Background/objectives: Distinguishing an acute Ménière’s disease (MD) attack from acute vestibular neuritis (VN) can be difficult in the emergency setting, where both may present as an acute vestibular syndrome. Video head impulse testing (vHIT) reliably separates peripheral vestibular loss from central causes, but its behavior during the acute phase of MD relative to VN is not well characterized. Methods: In this retrospective cohort study, horizontal vHIT gain (regression slope) on the affected side was compared between 10 acute MD attacks and 12 acute VN cases (tested within 72 h of onset) Results: Mean vHIT gain was higher in MD (0.48 ± 0.24) than in VN (0.28 ± 0.13; p = 0.033, Student’s t-test; p = 0.060, Mann–Whitney U). Receiver operating characteristic analysis yielded an area under the curve of 0.742; a cutoff of ≤0.39 provided 83.3% sensitivity and 70.0% specificity for VN. Absolute ranges overlapped substantially (0.10–0.78 for MD, 0.12–0.57 for VN). Conclusions: Horizontal canal vHIT gain exhibits a more prominent reduction in acute vestibular neuritis than in acute Ménière’s disease attacks, and a gain threshold near 0.39 may provide a modest adjunct for distinguishing the two peripheral conditions once a central cause has been excluded. Nonetheless, VOR gain analysis in isolation does not permit reliable clinical distinction between these entities.
Background/Objectives: Otologic and vestibular complaints are frequent in patients with temporomandibular disorders (TMDs), but evidence that TMD-directed treatment improves dizziness or aural fullness remains limited. This exploratory study evaluated 12-month changes in subjective otologic/vestibular symptoms and mandibular kinematics during neuromuscular orthotic therapy. Methods: Thirty-five patients with TMD underwent clinical assessment and K7 three-dimensional mandibular kinesiography at baseline (T0) and 12 months (T1); 20 asymptomatic subjects provided cross-sectional kinematic reference data. Audiologic and bedside otoneurological assessment screened for clinically evident primary auditory and vestibular disorders. Kinesiography was recorded on natural dentition at T0 and with the orthotic in situ at T1. Raw XYZ trajectories were analyzed with a reproducible post hoc signal-processing and segmentation pipeline. Results: Vertigo/dizziness improved or resolved in 10/10 patients (100%), aural fullness in 7/8 (87.5%), and tinnitus in 22/24 (91.7%). Across 35 paired recordings, vertical excursion decreased from 4.20 ± 3.16 to 3.14 ± 2.90 mm (p = 0.084), 3D path length from 16.84 ± 14.60 to 11.94 ± 11.74 mm (p = 0.078), and mean 3D speed from 5.25 ± 2.88 to 4.42 ± 3.42 mm/s (p = 0.065). A post hoc sensitivity analysis of 27 higher-confidence segmentations showed significant reductions in vertical excursion (p = 0.049), path length (p = 0.049), and mean speed (p = 0.030). Conclusions: Orthotic therapy was temporally associated with marked improvement in subjective otologic/vestibular symptoms and directional kinematic changes. The uncontrolled design, categorical symptom outcomes, non-age-matched controls, and different T0/T1 recording conditions preclude causal claims.
Background: Ocular counter-roll (OCR) is an otolith-mediated vestibulo-ocular reflex that produces torsional rotation of the eyes in response to head tilt. Accordingly, measuring ocular torsion can provide an assessment of vestibular tone balance related to otolith function. This can be objectively quantified from fundus photographs using the disc-foveal angle (DFA). Because head tilt also physiologically alters ocular torsion through OCR, head position during fundus imaging may influence the measured DFA. Here, we examined this effect of head tilt and the resulting OCR on fundus-based measurements of ocular torsion. Methods: Ten healthy adults (age 28–45 y/o; 2 females) underwent bilateral fundus photography under three conditions: routine head placement, controlled upright (0°) positioning, and 10° lateral head tilt. Head orientation was continuously measured using a strap-mounted gyroscope. DFA was quantified from fundus images as the angle between the fovea–optic disc axis and horizontal meridian using ImageJ. Results: Mean DFA did not differ between standard and controlled head positioning (p = 0.23), although within-subject variability was greater with standard positioning (p = 0.020). In contrast, 10° head tilt significantly changed DFA (p < 0.01). Conclusions: Small, naturally occurring variations in head position do not significantly alter DFA but may increase measurement variability, whereas larger head tilts produce significant changes in DFA. Careful control of head position during fundus photography can improve the reliability of DFA measurements for assessment of otolith-ocular function.
Background: Vestibular migraine (VM) and benign paroxysmal positional vertigo (BPPV) frequently present with overlapping positional symptoms, making their differential diagnosis challenging. This study aimed to characterize positional vestibular manifestations in patients with suspected VM. Methods: In this observational study, 85 adult patients presenting with positional vertigo or dizziness in whom typical BPPV could not be demonstrated were evaluated. All patients underwent detailed clinical and neurotological assessment, videonystagmography, and standardized positional testing. Results: Definite VM was diagnosed in 51/85 patients (60.0%) and probable VM in 23/85 (27.1%), accounting together for 87.1% of the selected cohort. Positional nystagmus was documented in 52 patients (61.2%), of whom 38/52 (73.1%) showed at least one atypical characteristic. Pupillary Nystagmus (PNy) was detected in 61/85 patients (71.8%). Among 14 patients with an initially BPPV-like positional pattern, five responded to canalith repositioning maneuvers, whereas nine had persistent or recurrent symptoms requiring diagnostic reassessment. At 3 months, 66/74 patients (89.2%) with definite or probable VM reported marked overall clinical improvement, while complete resolution of positional vertigo or dizziness occurred in 49/74 (66.2%). Positional nystagmus resolved in 36/47 patients (76.6%) who had presented with this finding at baseline. Conclusions: VM should be considered in patients with recurrent positional vestibular symptoms when positional findings are atypical, variable, or inconsistent with a single semicircular canal disorder, particularly when repositioning maneuvers are ineffective. PNy may provide an additional supportive finding, although its diagnostic value requires validation in controlled studies. Treatment response may support the overall clinical interpretation but should not be regarded as an independent diagnostic criterion.
Background: Indoor mold exposure (IME) has been associated with nonspecific neurological symptoms, including dizziness, cognitive complaints, and fatigue. Whether environmental exposures related to damp indoor environments influence vestibular migraine (VM), a common cause of episodic vertigo involving interactions among vestibular and migraine-related pathways, remains unclear. Objective: To examine the overlap between vestibular symptoms reported in association with IME and those characteristic of VM, and to explore how this overlap may contribute to potential diagnostic misattribution when environmental factors are not adequately considered during clinical assessment. Methods: A hypothesis-driven narrative review was conducted using PubMed and Scopus, synthesizing evidence on VM, symptoms reported in association with IME, and potential biological mechanisms to explore potential explanations for overlapping vestibular symptoms and their implications for diagnostic misattribution. An illustrative clinical case was included to provide clinical context for the proposed hypothesis. Results: Findings identify overlapping vestibular symptoms between patients with VM and symptoms associated with IME. However, the available evidence is largely indirect, and no studies have directly investigated whether this symptom overlap contributes to diagnostic misattribution of VM. Conclusions: Evidence remains insufficient to establish diagnostic misattribution of VM in the context of indoor mold exposure. Environmental exposure history should be considered alongside established diagnostic criteria, and further research is needed to investigate this possibility.
