This study aims to report our experience with endoscopic tenotomy in treatment of Ménière’s disease as its reported role in literature is still controversial.

Patients diagnosed with unilateral definite Ménière’s disease and underwent endoscopic tenotomy of middle-ear muscles in our tertiary care centre were retrospectively evaluated. Pure tone average, frequency of vertiginous attacks, functional level, tinnitus scale and Dizziness Handicap Inventory were compared pre-operatively and post-operatively.

Twenty-eight cases were included in the study with an average age of 50.78 ± 12.16 years. At the 2-year follow-up period, 16 cases (57.14 per cent) achieved complete control of vertigo, 5 cases (17.85 per cent) had substantial vertigo control, and 3 cases (10.71 per cent) had limited control. Significant improvement in Dizziness Handicap Inventory and functional level also was found post-operatively.

Endoscopic tenotomy for Ménière’s disease is easy and simple with no serious complications, but its relatively low results of absolute vertigo control limit its consideration as a definitive treatment.

The aim of this study is to systematically review and analyse the literature regarding clinical application of picrotoxin for vertigo caused by peripheral vestibular disorders.

We conducted a search in PubMed/MEDLINE and Google Scholar in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations. The primary selection included all studies exploring the effect of this phytopharmacological substance on the vestibular system and vertigo. The secondary selection included only reports on its clinical use for treatment of Ménière’s disease and other peripheral vestibular disorders.

From the 398 identified studies, 18 were included from the primary selection and 6 from the secondary selection. In total, 203 patients received picrotoxin; 85 of them were treated for vertigo with 1-mg picrotoxin suppositories. In this subgroup vertigo was reduced in 74.9 per cent.

Picrotoxin is a non-invasive treatment option worth considering, especially in cochlear-implanted patients with recurring disabling vertigo.

To describe vestibular dysfunction accompanied by sudden sensorineural hearing loss and explore its potential prognostic role.

A total of 44 Idiopathic Sudden Sensorineural Hearing loss cases were enrolled. Pure tone audiometry (PTA) was performed at the first visit and three months after standard therapy. Patients’ improvement and severity of hearing loss were categorised based on Siegel and American Speech and Hearing Association criteria. Their recovery rate and factors affecting recovery were explored.

The mean age of the participants was 52.1 years. The caloric and cervical vestibular-evoked myogenic potential test abnormalities were detected in 36.4 and 31.8 per cent of participants. Vertigo was present in 36.4 per cent at the first visit. Based on American Speech and Hearing Association criteria, 16 patients experienced at least 1 grade improvement to a less severe hearing loss status at the follow up. A total of 31.7 per cent of patients demonstrated complete or partial recovery. Vestibular dysfunction was associated with poorer PTA results.

Abnormal caloric and cervical vestibular-evoked myogenic potential tests, as well as the presence of vertigo, can indicate more profound inner-ear damage.

To analyse the evolution of the vertigo index and its relationship with perceived disability in unilateral and bilateral Ménière’s disease, assessing differences based on disease progression and clinical subtypes.

A longitudinal descriptive study was conducted on unilateral and bilateral Ménière’s disease patients, with data collected between 1977 and 2023 from two referral centres. Clinical and functional data were retrospectively reviewed to ensure compliance with updated diagnostic criteria. The vertigo index, integrating episode duration and frequency, quantified vertigo burden. Functional impact was assessed using the six-item American Academy of Otolaryngology Head and Neck Surgery disability scale, categorising patients into mild or moderate/severe disability groups.

Bilateral Ménière’s disease patients had a higher proportion of moderate/severe episodes (31.4 per cent) than unilateral Ménière’s disease patients (11 per cent). In unilateral Ménière’s disease patients, disability perception increased after 20 years of disease evolution. The vertigo index declined over time, except in later stages, where episodes were more disabling.

These findings underscore the need for long-term follow up, particularly in bilateral Ménière’s disease, where greater disability was observed. Disease management should adapt over time, addressing both vertigo burden and psycho-affective consequences.

The important role of the saccule is the sensing of gravity. In other words, gravity always stimulates the macula of the saccule.

The aim of this study was to clarify whether nystagmus and dizziness occur by intentional changes upon stimulation to the saccules.

The subjects were eight healthy humans. Experiment 1: Subjects were asked to maintain a supine position to check for nystagmus and dizziness. Experiment 2: Subjects were asked to tilt their heads 45º to the left in the supine position to check for nystagmus and dizziness. Experiment 3: Subjects were asked to maintain a left-ear-down 90º position to check for nystagmus and dizziness.

In all the experiments, no one revealed nystagmus and no one complained of dizziness.

Neither nystagmus nor dizziness occurs by intentional changes in the stimulation to the saccules.

The aim of this study was to evaluate the vestibular system in substance addicts.

A total of 34 substance addicts were included in the study. A demographic data form, the Dizziness Handicap Inventory, the Addiction Profile Index Screening – Short Form, the Video Head Impulse Test, videonystagmography, and cervical and ocular vestibular evoked myogenic potentials tests were administered in all participants.

A statistically significant difference was found between the study group and the control group (p < 0.05) in terms of gaze, saccade, pursuit and optokinetic results in the videonystagmography test; lateral, anterior and posterior semicircular canal gain values in the Video Head Impulse Test; P1 latency, P1–N1 interlatency, P1–N1 amplitude and asymmetry values in the cervical vestibular evoked myogenic potentials test; and N1–P1 interlatency, N1–P1 amplitude and asymmetry values in the ocular vestibular evoked myogenic potentials test (p < 0.05).

As a result of our study, it was observed that the vestibular system was affected in substance addicts.

Ménière’s disease is an inner-ear disorder caused by endolymphatic hydrops, characterised by recurrent episodes of vertigo, fluctuating hearing loss, and tinnitus. Ménière’s disease can be classified as ‘probable’ and ‘definite’ according to the criteria determined by the Bárány Society.

This analytical cross-sectional retrospective study included 28 Ménière’s disease patients (15 with definite Ménière’s disease and 13 with probable Ménière’s disease). Vestibular function was assessed using ocular-vestibular evoked myogenic potentials, cervical-vestibular evoked myogenic potentials and caloric test.

The results of these tests were evaluated separately for probable Ménière’s disease and definite Ménière’s disease groups and comparisons were made. Significant differences in vestibular evoked myogenic potential asymmetry rates were observed between the probable Ménière’s disease and definite Ménière’s disease groups, with the definite Ménière’s disease group exhibiting a higher rate of abnormal responses.

This suggests that vestibular evoked myogenic potentials testing may be a valuable tool in distinguishing between these two subtypes of Ménière’s disease. Further research is necessary to validate these findings and explore their implications for clinical practice.

In the era of the competition for the first transatlantic flight at the beginning of the nineteenth century, numerous accidents occurred. Whereas engine failure, bad weather and navigational problems are usually held responsible, the human factor has hardly been addressed.

In view of current insights, an inventory was made of possible physiologic and otoneurologic factors that could have contributed to failures and accidents.

Extreme fatigue, hyperventilation with vestibular hyperreactivity and airsickness may have played roles. When flying in the dark and in clouds, pilots were subject to spatial disorientation because of vestibulo-visual conflicts and gravitational misinformation. The loudness of the engines was deafening, which may have caused noise-induced vertigo. In some cases, asymptomatic third-window lesions may have become manifest and may have contributed to dizziness.

Accidents and failures in the early days of aviation were not only the result of technical defects. Undoubtedly, human physiology played a role as well.

The study aimed to determine the patterns of the vestibular and ocular motor findings in cerebellar infarction (CI).

We retrospectively analyzed vestibular and ocular motor test results in 23 CI patients and 32 acute unilateral vestibulopathy (AUVP) patients.

Among CI cases, the posterior inferior cerebellar artery (PICA) was the most commonly affected territory. Vertigo is predominantly observed in patients with infarctions affecting PICA or anterior inferior cerebellar artery (AICA). Lesions involving the superior cerebellar artery (SCA) mainly result in dizziness. Saccadic intrusion and oscillation, abnormal bilateral smooth pursuit (SP) and abnormal saccades were more prevalent in the CI group than in the AUVP group (all p < 0.05). Horizontal saccades were abnormal in 11 patients (47.8%) with CI. All AUVP patients had normal horizontal saccades. Horizontal SP was impaired in 13 patients (56.5%) with CI, with decreased gain toward both sides in 10 and toward 1 side in 3. Impaired horizontal SP was noted in nine patients (28.1%) with AUVP, with decreased gain toward the contralesional side in all cases. A total of 26.3% (5/19) of patients with CI exhibited subjective visual vertical (SVV) deviation toward the affected side and 31.6% (6/19) toward the unaffected side. In patients with AUVP, 70.0% (21/30) showed SVV deviation toward the affected side.

Vertigo is mainly seen in PICA or AICA infarctions. SCA lesions mostly cause dizziness. Saccadic intrusion and oscillation, abnormal bilateral SP and abnormal saccades contribute to the diagnosis of CI. Moreover, SVV deviation varies depending on the cerebellar structures involved.

The aim of this study is to identify risk factors for residual dizziness in benign paroxysmal positional vertigo patients after repositioning manoeuvres and explore the mediation role of lipid indicators.

In all, 110 benign paroxysmal positional vertigo patients treated from January 2019 to February 2022 were studied. Data on demographics, diseases, behaviours, and lipids were collected. Multivariate logistic regression assessed risk factors, and mediation analyses explored effects via lipid indicators. Odds ratios and 95 per cent confidence intervals are reported.

Differences between groups with and without residual dizziness included limb weakness, hypertension, nausea, arteriosclerosis, medication, dizziness handicap inventory scores, hospital anxiety and depression scale scores, and lipid distributions (p < 0.05). Significant risk factors were sleep disorders, medication, hypertension, triglycerides, and total cholesterol (p < 0.05). Total cholesterol mediated 9.1 per cent of the effect of sleep disorders on residual dizziness.

Managing lipid levels and sleep disorders is crucial in treating residual dizziness in benign paroxysmal positional vertigo patients after repositioning.

Ménière’s disease is a chronic inner-ear disease attributed to endolymphatic hydrops. Magnetic resonance imaging with gadolinium allows visualisation of endolymphatic hydrops in vivo and may be an adjunct to diagnosis.

Thirty-eight patients suspected of having Ménière’s disease underwent T2 weighted three-dimensional fluid-attenuated inversion recovery and true inversion recovery sequence magnetic resonance imaging 4 hours post double-dose intra-venous gadolinium. Presence of endolymphatic hydrops was graded by two radiologists at 0 and 4 months. Correlation to clinical diagnosis was assessed using Fisher’s exact test.

Hydrops was identified in 88 per cent, 17 per cent and 27 per cent of patients with Definite Ménière’s, Probable Ménière’s and Undifferentiated disease, respectively. A significant correlation existed between diagnosis and presence of hydrops. Sensitivity and specificity were 88 per cent and 67 per cent, respectively. Intra- and inter-observer agreement for presence and grading of hydrops was near-perfect and substantial to near-perfect, respectively.

Magnetic resonance imaging demonstrates radiographic hydrops with significant correlation to clinical diagnosis and good intra- and inter-observer agreement.

To identify changes in hearing loss, tinnitus, vertigo, and migraine in individuals with Ménière’s disease diagnosed with coronavirus disease 2019 and during the UK national lockdown.

Patients were questioned regarding coronavirus disease 2019 status and how their symptoms of hearing loss, tinnitus, vertigo, and migraine changed because of the pandemic. Of the 411 participants recruited into this study, 382 had a self-reported coronavirus disease 2019 status.

Of those individuals with a positive coronavirus disease 2019 diagnosis, 43 (11.3 per cent) were more likely to experience worsening symptoms of hearing loss and tinnitus. Worsening symptoms of hearing loss and tinnitus, but improved symptoms related to vertigo, were observed during the UK national lockdown.

A diagnosis of coronavirus disease 2019 and/or experiencing the consequences of a national lockdown potentially resulted in a worsening of hearing loss and tinnitus symptoms. Symptoms of vertigo were found to have improved during the same period.

This study aimed to evaluate clinical characteristics, treatments and outcomes of paediatric temporal bone fractures at our institute.

A retrospective study of paediatric skull fractures confirmed by imaging from January 2010 to December 2022. Data on demographics, clinical presentations, injury mechanisms and complications were analysed, and fractures were categorised into otic capsule sparing (OCS) and violating (OCV).

Of 369 skull fracture cases, 88 (24 per cent) involved temporal bones, predominantly caused by falls and vehicle accidents. Common symptoms were loss of consciousness, hematoma, and hemotympanum, with complications like facial nerve injury and cerebrospinal fluid leaks in 3.4 per cent of cases. OCV fractures led to more severe complications, including hearing loss. Audiology showed 65 per cent without hearing impairment, while others had various degrees of loss.

Paediatric temporal bone fractures, particularly OCV types, pose significant challenges. Early detection and thorough management are vital, underscoring the need for consistent data collection and regular audiometric monitoring.

Patients presenting to the emergency department with acute vertigo pose a diagnostic challenge. While ‘benign’ peripheral vestibulopathy is the most common cause, the possibility of a posterior circulation stroke is paradoxically the most feared and missed diagnosis in the emergency department.

This review will attempt to cover the significant advances in the ability to diagnose acute vertigo that have occurred in the last two decades. The review discusses the role of neurological examinations, imaging and specific oculomotor examinations. The review then discusses the relative attributes of the Head Impulse-Nystagmus-Test of Skew plus hearing (‘HINTS+’) examination, the timing, triggers and targeted bedside eye examinations (‘TiTrATE’), the associated symptoms, timing and triggers, examination signs and testing (‘ATTEST’) algorithm, and the spontaneous nystagmus, direction, head impulse testing and standing (‘STANDING’) algorithm. The most recent technological advancements in video-oculography guided care are discussed, as well as other potential advances for clinicians to look out for.

Balance dysfunction and vestibular conditions are major problems requiring significant resources. There is significant national and international variation in management pathways for such patients.

This paper outlines a collaborative project run by the ENT department and two vestibular rehabilitation trained physiotherapists to establish a clinic to manage patients referred to ENT with vestibular and/or balance complaints. As part of a six-month pilot, two physiotherapy-led balance clinics were provided per week.

A total of 159 new patients were seen, with only 15 needing ENT consultant input. This led to the successful creation of substantive posts; the clinic has seen 698 patients in its first two years.

Patient outcomes and experience have been positive, and accompanied by reduced waiting and in-service times. The authors discuss some of the pitfalls, challenges and opportunities of developing this type of clinic.

This pilot study aimed to evaluate a training programme for primary care physiotherapists focused on the assessment and management of benign paroxysmal positional vertigo.

A six-month training programme and toolkit utilising the revised Standards for Quality Improvement Reporting Excellence (‘SQUIRE 2.0’) guidelines was developed to facilitate the learning of new knowledge and skills in the assessment and management of benign paroxysmal positional vertigo following Gagne's model of instructional design. A pre- and post-training knowledge and confidence questionnaire evaluated the impact of the training programme.

Eleven participants started the training programme and five completed it. On average, knowledge increased by 54 per cent (range, 41–95 per cent) and confidence increased by 45 per cent (range, 31–76 per cent). A 73 per cent improvement in practical skills acquisition was demonstrated after the initial training session.

A structured approach to learning demonstrates improvements in knowledge, skills and confidence of physiotherapists in the evidence-based management of benign paroxysmal positional vertigo.

To examine the newly established role of a primary contact physiotherapist in an ENT clinic, in an Australian cohort and context, over two phases of development.

A retrospective cohort study was conducted with data collected from a medical record audit. Over the study duration, the primary contact physiotherapist completed initial appointments with patients; follow-up appointments were subsequently conducted by medical staff.

There was a 46 per cent reduction in patients with suggested vestibulopathy requiring an ENT medical review. This reduction could hypothetically increase to 71 per cent with follow-up primary contact physiotherapist appointments. Improvements in the service delivery model and a primary contact physiotherapist arranging diagnostic assessments could improve waitlist times and facilitate better utilisation of medical staff time.

The primary contact physiotherapist can help in the management of patients with suspected vestibulopathy on an ENT waitlist. This is achieved through: a reduction of patients requiring ENT review, improvements to waitlist time and improved utilisation of medical specialists’ time.

Persistent postural-perceptual dizziness classifies patients with chronic dizziness, often triggered by an acute episode of vestibular dysfunction or threat to balance. Unsteadiness and spatial disorientation vary in intensity but persist for over three months, exacerbated by complex visual environments.

Literature suggests diagnosis relies on a clinical history of persistent subjective dizziness and normal vestibular and neurological examination findings. Behavioural diagnostic biomarkers have been proposed, to facilitate diagnosis.

Research has focused on understanding the neural mechanisms that underpin this perceptual disorder, with imaging data supporting altered connectivity between neural brain networks that process vision, motion and emotion. Behavioural research identified the perceptual and motor responses to a heightened perception of imbalance.

Management utilises head and body motion detection, and downregulation of visual motion excitability, reducing postural hypervigilance and anxiety. Combinations of physical and cognitive therapies, with antidepressant medications, help if the condition is associated with mood disorder.