Head Thrust Test Research Articles

Role of the video head impulse test in the evaluation of vestibulo-ocular reflex in individuals with Parkinson's disease.

<p>Parkinson&rsquo;s disease (PD) is the most common movement disorder and the second most common neu&shy;rodegenerative disease of the central ner&shy;vous system. Dizziness is frequently reported by PD patients, yet there is a paucity of research focusing on the vestibulo-ocular reflex (VOR) in this population using high-frequency vestibular testing. This study aims to investigate the VOR in individuals with PD using the video head thrust test with and without suppression.&nbsp;</p>. <p>Forty individuals with PD and 40 healthy individuals were included in the study. According to the Hoehn-Yahr Scale, individuals with PD were defined as early stage with a score of 1&ndash;2.5 and middle to late stage with a score of 3 to 5. The Head Impulse Testing Paradigm (HIMP) and Suppression Head Impulse Testing Paradigm (SHIMP) were applied to all individuals.</p>. <p>No statistically significant difference was observed between the PD group and the control group in terms of semicircular canal (SCC) gains in both HIMP and SHIMP tests. No catch-up saccades were observed in the right anterior, right posterior, left anterior, and left posterior SCC planes in the PD and control groups. However, in the right lateral SCC plane 32 patients in the PD group had saccades, while 8 patients in the control group had saccades. In the left lateral SCC plane, 32 patients in the PD group and 9 patients in the control group had catch-up saccades. A statistically significant difference was observed in the number and amplitude of saccades in the right and left lateral SCC planes compared to the control group (p&lt;0.05). In addition, in the PD group, the amplitude, peak velocity, and latency of the anticompensatory saccades seen in SHIMP showed a statistically significant difference compared to the control group (p&lt;0.05).</p>. <p>VOR in the vertical SCC plane was not affected in individuals with PD. However, VOR in the lateral SCC plane was affected. It was concluded that when evaluating VOR with both HIMP and SHIMP in individuals with PD, the presence of catch-up saccades should be focused on and evaluated for possible vestibular dysfunction, even though SCC gains are normal. This study will contribute to a deeper understanding of vestibular function in PD, potentially informing better management strategies for dizziness in this population.&nbsp;</p>.

Preseason Measures of Cervical Spine Function, Vestibulo-Ocular Reflex, Dynamic Balance, and Divided Attention in Youth Ice Hockey Players.

OBJECTIVES: Report typical scores and examine preseason cervical spine, vestibulo-ocular reflex, dynamic balance, and divided attention measures in competitive youth ice hockey players aged 10 to 18 years with and without a previous concussion history. DESIGN: Cross-sectional secondary analysis. METHODS: The exposure of interest was self-reported history of concussion. The main outcomes were cervical spine measures (Cervical Flexor Endurance [CFE; seconds], Cervical Flexion-Rotation Test [normal/abnormal], Anterolateral Cervical Spine Strength [kilograms], Head Perturbation Test (/8), and Joint Position Error [JPE; centimeters]), vestibulo-ocular reflex (Dynamic Visual Acuity [logMAR], Head Thrust Test [Positive/Negative]), dynamic balance (Functional Gait Assessment [/30]) and divided attention (Walking While Talking Test [seconds]). Multivariable linear or logistic regression, adjusted for age-group, sex, level of play, and clustered by team, were used to assess potential differences by concussion history. RESULTS: We included data from 2311 participants in this study (87.2% male, 12.8% female, 39.0% reported a previous concussion). No differences by concussion history were found across any of the measures (P values range: 0.17-0.99). Measures of cervical spine function and divided attention differed by age group (eg, Median Left Anterolateral Cervical Spine Strength [kilograms] for males: U13 = 7.46, U15 = 9.10, U18 = 9.67). CONCLUSION: Clinical outcomes scores in youth ice hockey players did not differ by concussion history. Performance on cervical spine strength, CFE, and JPE test outcomes may improve with age, highlighting the importance of developmental considerations when interpreting test scores. J Orthop Sports Phys Ther 2024;54(3):1-11. Epub 30 November 2023. doi:10.2519/jospt.2023.11958.

The relationship between balance and flu-like symptoms: a medical condition that needs attention

Objective: In general, while upper respiratory tract viruses cause flu-like complaints, balance problems associated with these viruses are often overlooked. It has been a long time since the first appearance of Covid-19, but unfortunately, there is still no fully effective treatment for this disease. Along with balance manifestations, especially several vestibular symptoms such as dizziness, vertigo, and tinnitus are described as common clinical manifestations in COVID-19. In our study, we investigated the effects of Covid-19 on the balance system with routine balance tests and we tried to localize a possible disorder in the balance system. Materials and Methods: Volunteers were divided into two groups. The number of volunteers in each group was thirty. The first group consisted of SARS-CoV-2-positive patients and the second group consisted of healthy people. Spontaneous nystagmus determination, Romberg test, Fukuda stepping test (FST), head thrust test (HTT), head shake test (HST), finger-nose test, and tandem walking test were applied. Results: The lateral fall in the Romberg test, rotation in the FST, and nystagmus in the HST are significant in Group 1 (p&lt;0.001), (p&lt;0.001), (p&lt;0.03). The relationship between the fall side in the Romberg test and the direction of rotation in the FST were found to be significant in Group 1 (p&lt;0.001). Similarly, the relationship between the direction of rotation in the FST and the nys-tagmus direction in the HST, and the direction of the saccadic correction in the HTT were found to be sig-nificant (p&lt;0.026), (p&lt;0.010). Conclusion: In SARS-CoV-2 positive patients, the balance system, especially the peripheric vestibular system, may be affected even if the patients do not have obvious complaints about balance. Routine balance tests that can be performed quickly in the outpatient clinic can be used effectively for the evaluation of balance.

Determining the Agreement Between Common Measures Related to Vestibulo-ocular Reflex Function After a Mild Traumatic Brain Injury in Children and Adolescents

ObjectiveTo (1) determine the level of agreement between symptom provocation and performance-based tests of vestibulo-ocular reflex (VOR) function after pediatric mild traumatic brain injury (mTBI) and (2) describe the level of symptom provocation induced by a VOR task in individuals with and without cervical findings. DesignCross-sectional. SettingThis study was conducted at a tertiary care pediatric hospital. ParticipantsA total of 101 participants (N=101) aged 6-18 years within 3 weeks of mTBI diagnosis were included (54.5% female; mean age, 13.92±2.63 years; mean time since injury at assessment, 18.26±6.16 days). InterventionsNone. Main Outcome MeasuresSymptom provocation (Vestibular/Ocular Motor Screening tool), performance (clinician-observed VOR performance, head thrust test [HTT], computerized dynamic visual acuity test, video head impulse test), and cervical impairment (cervical flexion-rotation test, range of motion test, self-reported neck pain). Agreement was evaluated using Cohen's κ statistic. ResultsNo outcomes demonstrated agreement with symptom provocation (κ=−0.15 to 0.14). Fair agreement demonstrated between clinician-observed VOR performance and HTT (κ=0.32), with little to no agreement demonstrated between other measures. Proportions reporting test-induced dizziness and headache were greater among individuals with cervical findings (29.1%-41.8%) than without (2.3%-6.8%). ConclusionsFindings support that symptom provocation and performance-based tests measure different constructs and thus have distinct roles when assessing VOR function. Findings suggest results from measures of symptom provocation may be influenced by coexisting cervical impairments, underlining the value of assessing for cervical injury after pediatric mTBI.

Efficacy and Durability of Intratympanic Gentamicin Treatment for Meniere's Disease.

Objective: To study the success of intratympanic gentamicin (ITG) treatment in reducing vertigo attacks in Meniere's disease (MD) and the value of the Halmagyi head thrust test (HTT) in predicting treatment durability.Study Design: Retrospective cohort study.Setting: Tertiary care vestibular clinic.Patients: Unilateral MD patients treated with ITG from 2006–2019 with ≥6 months follow-up.Main Outcome Measures: Demographics, audiometric data, subjective symptomatology, and HTT results were collected. Treatment success was defined as sufficient symptom relief. Treatment failure indicated vertigo control of less than 6 months duration. Treatment relapse indicated vertigo recurrence after 6 months.Results: Of 255 patients, treatment success, failure, and relapse occurred in 226 (88.6%), 29 (11.4%), and 121 (47.1%) patients, respectively. 48 (18.8%) patients who failed to respond or relapsed underwent labyrinthectomy. Mean follow-up time was 3.7 yrs (range 0.5–12.8). After ITG treatment, 25% patients reported worse hearing; mean pure tone average (PTA) increased by 18.6 ± 11.3 dB and mean word recognition score (WRS) decreased by 33 ± 21%. Of the 148 patients with negative pre-treatment HHT, 103 (69.6%) converted to positive after ITG treatment. Mean time-to-relapse in the converted and non-converted HTT cohorts was significantly different (49.7 vs. 27.0 months, p = 0.009) even after adjusting for gender, age, laterality, duration of symptoms, and number of ITG treatments. There were no significant differences between the two groups in hearing outcomes or subjective symptoms (e.g. lingering disequilibrium).Conclusions: ITG treatment effectively reduces the number of vertigo attacks in MD. HTT is valuable in predicting durability of treatment benefit.

Editors' Note: Opinion and Special Articles: Remote Evaluation of Acute Vertigo: Strategies and Technological Considerations

In “Opinion and Special Articles: Remote Evaluation of Acute Vertigo: Strategies and Technological Considerations,” Green et al. discussed the telemedicine approach to a patient with acute vertigo by describing a modified version of the penlight-cover test to detect nystagmus, the alternate-cover test to check for a skew deviation and techniques to perform a virtual Dix-Hallpike maneuver and the head thrust test. Tjell agreed with the strategies described, but reported they may be challenging in a busy emergency department, and indicated a preference for 3 different assessments including the Romberg test, the horizontal smooth pursuit eye movement test, and tragal pressure. Green et al. noted that evaluation of nystagmus by smooth pursuit has pitfalls and the diagnostic value of tragal compression is unclear. They suggested that a very large multicenter international trial would be needed to clarify whether there is a difference in diagnostic accuracy between their proposed batteries or a combination of their tests. In “Opinion and Special Articles: Remote Evaluation of Acute Vertigo: Strategies and Technological Considerations,” Green et al. discussed the telemedicine approach to a patient with acute vertigo by describing a modified version of the penlight-cover test to detect nystagmus, the alternate-cover test to check for a skew deviation and techniques to perform a virtual Dix-Hallpike maneuver and the head thrust test. Tjell agreed with the strategies described, but reported they may be challenging in a busy emergency department, and indicated a preference for 3 different assessments including the Romberg test, the horizontal smooth pursuit eye movement test, and tragal pressure. Green et al. noted that evaluation of nystagmus by smooth pursuit has pitfalls and the diagnostic value of tragal compression is unclear. They suggested that a very large multicenter international trial would be needed to clarify whether there is a difference in diagnostic accuracy between their proposed batteries or a combination of their tests.

Determining the Agreement Between Common Measures Of VOR Function After A Mild Traumatic Brain Injury in Children and Adolescents

<h3>Research Objectives</h3> Alterations to vestibulo-ocular reflex (VOR) function (1-3) and cervical spine injury (4-6) may contribute to dizziness reported following pediatric mild traumatic brain injury (mTBI). Moreover, dizziness has been correlated with a more negative prognosis. While various measures are used to assess VOR function, there is no consensus on what the optimal battery of tests may be. The influence of cervical injury on findings from these tests remains unclear. Objectives: i) to determine the level of agreement between symptom- and performance-based tests of VOR function in a pediatric mTBI sample; ii) to characterize the level of symptom provocation induced by VOR tests in individuals with and without cervical findings. <h3>Design</h3> Cross-sectional study. <h3>Setting</h3> Tertiary care pediatric hospital. <h3>Participants</h3> 101 participants (54.5% female), mean age 13.92 years (SD 2.63), completed a VOR assessment (mean time since injury 18.26 days (SD 6.16)). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Symptom provocation was measured by the Vestibular/ocular motor screening tool (VOMS). Performance was measured by VOMS VOR performance, the head thrust test (HTT), the computerized dynamic visual acuity test, and the video head impulse test. Cervical impairment was measured by the cervical flexion rotation test, range of motion test and self-reported neck pain. <h3>Results</h3> No outcomes demonstrated agreement with VOR symptom provocation (k=-0.15-0.14). Among performance-based measures, fair agreement was demonstrated between VOMS VOR performance and the clinical HTT (k=0.32), while little to no agreement was demonstrated between the remaining measures. VOR dizziness symptoms were reported in a greater proportion of individuals with cervical findings (41.1-41.8%) than without (2.3-6.8%). <h3>Conclusions</h3> The findings indicate i) that symptom-based VOR tests measure a different construct than performance-based tests, ii) the distinct role of each measure when assessing VOR function should be further understood, and iii) cervical injury may contribute to symptoms induced by tests of VOR function. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose. This study was funded by an ERA-Net NEURON JTC Cofund Program.

The effect of high-intensity physical exertion on measures of cervical spine, vestibular/ocular-motor screening, and vestibulo-ocular reflex function in university level collision and combative sport athletes

ObjectivesTo examine how high-intensity physical exertion affects clinical measures of cervical spine (CSp), vestibular/ocular motor screen (VOMS), and vestibulo-ocular reflex (VOR) function. DesignCase series. SettingSports Medicine Centre. ParticipantsA total of 37 athletes consented to participate (22 rugby, 15 wrestling; 9 men, 28 women; median age = 19 years [range 17–23 years]). Main outcome measuresOutcome measures included tests of CSp (cervical flexor endurance, head perturbation test, cervical flexion rotation test and anterolateral strength), VOR (head thrust test and dynamic visual acuity [DVA]), and a quantified version of the VOMS. These metrics were assessed prior to and after completing the 30–15 Intermittent Fitness Test. Bland-Altman plots and Wilcoxon signed-rank tests were utilized to analyze the data using an alpha of p < 0.004. ResultsCervical anterolateral strength (kg) was reduced post-exertion on the left (z = 3.87; p < 0.001), but not on the right between conditions (z = −1.49; p = 0.14). Athletes reported increased dizziness (z = −3.55; p = 0.004) and had reduced DVA following exertion (z = −2.78; p < 0.001). All other metrics were not significantly different following exertion (p > 0.011). ConclusionReduced performance on DVA, decreased left-anterolateral strength, and increased dizziness occurred following high-intensity exertion in varsity collision and combative athletes, which has implications for sideline screening for sport-related concussion.

Routine Vestibular Function Assessment in Children With Congenital CMV: Are We Ready?

Routine Vestibular Function Assessment in Children With Congenital CMV: Are We Ready?

Dizziness

Dizziness is the quintessential symptom presentation in all of clinical medicine. It is a common reason that patients present to a physician. This chapter provides background information about the vestibular system, then reviews key aspects of history-taking and examination of the patient, then discusses specific disorders and common presentation types. Throughout the chapter the focus is on neurologic and vestibular disorders. Normal vestibular anatomy and physiology are discussed, followed by recommendations for history-taking and the physical examination. Specific disorders that cause dizziness are explored, along with common causes of non-specific dizziness. Common presentations are discussed, including acute severe dizziness, recurrent attacks, and recurrent positional vertigo. Finally, the chapter looks at laboratory investigations in diagnosis and management. Figures include population prevalence of dizziness symptoms, the anatomy of inner structures, primary afferent vestibular nerve activity, the head thrust test, the Dix-Hallpike maneuver, the supine positional test, the canalith repositioning procedure, and the barbecue roll maneuver. Tables list physiologic properties and clinical features of the components of the peripheral vestibular system, information to be acquired from history of the present illness, common symptoms patients report as dizziness, examination components, distinguishing among common peripheral and central vertigo syndromes, common causes of nonspecific dizziness, types of dizziness presentations, relevant imaging abnormalities on neuroimaging studies, vestibular testing components, and medical therapy for symptomatic dizziness. This review contains 8 highly rendered figures, 10 tables, and 68 references.

Dizziness

Dizziness is the quintessential symptom presentation in all of clinical medicine. It is a common reason that patients present to a physician. This chapter provides background information about the vestibular system, then reviews key aspects of history-taking and examination of the patient, then discusses specific disorders and common presentation types. Throughout the chapter the focus is on neurologic and vestibular disorders. Normal vestibular anatomy and physiology are discussed, followed by recommendations for history-taking and the physical examination. Specific disorders that cause dizziness are explored, along with common causes of non-specific dizziness. Common presentations are discussed, including acute severe dizziness, recurrent attacks, and recurrent positional vertigo. Finally, the chapter looks at laboratory investigations in diagnosis and management. Figures include population prevalence of dizziness symptoms, the anatomy of inner structures, primary afferent vestibular nerve activity, the head thrust test, the Dix-Hallpike maneuver, the supine positional test, the canalith repositioning procedure, and the barbecue roll maneuver. Tables list physiologic properties and clinical features of the components of the peripheral vestibular system, information to be acquired from history of the present illness, common symptoms patients report as dizziness, examination components, distinguishing among common peripheral and central vertigo syndromes, common causes of nonspecific dizziness, types of dizziness presentations, relevant imaging abnormalities on neuroimaging studies, vestibular testing components, and medical therapy for symptomatic dizziness. This review contains 8 highly rendered figures, 11 tables, and 69 references.

Dizziness

Dizziness is the quintessential symptom presentation in all of clinical medicine. It is a common reason that patients present to a physician. This chapter provides background information about the vestibular system, then reviews key aspects of history-taking and examination of the patient, then discusses specific disorders and common presentation types. Throughout the chapter the focus is on neurologic and vestibular disorders. Normal vestibular anatomy and physiology are discussed, followed by recommendations for history-taking and the physical examination. Specific disorders that cause dizziness are explored, along with common causes of non-specific dizziness. Common presentations are discussed, including acute severe dizziness, recurrent attacks, and recurrent positional vertigo. Finally, the chapter looks at laboratory investigations in diagnosis and management. Figures include population prevalence of dizziness symptoms, the anatomy of inner structures, primary afferent vestibular nerve activity, the head thrust test, the Dix-Hallpike maneuver, the supine positional test, the canalith repositioning procedure, and the barbecue roll maneuver. Tables list physiologic properties and clinical features of the components of the peripheral vestibular system, information to be acquired from history of the present illness, common symptoms patients report as dizziness, examination components, distinguishing among common peripheral and central vertigo syndromes, common causes of nonspecific dizziness, types of dizziness presentations, relevant imaging abnormalities on neuroimaging studies, vestibular testing components, and medical therapy for symptomatic dizziness. This review contains 8 highly rendered figures, 10 tables, and 68 references.

Dizziness

Dizziness is the quintessential symptom presentation in all of clinical medicine. It is a common reason that patients present to a physician. This chapter provides background information about the vestibular system, then reviews key aspects of history-taking and examination of the patient, then discusses specific disorders and common presentation types. Throughout the chapter the focus is on neurologic and vestibular disorders. Normal vestibular anatomy and physiology are discussed, followed by recommendations for history-taking and the physical examination. Specific disorders that cause dizziness are explored, along with common causes of non-specific dizziness. Common presentations are discussed, including acute severe dizziness, recurrent attacks, and recurrent positional vertigo. Finally, the chapter looks at laboratory investigations in diagnosis and management. Figures include population prevalence of dizziness symptoms, the anatomy of inner structures, primary afferent vestibular nerve activity, the head thrust test, the Dix-Hallpike maneuver, the supine positional test, the canalith repositioning procedure, and the barbecue roll maneuver. Tables list physiologic properties and clinical features of the components of the peripheral vestibular system, information to be acquired from history of the present illness, common symptoms patients report as dizziness, examination components, distinguishing among common peripheral and central vertigo syndromes, common causes of nonspecific dizziness, types of dizziness presentations, relevant imaging abnormalities on neuroimaging studies, vestibular testing components, and medical therapy for symptomatic dizziness. This review contains 8 highly rendered figures, 11 tables, and 69 references.

Dizziness

Dizziness is the quintessential symptom presentation in all of clinical medicine. It is a common reason that patients present to a physician. This chapter provides background information about the vestibular system, then reviews key aspects of history-taking and examination of the patient, then discusses specific disorders and common presentation types. Throughout the chapter the focus is on neurologic and vestibular disorders. Normal vestibular anatomy and physiology are discussed, followed by recommendations for history-taking and the physical examination. Specific disorders that cause dizziness are explored, along with common causes of non-specific dizziness. Common presentations are discussed, including acute severe dizziness, recurrent attacks, and recurrent positional vertigo. Finally, the chapter looks at laboratory investigations in diagnosis and management. Figures include population prevalence of dizziness symptoms, the anatomy of inner structures, primary afferent vestibular nerve activity, the head thrust test, the Dix-Hallpike maneuver, the supine positional test, the canalith repositioning procedure, and the barbecue roll maneuver. Tables list physiologic properties and clinical features of the components of the peripheral vestibular system, information to be acquired from history of the present illness, common symptoms patients report as dizziness, examination components, distinguishing among common peripheral and central vertigo syndromes, common causes of nonspecific dizziness, types of dizziness presentations, relevant imaging abnormalities on neuroimaging studies, vestibular testing components, and medical therapy for symptomatic dizziness. This review contains 8 highly rendered figures, 11 tables, and 69 references.

Perioperative vestibular assessment and testing

Vestibular disorders can be difficult to accurately diagnose and manage. A careful history and focused physical examination are typically adequate to establish a diagnosis and initiate medical treatment. Vestibular testing is an important component of the work-up, but it is particularly essential for patients being considered for surgical intervention for a vestibular disorder, where the testing can be used to more definitively confirm a suspected diagnosis and to determine baseline vestibular organ function. In this article, we will first briefly review key components of the history and physical examination of patients with vestibular complaints. We will then discuss the most commonly used vestibular tests and their role in the preoperative assessment of patients undergoing vestibular surgery, including nystagmography, caloric testing, rotary chair testing, video head impulse testing, and vestibular evoked myogenic potential testing.

Egocentric vertigo symptoms diminished by multi-modal neurorehabilitation treatment

Egocentric vertigo symptoms diminished by multi-modal neurorehabilitation treatment

Improved Gait, Diplopia, Motor Speed, Symptoms, and Cognition in a 60-year-old female Patient with Stiff Person Syndrome

Improved Gait, Diplopia, Motor Speed, Symptoms, and Cognition in a 60-year-old female Patient with Stiff Person Syndrome

Amelioration of pain and post-concussive symptoms using multi-modal neurorehabilitation strategies in a 28-year-old male

Amelioration of pain and post-concussive symptoms using multi-modal neurorehabilitation strategies in a 28-year-old male

Changes in Measures of Cervical Spine Function, Vestibulo-ocular Reflex, Dynamic Balance, and Divided Attention Following Sport-Related Concussion in Elite Youth Ice Hockey Players

Concussion is a commonly occurring injury. The extent to which the cervical spine, vestibulo-ocular reflex (VOR), dynamic balance, and divided attention are affected following concussion is not well understood. To evaluate acute changes in measures of (1) cervical spine function, (2) VOR function, (3) dynamic balance, and (4) tasks of divided attention in elite youth ice hockey players following a sport-related concussion. In this prospective cohort study, elite 13- to 17-year-old ice hockey players completed cervical spine measures (cervical flexor endurance test, head perturbation test, anterolateral strength, cervical flexion rotation test, joint position error), VOR function tests (head thrust test, dynamic visual acuity [clinical and computerized]), dynamic balance tests (Functional Gait Assessment), and divided-attention tasks (walking-while-talking test) both in the preseason and following concussion. At least 1 test was completed by 69 of 97 (71%) players (a maximum of 55 for any 1 test) at both preseason and immediately following concussion (median, 4 days post concussion). After Bonferroni corrections (α = .00625), using Wilcoxon signed-rank tests, cervical spine measures were significantly worse following concussion compared to baseline (cervical flexor endurance test: z = -5.20, P<.001; anterolateral neck strength: zleft = -5.36, P<.001 and zright = -5.45, P<.001; and head perturbation test: z = -4.36, P<.001). Time taken to complete a complex task of divided attention relative to normal walking speed was faster (improved) compared to the preseason (z = -2.59, P<.01). There was no change in VOR or dynamic balance following concussion. Measures of cervical spine function and divided attention were altered following concussion. However, tests of VOR and dynamic balance were not significantly different from baseline. Future research to evaluate the mechanism underlying these changes is warranted. J Orthop Sports Phys Ther 2018;48(12):974-981. Epub 27 Jul 2018. doi:10.2519/jospt.2018.8258.

Intratympanic Gentamicin for Intractable Ménière's Disease - A Review and Analysis of Audiovestibular Impact.

Introduction Intratympanic gentamicin regulates the symptoms in most patients with incapacitating Ménière's disease. The treatment protocols have changed over the years from medical labyrinthectomy to preservation of vestibular function. Objectives This study aims to review the audiovestibular response related to the effect of the drug in controlling vertigo. Data Synthesis Articles were identified by means of a search in the PubMed database using the key words Meniere and intratympanic or transtympanic gentamicin . Total 144 articles were reviewed after excluding those that were technical reports, those based on experimental animal studies, those that focused on outcomes other than vertigo (tinnitus or aural fullness), those with delivery methods other than tympanic membrane injection, and those with bilateral cases. If there was more than one article by the same author(s) or institution, only the most recent one matching the aforementioned criteria and those that were not overlapping were included. Conclusion Titration methods or multiple injections on a daily basis can be preferred if the patients have profound or non-serviceable hearing, since these methods have significant incidence of hearing loss. Treatment protocols with a frequency of injection not shorter than once a week, or those with injections on a monthly basis as “needed” provide the same level of vertigo control with better preservation of hearing. Caloric testing is not an ideal tool to analyze the correlation between vertigo control and the effect of gentamicin as compared with gain asymmetry of the vestibulo-ocular reflex. Vestibular-evoked myogenic potentials and the head thrust test are more reliable than other vestibular tests for the follow-up of patients undergoing gentamicin treatment.