BackgroundPersistent postural-perceptual dizziness (PPPD) is a functional neurological disorder characterized by chronic, non-spinning dizziness exacerbated by motion, visual stimulation, or upright posture. Although antidepressants are commonly prescribed for PPPD, their efficacy and tolerability have not been well established.ObjectiveTo evaluate the available evidence on antidepressant use in PPPD, with a focus on clinical outcomes.MethodsA systematic search of Embase, APA PsycINFO, and MEDLINE was conducted via the Ovid platform for any studies on antidepressant use in PPPD (or related symptoms under prior diagnostic terms) published before May 8, 2025.ResultsThirteen studies met inclusion criteria, comprising two randomized controlled trials (RCTs), seven open-label trials, and four observational or retrospective studies including a total of 807 participants. Four studies enrolled participants with a PPPD diagnosis, while others included participants with symptoms mirroring PPPD or precursor terms for the disorder. Specific antidepressant regimens varied greatly. Across studies, antidepressants were generally associated with reductions in both dizziness and psychiatric symptoms. Reported treatment response rates ranged from 55% to 84%. However, up to 25% of participants were unable to tolerate treatment. Reported adverse events included gastrointestinal symptoms, sedation or fatigue, sexual adverse effects, and headache.ConclusionsCurrent evidence regarding the use of antidepressants for the treatment of PPPD and precursor chronic dizziness disorders is limited by low-quality studies, heterogeneous designs, and inconsistent diagnostic criteria. The available evidence suggests antidepressants may be effective for PPPD; however, high-quality, randomized placebo-controlled trials are urgently needed to clarify the efficacy and tolerability of antidepressants for PPPD.
Despite significant advancements in Virtual Reality (VR) technology, exposure to VR can induce side effects on the user. One such effect is Depersonalisation and Derealisation (DPDR): feelings of detachment from the self and surroundings. The exact mechanism behind the development of DPDR symptoms following VR use is unknown. Stable representations of the bodily self depend on the integration of visual and vestibular signals. However, VR disrupts this integration. The brain is thought to resolve visuo-vestibular conflict by downweighting vestibular signals. However, whether this reweighting accounts for VR-induced DPDR has not been tested. We investigated whether changes in vestibular sensitivity are associated with DPDR. Thirty-two participants were exposed to 10 min of either roll optic flow, inducing visuo-vestibular conflict, or random dot motion, inducing no conflict. Vestibular sensitivity was assessed before and after VR using a psychophysical detection task. A moderation analysis revealed that in the roll condition, participants whose sensitivity to GVS increased following VR reported the greatest increases in DPDR, whereas no such relationship was seen in the random condition. Thus, these findings suggest that individuals who are unable to resolve the sensory conflict by vestibular-downweighting are most susceptible to DPDR.
Hypoxia when breathing air with the percentage of inspired oxygen (% O2) reduced has been shown to diminish sensory, motor, and cognitive function. We recently showed that hypoxia experienced while inspiring air with 15.4% O2 decreased sensitivity to upward and downward motions (Z-Translations). Here, we follow-up with similar Z-Translation perceptual threshold testing in 5 patients with unilateral vestibular hypofunction. All testing was completed at an altitude of 820 ft (249 m). Each patient completed Z-Translation vestibular threshold testing with inspired % O2 set to 20.9%, 17.9%, 16.6%, and 15.4% to mimic the effects of altitudes of 820 ft, 4000 ft, 6000 ft, or 8000 ft (249 m, 1219 m, 1828 m, or 2438 m), respectively. Z-Translation thresholds significantly increased in the hypoxic conditions (F (3,88) = 8.29, p = 6.48 × 10-5). Further, greater reductions in peripheral oxygen saturation (SpO2) significantly predicted higher Z-Translation thresholds (estimated slope = 0.67 cm/s/%, t (73.37) = -2.83, p = 0.006). These results provide evidence that sensing whole-body motion is susceptible to hypoxia. Extra precautions and countermeasures may be warranted for people experiencing mild reductions in blood oxygenation - especially patients with vestibular hypofunction - while performing tasks that require balance and/or accurate and precise spatial orientation.
ObjectivesThe relationship between sleep and motion sickness (MS) remains underexplored. This study examined whether objective sleep parameters were related to susceptibility to motion sickness, elicited by different sensory conflicts.MethodsIn a cross-over design, twenty-six participants completed a virtual reality (VR) paradigm inducing cybersickness-provoking stimuli, while twenty of them underwent a parabolic flight (PF) simulating space sickness. Actigraphy was recorded during a period of 6 nights for each paradigm to measure objective sleep quality, while subjective sleep ratings, motion sickness scores, nausea onset, and cortisol levels were collected throughout the experiment.ResultsBetter sleep quality before the paradigm-reflected by greater sleep efficiency, shorter sleep onset latency, less wake after sleep onset, and longer total sleep time-was associated with lower motion sickness severity during PF, but not with lower cybersickness in VR. Stress, whether subjective or cortisol-based, did not correlate with motion sickness levels in PF.ConclusionsOur findings show that sleep quality may protect against motion sickness in parabolic flights, independent of stress, even in those without sleep disorders. These findings identify sleep metrics as possible predictors of susceptibility to altered-gravity motion sickness.
ObjectiveAs large language models (LLMs) enter clinical decision support, concerns persist about sociodemographic bias. We assessed whether LLM recommendations for dizziness vary by patient descriptors and clinical detail.MethodsWe conducted a cross-randomized in-silico vignette study. One hundred synthetic emergency department dizziness cases were created using established diagnostic frameworks including the TiTrATE paradigm, SAEM GRACE-3 guidelines, and Bárány Society diagnostic criteria. Each vignette was tested in a neutral form and with 33 sociodemographic descriptor variants (34 total). Twelve instruction-tuned LLMs from multiple model families were evaluated. Models answered five binary clinical decision questions addressing etiology classification, triage disposition, neuroimaging, bedside vestibular examination, and mental health referral. Each model-vignette-descriptor combination was repeated 10 times, yielding 2,040,000 responses. Sociodemographic bias was quantified as descriptor-specific percentage-point deviations from neutral control recommendations with 95% confidence intervals.ResultsSociodemographic descriptors influenced LLM recommendations, with the largest differences observed for mental health referral decisions in diagnostically ambiguous cases. Referral likelihood was lower for Black transgender women (-12.2 pp; 95% CI -14.0 to -10.3), Black patients experiencing homelessness (-9.1 pp; -11.0 to -7.3), and patients experiencing homelessness (-7.7 pp; -9.5 to -5.9). Differences were attenuated when vignettes contained clearer diagnostic information. Other effects were smaller, including increased neuroimaging recommendations for low-income descriptors (+4.0 pp; 95% CI 2.1-5.8).ConclusionLLM clinical recommendations varied by sociodemographic descriptors, particularly under diagnostic uncertainty. More detailed clinical information reduced these disparities, suggesting structured inputs may mitigate bias in clinical AI systems.
Background Bilateral vestibular hypofunction (BVH) is a debilitating condition presenting acutely or progressively with oscillopsia, floating sensation, imbalance, and disequilibrium. Objective This study aims to identify the sensitivity of the Barany Society criteria for definitive diagnosis of patients with symptoms of BVH but not meeting the strict criteria and to explore the dissociation of objective testing and subjective patient experience. Methods Retrospective case study of patients ( n = 71) diagnosed at a tertiary vestibular clinic between 2015 and 2021. Diagnostic vestibular testing included caloric testing, rotary chair, and video head impulse testing (vHIT) to quantify vestibular function for definitive diagnosis. Subjective data was collected by means of questionnaires. Results The sensitivity of Barany Society criteria for definite BVH in any vestibular test was 49% ( n = 35). The highest sensitivity for an individual test was vHIT (51%). Those meeting Barany Society criteria had a mean Dizziness Handicap Inventory (DHI) score of 59.5 in comparison to 66.7 in those meeting expansive criteria. Conclusions Barany Society criteria show poor sensitivity (49%). When comparing this criterion with the more widely used expansive criteria, about 50% of patients in our population will be excluded from a BVH diagnosis. This is compounded with the fact that those meeting Barany Society criteria and expansive criteria were at large not significantly different in terms of symptoms types, chronicity, postural stability, and subjective disability. It should be considered that the definite BVH category may need to be renamed “vestibular areflexia” since patients with less severe dysfunction on reflexive testing may still have similar disability from symptoms and can be characterized as having BVH.
Background Patients with vestibular disorders frequently avoid specific environments and activities due to the fear of dizziness episodes. However, this fear avoidance belief and behavior may inhibit the compensatory mechanisms of the vestibular system, thereby impacting the rehabilitation process. The Vestibular Activities Avoidance Instrument-9 (VAAI-9) is a 9-item tool specifically designed to identify and measure the fear avoidance beliefs and behaviors associated with vestibular disorders. Objective To translate and culturally adapt the VAAI-9 into Chinese and to investigate its reliability and validity of the Chinese Version. Methods The Brislin translation model was strictly followed to conduct cross-cultural adaptation of the VAAI-9, which included translation, back translation, expert consultation, and preliminary investigation, ultimately resulting in the Chinese version of the VAAI-9 (VAAI-9-C). A total of 330 Chinese-speaking patients with dizziness or vestibular disorders were recruited through convenience sampling, and they were asked to complete the baseline questionnaire and the VAAI-9-C. The reliability of the instrument was evaluated through item analysis, internal consistency was measured by Cronbach’s alpha, and test-retest reliability was assessed by the intraclass correlation coefficient (ICC) and the minimal detectable change (MDC 95 ). Content validity was determined by expert evaluation results, including the item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). Structural validity was assessed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Results During the cross-cultural adaptation process, minor revisions were made to the content expression to ensure semantic equivalence. The correlation coefficients between each item and the total score of VAAI-9-C ranged from 0.745 to 0.794. Cronbach’s alpha was 0.911 and ICC was 0.886 for the VAAI-9-C total scale. The MDC 95 was 8.78 points. The I-CVI for each item of the VAAI-9-C ranged from 0.9 to 1.0, and the S-CVI was 0.98. Exploratory factor analysis revealed three common factors and explained 88% of the total variance. Confirmatory factor analysis indicated that χ 2 /df = 1.317, incremental fit index (IFI) = 0.995, Tucker-Lewis index (TLI) = 0.992, comparative fit index (CFI) = 0.995, root mean square error of approximation (RMSEA) = 0.038, and standardized root mean square residual (SRMR) = 0.024, demonstrating a good model fit. Conclusions The VAAI-9-C demonstrates strong reliability and validity, making it an effective tool for evaluating fear avoidance beliefs and behaviors in the Chinese-speaking population with dizziness.
IntroductionThe subscales of the Vestibular Activities and Participation measure (VAP) assess the impact of vestibular dysfunction on activity and participation; however, no diagnostic accuracy studies have evaluated their ability to identify severe handicap in individuals with vestibular disorders.ObjectiveTo evaluate the diagnostic accuracy of the VAP subscales in detecting severe handicap in individuals with vestibular dysfunction.MethodsThe diagnostic accuracy study included individuals with vestibular dysfunction who were ≥18 years. The diagnostic accuracy of the VAP subscales (VAP1-BR and VAP2-BR) was analyzed using Receiver Operating Characteristic (ROC) curves, with the Dizziness Handicap Inventory serving as the reference test. The area under the curve (AUC), cutoff points, sensitivity, specificity, and 95% confidence intervals were determined. Statistical analysis was performed using MedCalc® software, with a significance level of p < 0.05.ResultsThe VAP1-BR showed an AUC of 0.83 (95% CI: 0.744-0.899; p < 0.001), a cutoff point ≥9.37, sensitivity of 69%, and specificity of 84%. The VAP2-BR yielded an AUC of 0.80 (95% CI: 0.710-0.875; p < 0.001), a cutoff point ≥7.71, sensitivity of 68%, and specificity of 83%.ConclusionThe VAP subscales adequately identify severe handicap in individuals with vestibular dysfunction.
Background Carsickness is a potential barrier to the acceptance of automated driving as it turns drivers into passengers, thus making them more susceptible to motion sickness. However, most of our current knowledge of how vehicle motion causes motion sickness comes from seasickness studies, using vertical motion only. Some more recent studies have investigated the relationship between horizontal accelerations and motion sickness, but with inconsistent methodology and sometimes conflicting results. Objective To quantify the effects of acceleration frequency and magnitude for periodic accelerations along the longitudinal, lateral, and vertical axes in a large sample of participants, using consistent methodology throughout. Methods In three separate experiments, in total 107 participants were exposed to sinusoidal accelerations along either the longitudinal, lateral or vertical axis with different combinations of motion frequency and peak acceleration. Motion frequency was varied between 0.03 and 3.2 Hz, with peak acceleration ranging from 0.5 to 4.0 m/s 2 . Motion sickness was measured during motion exposure using the Motion Illness Symptoms Classification (MISC) scale, while the Simulator Sickness Questionnaire (SSQ) and a visual analogue Discomfort scale were administered after each motion exposure. Results Motion sickness severity due to motion exposure was similar for the three motion axes. All three outcome measures showed a clear motion frequency dependency, with motion sickness in general most severe for frequencies around 0.2 Hz. However, significant motion sickness symptoms were observed for the entire frequency range tested. The frequency dependency was less clear for lateral motion than for longitudinal and vertical motion. Higher accelerations led to more severe motion sickness, with the rate of increase decreasing when accelerations became higher. Conclusions Our results show that motion sickness due to periodic linear accelerations occurs along all three cardinal axes and that it depends on motion frequency. This frequency dependency was less clear for lateral motion than for longitudinal and vertical motion. Our results have important implications for both predictive models of motion sickness as well as for applications in automated vehicles.
BackgroundHereditary vestibular dysfunctions (HVDs) are a group of diseases caused by genetic mutations, characterized by congenital or progressive vestibular dysfunction, often accompanied by hearing loss or other systemic damages. These diseases are divided into syndromic (e.g., Usher syndrome, CHARGE syndrome) and non-syndromic types, involving mutations in key genes such as MYO7A, COCH, SLC26A4, TMC1, etc. Although clinical phenotypes vary, the pathogenesis is complex, traditional diagnostic methods are limited, and effective treatments are lacking. Mouse models are important tools for studying hereditary vestibular dysfunction, providing critical platforms for understanding disease mechanisms, developing diagnostic biomarkers, and treatment strategies.MethodsThis review systematically searched English and Chinese literature in databases including PubMed, Web of Science, Embase, and CNKI from January 2000 to April 2026. The search strategy combined Medical Subject Headings (MeSH) terms and free-text keywords, including "hereditary vestibular dysfunction," "mouse models," "gene therapy," "CRISPR-Cas9," "Usher syndrome," "translational research," "biomarkers," "Meniere disease," and "International Mouse Phenotyping Consortium." Inclusion criteria were: (1) peer-reviewed articles on hereditary vestibular dysfunction mouse models; (2) studies reporting genetic mechanisms, pathophysiology, or therapeutic interventions; and (3) English or Chinese language publications. Exclusion criteria were: (1) non-peer-reviewed conference abstracts or preprints and (2) studies without clear genetic or phenotypic characterization. Two authors independently screened titles, abstracts, and full texts, with disagreements resolved by consensus. The review focuses on analyzing the applications of spontaneous mutation models, genetic engineering models, CRISPR technology-based models, and knockout models from the International Mouse Phenotype Consortium (IMPC) in disease mechanism research and treatment development.ResultsIn recent years, significant progress has been made in hereditary vestibular dysfunction mouse model research. Spontaneous mutation models like Myo6 and Cdh23 mutant mice have revealed the key role of cytoskeletal and cell junctions in vestibular function. Genetic engineering models have successfully simulated a variety of diseases, including Usher syndrome, ion channel defects, and vestibular development abnormalities, elucidating the molecular mechanisms of TMC1/2 mechanosensory channels, SLC26A4 ion transport, and vestibular system development genes. The application of CRISPR-Cas9 technology has greatly improved model construction efficiency and precision. These models have shown positive results in gene therapy, gene editing, and drug treatment research. AAV-mediated gene replacement therapy, CRISPR gene repair, and new drugs such as α1-antitrypsin have all achieved positive outcomes in mouse models. Biomarker studies based on multi-omics techniques have identified potential diagnostic markers such as Slc17a6 and BDNF.ConclusionMouse models play an irreplaceable role in the study of hereditary vestibular dysfunction, providing a solid foundation for elucidating disease mechanisms, improving diagnostic methods, and developing treatment strategies. Although clinical translation still faces challenges such as species differences, delivery efficiency, and treatment windows, with the continuous development of gene editing technology, nano-delivery systems, and multi-omics techniques, personalized diagnosis and treatment for hereditary vestibular dysfunction are expected to be realized, bringing new hope to patients.
BackgroundVestibular disorders affect mobility, independence, and quality of life. Culturally adapted assessment tools are essential for accurate evaluation and effective treatment in diverse populations.ObjectivesTo translate, culturally adapt, and evaluate the psychometric properties of the Vestibular Disorders Activities of Daily Living Scale (VADL) into European Spanish (VADL-ES).MethodsThe VADL was adapted following international cross-cultural guidelines. Psychometric testing included internal consistency (Cronbach's α), test-retest reliability (ICC), content validity (CVI), convergent validity with the Dizziness Handicap Inventory (DHI), and discriminant validity (ROC analysis, Youden index). Floor/ceiling effects, standard error of measurement (SEM), minimal detectable change (MDC95), and structural validity (exploratory and confirmatory factor analysis) were also assessed.ResultsThe VADL-ES showed excellent internal consistency (α = 0.978), test-retest reliability (ICC = 0.988), strong correlation with the DHI (ρ = 0.768), and high content validity (S-CVI = 0.93). ROC analysis yielded an AUC = 0.988 with 100% specificity. Factor analysis confirmed a three-factor structure explaining 72% of variance. No floor or ceiling effects were observed; MDC95 was 0.91.ConclusionsThe VADL-ES is a valid and reliable instrument for assessing functional limitations in Spanish-speaking patients with vestibular disorders, enabling standardized evaluation and longitudinal monitoring in clinical and research settings.
Since the diagnostic criteria of benign paroxysmal positional vertigo (BPPV) were published in 2015 by the Bárány Society, many new ideas and observations have been introduced concerning the diagnostic methods, classification and related theories of pathomechanisms of this most frequent vestibular disease. The aim of the authors was to review new diagnostic methods, classification, hypothetical pathomechanisms of the recently introduced BPPV variants. To look for answers to the "Questions for the Future" published in the Consensus Document (2015) of the Committee for Classification of Vestibular Disorders of the Bárány Society, the authors reviewed the publications listed in PUBMED since 2015 on "diagnosis," "classification," "pathomechanism," of BPPV in the light of their own studies. The questions were:1. The possible role of loose otoconia within the short arm of the semicircular canals.2. Coexistence of canalithiasis and cupulolithiasis.3. Mechanism of "pseudospontaneous" nystagmus and the theory of "canalith jam".4. Mechanism of persistent geotropic direction-changing positional nystagmus and the theory of light cupula.5. Anterior canalithiasis and the posterior cupulolithiasis.New research results contribute to our understanding of previously unclassified symptoms and examination results. As a conclusion it can be stated that the newly defined entities are important for topodiagnosis and successful treatments by physiotherapy.
BackgroundIn obstructive sleep apnea syndrome (OSAS), intermittent hypoxia and oxygen desaturation resulting from recurrent apnea episodes may adversely affect vestibular function.ObjectiveThis study aimed to provide a multidimensional evaluation of vestibular function in individuals with OSAS by assessing objective and functional/subjective vestibulo-ocular reflex (VOR), visual perception, and fall risk.MethodsVideo Head Impulse Test (vHIT), functional Head Impulse Test (fHIT), Tinetti Balance and Gait Test, and static and dynamic subjective visual vertical and horizontal tests were administered to 22 individuals with moderate OSAS, 22 with severe OSAS, and 23 healthy controls aged 18-55 years.ResultsFall risk was significantly increased in both OSAS groups compared with controls. Dynamic visual perception and functional VOR performance were predominantly impaired in severe OSAS, whereas vHIT gains did not differ between groups. Tinetti scores were not associated with subjective visual perception but showed moderate-to-strong correlations with fHIT performance in moderate and severe OSAS.ConclusionsFall risk is increased in OSAS, and functional VOR deficits may occur despite normal vHIT findings, suggesting involvement of higher-level (central) vestibular processing and underscoring the need for comprehensive vestibular assessment.
ObjectivesThis study aims to develop a prognostic model, based on the video Head Impulse Test (vHIT)-Vestibulo-Ocular Reflex (VOR) gain, of vestibular loss after an acute Unilateral Vestibulopathy (aUVP) predicting the probability of an objective and significant recovery.DesignData gathered prospectively in patients with aUVP were re-analyzed. After an exploratory cluster analysis, a multivariate PROBIT regression model was used to objectively pinpoint the value of vHIT-VOR gain at baseline that predicts a significant recovery after 10 weeks. Significant recovery was defined as a vHIT-VOR gain superior or equal to 0.70 after 10 weeks.ResultsA total of 48 subjects were included. The final model identified 2 thresholds, respectively, at 0.53 and 0.74, to classify severe (vHIT-VOR gain ≤0.53), moderate (0.53 < vHIT-VOR gain ≤0.74), and non-significant (0.74 < vHIT-VOR gain) vestibular loss. The probability of a significant recovery was 20% ((Prediction Interval 95% (PI) [0%-43%]) for a gain of 0.50 at baseline, while it doubles (45% (PI [0%-63%]) for an initial gain of 0.60. Our final model demonstrated a good area under the curve (AUC) of 0.85. The corrected AUC after bootstrap resampling was 0.81 (CI 95% [0.74, 0.89]). A good Brier score of the predicted probabilities was also obtained, at 0.15.Conclusions and relevanceFor the first time, this paper proposes a model that objectively defines the severity of vestibular loss at baseline after an aUVP. This research lays the groundwork for future studies to validate our prognostic model and perform more precise analyses of vestibular compensation patterns.
BackgroundVisual vertigo (VV) refers to dizziness or discomfort provoked by dynamic visual environments and is common after vestibular disorders. The Visual Vertigo Analogue Scale (VVAS) is a nine-item questionnaire developed to assess VV. However, no validated Japanese version has been available. This study aimed to translate the VVAS into Japanese (VVAS-J) and evaluate its reliability and validity.MethodsThe VVAS-J was translated and cross-culturally adapted according to standardized guidelines. The study included 168 patients with vestibular disorders and 73 healthy controls. Reliability was assessed by internal consistency and test-retest reliability using Cronbach's α, intraclass correlation coefficient [ICC(3,1)], and Cohen's κ. Validity was examined in terms of content, criterion-related, and construct validity. For criterion-related validity, VV Severity and VVAS Positive were calculated and analyzed in relation to the Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), and stabilometry. For construct validity, VV Severity and VVAS Positive were compared between patients and controls and across diagnostic subgroups.ResultsThe VVAS-J showed excellent internal consistency (Cronbach's α = 0.911) and good test-retest reliability (ICC = 0.87). VV Severity correlated strongly with the DHI (r = 0.62, p < 0.001) but weakly with the HADS and stabilometry. VV Severity and all items were significantly higher in patients with vestibular disorders than in controls, and highest in PPPD among diagnostic subgroups (p < 0.001).ConclusionThe VVAS-J demonstrated good reliability and validity, providing a simple, standardized tool to quantify VV in Japanese patients.
BackgroundVisual Vertigo Analogue Scale (VVAS) is valid and reliable self-administered questionnaire to assess visual vertigo. Although VVAS has been culturally adapted and validated in several cultures, it has not been adapted in Turkish.ObjectivesThe aim of this research is to translate and cross-culturally adapt the VVAS into Turkish (VVAS-Tr) and evaluate its psychometric properties.MethodsFollowing established cross-cultural adaptation guidelines, the VVAS was translated into Turkish and completed by 113 patients with vestibulopathy. Validity was assessed using exploratory and confirmatory factor analyses, correlations with the Dizziness Handicap Inventory (DHI), Bland-Altman plots, and regression analyses. Reliability was tested with Cronbach's alpha.ResultsThe VVAS-Tr demonstrated a unidimensional structure with strong factor loadings (0.743-0.928) and excellent internal consistency (Cronbach's α = 0.954). Moderate correlations with DHI scores (rho = 0.553-0.595) supported criterion-related validity. Agreement with DHI was confirmed through Bland-Altman analysis, and predictive validity was explained by DHI physical and emotional subscales (R2 = 0.41).ConclusionThe VVAS-Tr is the first Turkish tool specifically designed to measure visual vertigo and the first adaptation of the VVAS to undergo both exploratory and confirmatory factor analyses. It demonstrates strong validity and reliability and is suitable for clinical use in Turkish-speaking patients with vestibular disorders.
Introduction: Third-window syndromes (TWS), including superior semicircular canal dehiscence (SSCD) and enlarged vestibular aqueduct (EVA), cause paradoxical auditory and vestibular symptoms such as apparent conductive loss, bone-conduction hyperacusis, and sound- or pressure-induced vertigo. Numerical modeling provides a unique means to explore the mechanical consequences of lesion size, geometry, and location.Methods: A structured search of PubMed, Scopus, and Google Scholar (July 2025) identified nine studies applying lumped-element, finite-element (FE), or computational fluid dynamics (CFD) models to SSCD or EVA, which were analyzed qualitatively.Results: Lumped-element models reproduced air-bone gaps and bone-conduction hypersensitivity, showing that lesion size and location modulate functional severity. FE and CFD simulations offered anatomically detailed insights, revealing that dehiscence geometry strongly shapes basilar membrane motion, that sound-induced endolymphatic streaming can account for the Tullio phenomenon, and that large vestibular aqueducts transmit intracranial pressure fluctuations. Validation across studies remained limited.Conclusion: Numerical models provide complementary insights into TWS. Lumped-element approaches are rapid and clinically interpretable, while FE and CFD enable detailed exploration of fluid-structure interactions. Patient-specific simulations may eventually support individualized diagnosis and surgical planning but remain speculative.
ObjectiveThe aim of this study is to evaluate utricle function in Meniere's disease (MD) patients using video ocular counter roll (vOCR), ocular vestibular evoked myogenic potential (oVEMP), subjective visual vertical (SVV), and subjective visual horizontal (SVH) tests, and compare the test results with those of healthy individuals.MethodsThe study included 21 patients aged 18-55 years with a definitive diagnosis of MD (mean age: 49 ± 6.92) and 24 healthy individuals (mean age: 39 ± 16.66) with normal audiological and vestibular function, no neurological or systemic diseases, and no use of ototoxic medications. All participants underwent a series of auditory and vestibular assessments, including pure-tone audiometry, acoustic immittance testing, videonystagmography (VNG), vOCR, oVEMP, and SVV/SVH testing.ResultsStatic vOCR gain did not differ significantly between the MD and control groups. However, the MD group exhibited significantly higher OCR asymmetry ratio (p = .01) and oVEMP asymmetry (p < .001) compared to controls. Perceptually, MD patients showed significantly larger deviations in SVV and SVH in the upright position (0°) (p < .05), but no significant differences were observed at tilt angles (15°, 30°, 45°).ConclusionUtricular dysfunction in MD is multidimensional. During the interictal phase, while static reflex gains may appear preserved, functional asymmetries and static perceptual deficits persist. The findings highlight that single-modality testing is insufficient; a multimodal approach combining reflex and perceptual assessments is essential for detecting subclinical utricular dysfunction.
ObjectiveThis study aimed to translate and cross-culturally adapt the Niigata Persistent Postural-Perceptual Dizziness Questionnaire (NPQ) into Turkish and evaluate its psychometric properties, including reliability, validity, and diagnostic accuracy, in Turkish-speaking patients with Persistent Postural-Perceptual Dizziness (PPPD).MethodsThis prospective case-control study included 114 participants: 36 PPPD patients, 40 with other vestibular disorders, and 38 healthy controls. Participants completed the Turkish version of the NPQ (T-NPQ) and the Dizziness Handicap Inventory (DHI). Internal consistency was assessed using Cronbach's alpha, and test-retest reliability was evaluated over 14-30-day interval. Construct validity was tested through confirmatory factor analysis (CFA) to test the hypothesized three-factor structure (Upright Posture/Walking, Movement, and Visual Stimulation), while convergent validity was examined by correlating T-NPQ scores with DHI scores. Diagnostic accuracy was assessed using Receiver Operating Characteristic (ROC) curve analysis.ResultsThe T-NPQ demonstrated excellent internal consistency (Cronbach's α = 0.919) and strong test-retest reliability (r = 0.832, p < .001). CFA supported the hypothesized three-factor structure and showed good model fit (χ2/df = 1.47, CFI = 0.964, RMSEA = 0.064). T-NPQ total scores strongly correlated with DHI total scores (r = 0.709, p < .001). The T-NPQ discriminated PPPD patients from other vestibular patients with an Area Under the Curve (AUC) of 0.746. The optimal cut-off score of 27.5 showed sensitivity of 86.1% and specificity of 57.5%.ConclusionThe Turkish version of the NPQ is a reliable and valid tool that may be useful for assessing symptom severity in PPPD patients. It has the potential to be effective for screening and measuring outcomes in clinical practice and research in Turkey.
BackgroundIndividuals with vestibular disorders often describe symptoms of dizziness, disorientation, and impaired balance induced by visual stimuli, commonly referred to as visual vertigo.ObjectiveThe purpose of this study was to improve assessment of visually induced symptoms by modifying the original, nine-item Visual Vertigo Analogue Scale (VVAS) to produce a more robust, interpretable, and clinically useful measure of visual vertigo. We also aimed to establish a cut-off score for identifying patients with vestibular disorders and low- versus high-severity visual vertigo.MethodsPatients with vestibular disorders (n = 199) and controls (n = 107) completed the modified VVAS (mVVAS). Exploratory factor analysis was conducted to develop a shorter scale and internal consistency analyses were performed. A K-means cluster analysis was used to determine a cut-off score for identifying low- and high-severity groups.ResultsA reduced six-item scale (VVAS-6), which included three items from the VVAS and three items from the mVVAS, had excellent internal consistency (Cronbach's α = 0.93). We identified four concepts within the VVAS-6 (walking with visual stimulation, visual stimulation only, escalator, car). A cut-off score of 37 was able to identify patients with vestibular disorders and high severity of visual vertigo.ConclusionsThe use of a cut-off score of 37 for the VVAS-6 scale resulted in an improvement in correctly identifying patients with vestibular disorders and high severity of visual vertigo from controls.
