dependent performance, with superior reliability and comparability for length-based postural measures compared with area-based measures. The device could provide balance assessments compatible with both static and dynamic posturographic systems, accounting for physiological variability. These findings support the potential clinical use of wearable IMU-based posturography, particularly in settings where conventional force-platform systems are not readily available, and warrant further validation in larger, more clinically diverse populations. Full article

Context: Sport-related concussion (SRC) management has evolved substantially over the past 25 years. Early paradigms emphasized prolonged physical and cognitive rest; however, growing evidence has demonstrated that recovery following SRC is multidimensional and influenced by interacting neurological, vestibular, autonomic, cervical, cognitive, and psychological systems. Consequently, contemporary clinical practice has shifted toward active, multifaceted rehabilitation approaches. Objective: We aimed to synthesize and contextualize the evidence supporting a multifaceted approach to sport-related concussion management from 2000 through 2025, with emphasis on implications for athletic training practice. Data Sources: A structured literature search was conducted using PubMed, SPORTDiscus, CINAHL, and Web of Science to identify peer-reviewed publications related to SRC evaluation, management, and rehabilitation. Study Selection: Studies published between 1 January 2000, and 31 December 2025 involving human participants with sport-related concussion or sport-like mechanisms of mild traumatic brain injury were included. Evidence from randomized controlled trials, cohort studies, systematic and narrative reviews, and major consensus or position statements was considered. Data Extraction: Relevant studies were reviewed and synthesized across key domains of SRC management, including aerobic exercise, vestibular and oculomotor rehabilitation, cervical spine management, multimodal and profile-based rehabilitation, return-to-learn strategies, psychological and behavioral health considerations, and implementation patterns within athletic training settings. Results: A total of 182 publications contributed evidence to one or more components of multifaceted SRC management. Across domains, evidence supports early, symptom-limited aerobic exercise; targeted vestibular and cervical rehabilitation; structured return-to-learn planning; and the integration of psychological support. Multimodal rehabilitation and profile-based clinical categorization approaches were associated with shorter recovery timelines and improved functional outcomes compared with rest-only strategies. Despite strong evidence, implementation variability persists across athletic training settings. Conclusions: Evidence accumulated over the past 25 years supports a shift toward active, individualized, and multidisciplinary approaches to SRC management. Athletic trainers are uniquely positioned to coordinate multifaceted care addressing the diverse contributors to concussion recovery. 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

Objectives: To investigate the differences in inner ear anatomical variations between patients with acute low-tone sensorineural hearing loss (ALHL) and those with unilateral stage I/II Ménière’s disease (MD) based on magnetic resonance imaging (MRI). Methods: A total of 30 patients with unilateral ALHL, 41 patients with unilateral stage I/II MD, and 59 healthy controls were enrolled retrospectively. 3.0T MRI was used to evaluate the distance between the vertical part of the posterior semicircular canal and the posterior fossa (PPD) and vestibular aqueduct (VA) visibility. Inter-group and intra-group comparisons and correlation analyses were performed to clarify the characteristics of anatomical variations. Results: (1) There were no significant differences in PPD and VA visibility between ALHL patients and healthy controls; the PPD of unaffected ears in MD patients was significantly shorter than that in healthy controls, while no significant difference was observed in the PPD of affected ears between MD patients and healthy controls. (2) The VA visibility of affected ears in ALHL patients was significantly higher than that in MD patients. (3) No significant intra-group differences in PPD and VA visibility between affected and unaffected ears were noted in ALHL or MD patients. (4) A significant negative correlation was found between the PPD of affected ears and pure tone average of affected ears in MD patients, while no correlations were observed between anatomical indices and clinical characteristics in ALHL patients. Conclusions: Although both ALHL and MD are categorized as hydropic ear diseases, radiological evidences demonstrate that MD patients exhibit inner ear anatomical variations, whereas no significant anatomical variations are observed in ALHL patients. This suggests that anatomical variations in the endolymphatic drainage system may be a predisposing factor for the pathogenesis of unilateral MD rather than for unilateral ALHL. Full article

Long COVID-19 syndrome (or so-called post-COVID-19) is indicated by miscellaneous symptoms, usually starting 3 months from the COVID-19 infection and lasting for at least 2 months, which cannot be explained by an alternative diagnosis. There has been more and more reports addressing the audiovestibular dysfunction related to long COVID-19 syndrome. Emerging evidence suggests that the linkage between audiovestibular dysfunction and long COVID-19 syndrome might rely on (a) direct inner ear system damage related to viral invasion and consequent inflammation, (b) micro thromboembolic events, which might result from the COVID-19-induced autoimmune reaction against endothelial cells, and consequent transient-ischemia and hypoxia of the auditory pathways, (c) the disturbed nerve conduction in vestibulocochlear nerves due to viral invasion, and finally (d) altered auditory cortex function, either imbalanced central gain or neurotransmitter disturbance. However, most of the aforementioned mechanism remained hypothetic and still needed further studies to approve or refute. This systematic review synthesizes current evidence on the characteristics, pathophysiology, diagnostic approaches, and management of audiovestibular dysfunction related to long COVID-19 syndrome. Literature searches across PubMed, Embase, ClinicalKey, Web of Science, and ScienceDirect (up to 15 December 2025) were conducted in accordance with PRISMA guidelines. Through this systematic review, we provided a schematic diagram of the physiopathology of long COVID-19 syndrome-related audiovestibular dysfunction. Further, we summarized the currently available diagnostic tools to explore the audiovestibular function in such patients. The currently available treatment, either pharmacotherapy or nonpharmacotherapy, mainly tackles idiopathic audiovestibular dysfunction but not specifically long COVID-19 syndrome-related audiovestibular dysfunction. Timely recognition and intervention may prevent progression to permanent hearing loss or vestibular disability, improving quality of life. Trial registration: PROSPERO CRD420251265741. Full article

Background: The vestibular system encodes head motion through specialized Type I and Type II hair cells, which differentially respond to acceleration and its temporal derivative, jerk. Molecular gradients of retinoic acid establish zonal distributions of these hair cells, prefiguring their functional specialization. Objectives & Methods: Here I integrate developmental, synaptic, biomechanical, and neural evidence to propose that Type I hair cells, via multimodal synaptic transmission, are particularly well suited for ultrafast detection of transient inertial deformation (jerk), whereas Type II cells play a greater role in encoding sustained acceleration through viscous-flow mechanisms. Molecular gradients of retinoic acid help establish central–peripheral zonal patterning in the otolith and canal epithelia, which in turn underlies differential mechanical and synaptic specialization rather than a simple redistribution of hair-cell types. Computational and experimental studies reveal that the vestibular organs operate in dual mechanical regimes, enabling the dynamic encoding of motion onset and continuity. In systems terms, these viscous and inertial activation modes correspond to distinct temporal filters, whose different time constants naturally give rise to distinct frequency responses. What has traditionally been described as ‘low- vs. high-frequency’ tuning therefore emerges as the frequency-domain signature of acceleration- versus jerk-sensitive pathways. Conclusions: This hierarchical organization elucidates the selective activation observed in clinical vestibular tests and informs novel diagnostic and rehabilitative strategies targeting specific receptor pathways. Together, these findings redefine vestibular transduction as a multimodal dynamic sensor, enhancing our understanding of balance and spatial orientation under complex motion conditions. Full article

Human-in-the-loop (HIL) immersive simulators integrate a human operator into the simulation loop, enabling real-time interaction with virtual environments. To expose users to controlled acceleration fields, they employ parallel kinematic machines (PKMs), including reduced-degree-of-freedom (DoF) configurations when compact and cost-effective systems are required. These reduced-DoF platforms frequently exhibit kinematic crosstalk, whereby motion along one axis causes unintended displacements or rotations along others. Among compact PKMs, the four-legged, three-DoF platform is widely used, particularly in driving simulators. However, to the best of the authors’ knowledge, its kinematics have never been systematically analyzed in the literature. It is an over-actuated system with specific constraint conditions characterized by actuators that are not fully grounded. As a result, kinematic crosstalk accelerations are not fully determined by kinematic relationships. They also depend on friction at the constraints; thus, they are also determined by the dynamic behavior of the machine, which is difficult to predict during operation. To address this issue, this paper introduces a simplified modeling approach to estimate kinematic crosstalk whose usability is evaluated experimentally both with mono-harmonic, combined DoF tests and in a real-world engineering application on an actual driving simulator. Results show that kinematic crosstalk on the platform is likely to generate acceleration levels up to 4 $\mathrm{m}/{\mathrm{s}}^2$, exceeding the vestibular perception threshold of 0.17 $\mathrm{m}/{\mathrm{s}}^2$ defined by Reid and Nahon. This result is relevant with respect to enabling a comprehensive assessment of the acceleration field to which the user is actually subjected, which determines the actual quality and immersiveness of the simulation. Full article

The use of virtual reality (VR) has made significant advancements, and now it is widely used across a range of applications. However, consumers’ capacity to fully enjoy VR experiences continues to be limited by a chronic problem known as cybersickness (CS). This study explores the feasibility of mitigating CS through geometric scene simplification combined with electroencephalography (EEG)-based monitoring. According to the sensory conflict theory, this issue is caused by the discrepancy between the visually induced self-motion (VIMS) through immersive displays and the real motion the vestibular system detects. While prior mitigation strategies have largely relied on hardware modifications or visual field restrictions, this paper introduces a novel framework that integrates geometric scene simplification with EEG-based neurophysiological activity to reduce VIMS during VR immersion. The proposed framework combines EEG neurophysiology, allowing us to monitor users’ brainwave activity and cognitive states during virtual immersion experience. The empirical evidence from our investigation shows a correlation between CS manifestation and neural activation in the parietal and temporal lobes. As an experiment with 15 subjects, statistical differences were significantly different with $P= 0.001$ and large effect size $\eta 2=0.28$, while preliminary trends suggest lower neural activation during simplified scenes. Notably, a decrease in neural activation corresponding to reduced optic flow (OF) suggests that VR environment simplification may help attenuate CS symptoms, providing preliminary support for the proposed strategy. Full article

Background: Adult patients with a thin buccal cortical plate and fragile periodontal phenotype are at high risk of dehiscence, fenestration and recession during transverse orthodontic expansion. Conventional mechanics often create a cervical compression-dominant environment that exceeds the adaptive capacity of the periodontal ligament (PDL)–bone complex. Objectives: This study proposes an integrative mechanobiological model in which a skeletal-anchorage-assisted loading protocol (Bone Protection System, BPS) transforms expansion into a tension-dominant regime that favours buccal phenotype preservation. Methods: Patient-specific finite element models were used to compare conventional expansion with a BPS-modified force system. Regional PDL stress patterns and crown/apex displacement vectors were analysed to distinguish tipping-dominant from translation-dominated mechanics. A pilot CBCT proof-of-concept (n = 1 thin-phenotype adult) with voxel-based registration quantified changes in maxillary and mandibular alveolar ridge width and buccal cortical plate thickness before and after BPS-assisted expansion. The mechanical findings were integrated with current evidence on compression- versus tension-driven inflammatory and osteogenic pathways in the PDL and cortical bone. Results: FEM demonstrated that conventional expansion concentrates high cervical compressive stress along the buccal PDL and cortical surface, accompanied by bending-like crown–root divergence. In contrast, the BPS protocol redirected forces to create a buccal tensile-favourable region and a more parallel crown–apex displacement pattern, indicative of translation-dominated movement. In the proof-of-concept (n = 1) CBCT case, BPS-assisted expansion was associated with preservation or increase of buccal ridge dimensions without radiographic signs of cortical breakdown. Conclusions: A tension-dominant orthodontic loading environment generated by a skeletal-anchorage-assisted force system may support buccal cortical preservation and vestibular phenotype reinforcement in thin-phenotype patients. The proposed mechanobiological model links these imaging and FEM findings to known molecular pathways of inflammation, angiogenesis and osteogenesis. It suggests a functional biomaterial-based strategy for widening the biological envelope of safe tooth movement. Full article