Peripheral Vestibular Syndrome Research Articles

The six most frequent peripheral vestibular syndromes

Three forms of peripheral vestibular disorders, each with its typical symptoms and clinical signs, can be differentiated functionally, anatomically and pathophysiologically: 1. inadequate unilateral paroxysmal stimulation or rarely inhibition of the peripheral vestibular system, e. g., BPPV, Menière's disease, vestibular paroxysmia or syndrome of the third mobile windows; 2. acute unilateral vestibulopathy leading to an acute vestibular tone imbalance manifesting as an acute peripheral vestibular syndrome; and 3. loss or impairment of function of the vestibular nerve and/or labyrinth: bilateral vestibulopathy. For all of these diseases, current diagnostic criteria by the Bárány-Society are available with a high clinical and scientific impact, also for clinical trials. The treatment depends on the underlying disease. It basically consists of 5 principles: 1. Explaining the symptoms and signs, pathophysiology, aetiology and treatment options to the patient; this is important for compliance, adherence and persistence. 2. Physical therapy: A) For BPPV specific liberatory maneuvers, depending on canal involved. Posterior canal: The new SémontPLUS maneuver is superior to the regular Sémont and Epley maneuvers; horizontal canal: the modified roll-maneuver; anterior canal the modified Yacovino-maneuver; 3. Symptomatic or causative drug therapy. There is still a deficit of placebo-controlled clinical trials so that the level of evidence for pharmacotherapy is most often low. 4. Surgery, mainly for the syndrome of the third mobile windows. 5. Psychotherapeutic measures for secondary functional dizziness.

Suspected idiopathic vestibular syndrome in the horse: Eight cases (2014–2021)

SummaryA descriptive case series of the presentation, diagnosis, treatment and outcome of eight horses presenting to a UK equine veterinary hospital with suspected idiopathic peripheral vestibular syndrome over a 7‐year period (2014–2021). Idiopathic vestibular syndrome in the horse causes unilateral clinical signs including; ataxia, nystagmus, strabismus and a head tilt. Diagnosis is aided by neurological examination, endoscopy of the upper airway and cross‐sectional imaging (i.e. magnetic resonance imaging and computed tomography). This case series indicates that horses with this condition can make a full recovery with return to ridden exercise. Treatment with anti‐inflammatory medication did not appear to influence outcome.

Retracted: Vestibular Autorotation Test: The Differences in Peripheral and Central Acute Vestibular Syndrome.

[This retracts the article DOI: 10.1155/2022/8180013.].

Neurological Disorders in Pug Dogs: a Retrospective Study of 285 Cases (2013 – 2020) from a Single Referral Hospital in the United Kingdom

Pugs are commonly affected by neurological disorders and this retrospective observational study aims to describe what pathologies were more commonly diagnosed, their diagnostic approach and clinical features. This study was performed in a single referral hospital in the United Kingdom (UK). Medical records of pugs referred to the Neurology & Neurosurgery department from 2013 to 2020 were retrieved. Signalment, presenting complaint, presence of pain at neurological examination and diagnostic tests were recorded. Final diagnosis was classified as: encephalopathies, myelopathies or peripheral nervous system (PNS) disease. Descriptive and univariate statistical analysis were performed. A total of 285 records were included in the study. The most common presenting complaints were: ambulatory paraparesis (27.6%), seizures (20.3%), ataxia (16.4%), spinal pain (10.1%) and vestibular signs (5.6%). Myelopathies were diagnosed in 64.7% of pugs, while encephalopathies and PNS disease in 29.7% and 5.3% of pugs respectively. Different types of intervertebral disc diseases (IVDDs; 44.3%), spinal arachnoid diverticulum (SAD; 22.2%) and vertebral malformations (VMs; 18.9%) were the most prevalent myelopathies. Idiopathic epilepsy (IE; 44.7%) and meningoencephalitis of unknown aetiology (MUA; 29.4%) were the most common encephalopathies. Peripheral vestibular syndrome (60%) and masticatory muscle myositis (20%) were the most prevalent PNS diseases. Pugs with IVDDs were more likely to be painful than pugs diagnosed with SAD and VMs. In this study, IVDDs, SAD and VMs were the most represented myelopathies, while IE and MUA the most prevalent encephalopathies. SAD and VMs were found to be non-painful myelopathies, as opposed to IVDDs being painful. These results may be used as a guide reflecting the prevalence of neurological diseases in a larger population of pugs.

ПОД МАСКОЙ ПЕРИФЕРИЧЕСКОГО ВЕСТИБУЛЯРНОГО СИНДРОМА

The article highlights the problem of differential diagnosis of peripheral vestibular syndrome, which hides such pathological processes as benign positional paroxysmal vertigo, vestibular neuronitis, Meniere's disease. The lack of specification in the diagnosis in this category of patients leads to erroneous diagnosis, inadequate treatment, an increase in the duration of disability and the occurrence of anxiety and depressive disorders. The article presents the differential diagnosis of peripheral vestibular syndrome, examples of therapeutic maneuvers and cases from practice. For effective diagnosis and treatment, it is necessary to take into account the clinical signs of the onset and manifestations of peripheral vestibular disorders, pay special attention to the questioning and detailed description of the patient's complaints, conduct special positional tests and consult with specialized specialists.

A case of Bow hunter's syndrome diagnosed after treatment foracute peripheral vestibular syndrome

A case of Bow hunter's syndrome diagnosed after treatment foracute peripheral vestibular syndrome

Vestibular syndromes after COVID-19 vaccination: A prospective cohort study.

Background and purposeDizziness and vertigo are common symptoms after COVID‐19‐vaccination. We aimed to prospectively evaluate objective central or peripheral vestibular function in patients with dizziness, vertigo, and postural symptoms that started or worsened after COVID‐19‐vaccination.MethodsOf 4137 patients who presented between January 2021 and April 2022 at the German Center for Vertigo and Balance Disorders, Ludwig Maximilian University of Munich, we identified 72 patients (mean age = 47 years) with enduring vestibular symptoms following COVID‐19 vaccination. All underwent medical history‐taking, and neurological and neuro‐otological workup with bithermal caloric test, video head‐impulse test, orthoptics, and audiometry. Diagnoses were based on international criteria. The distribution of diagnoses was compared to a cohort of 39,964 patients seen before the COVID‐19 pandemic.ResultsSymptom onset was within the first 4 weeks postvaccination. The most prevalent diagnoses were somatoform vestibular disorders (34.7%), vestibular migraine (19.4%), and overlap syndromes of both (18.1%). These disorders were significantly overrepresented compared to the prepandemic control cohort. Thirty‐six percent of patients with somatoform complaints reported a positive history of depressive or anxiety disorders. Nine patients presented with benign paroxysmal positional vertigo, three with acute unilateral vestibulopathy, and seven with different entities (vestibular paroxysmia, Ménière disease, polyneuropathy, ocular muscular paresis). Causally related central vestibular deficits were lacking. Novel peripheral vestibular deficits were found in four patients.ConclusionsNewly induced persistent vestibular deficits following COVID‐19 vaccination were rare. The predominant causes of prolonged vestibular complaints were somatoform vestibular disorders and vestibular migraine, possibly triggered or aggravated by stress‐related circumstances due to the COVID‐19 pandemic or vaccination. An increase of other central or peripheral vestibular syndromes after COVID‐19 vaccination was not observed.

Vestibular Autorotation Test: The Differences in Peripheral and Central Acute Vestibular Syndrome.

Objective To evaluate the difference between the vestibular autorotation test (VAT) in the peripheral and central acute vestibular syndrome (AVS). Methodology. Patients with AVS diagnosed by clinical manifestation admitted to the third affiliated hospital of Qiqihar Medical College from January 2019 to January 2021 were enrolled and divided into peripheral AVS (peripheral group) and central AVS (central group) according to the results of the MRI examination. Results A total of 332 patients with AVS were recruited, including 282 patients in the peripheral group and 50 patients in the central group. The horizontal gain of both groups showed a downward trend at 2–6 Hz. There was no significant change in the horizontal phase between the two groups at 2–6 Hz. The horizontal gain of the two groups was stable at 2–6 Hz with no significant changes in the horizontal phase between 2–6 Hz in both groups. The central group showed a significantly lower proportion of gain increase coupled with loss and a strikingly higher proportion of gain increase without a loss than in the peripheral group (all P < 0.001). Conclusion The increased horizontal and vertical gain of VAT in patients with AVS is of high value in the diagnosis of ACS. Significant differences in the results of VAT in patients with central and peripheral AVS could provide a reference for diagnosis.

Acute unilateral vestibular lesion induced by SARS-CoV-2 infection

SARS-CoV-2 infection has a wide range of symptoms, with a series of ENT manifestations reported in the pandemic years, some of them being considered specific for the infec­tion, such the loss of smell or taste. Dizziness and postural in­sta­bi­li­ty are common symptoms in COVID-19 patients and are nonspecific, but the onset of the disease with acute uni­la­te­ral peripheral vestibular syndrome, without any other symp­toms, is not very frequent. We report two cases of SARS-CoV-2 infection with acute unilateral peripheral vestibular syndrome onset.

Neurogenic keratoconjunctivitis sicca in 34 dogs: A case series.

To describe the clinical findings, imaging features, underlying conditions, treatment, and progression of dogs presented between 2010 and 2019 with neurogenic keratoconjunctivitis sicca (NKCS). Dogs diagnosed with NKCS were searched in the clinical database. Inclusion criteria were STT-1 readings <15mm/min, clinical signs of KCS with concurrent ipsilateral xeromycteria. Thirty-four cases were identified. Mean age at presentation was 8.2years, median 8.9years (0.3-14.7). Twenty dogs were male, and 14 dogs were female. Concurrent neurological deficits included facial neuropathy (n=13, 38%), peripheral vestibular syndrome (n=10, 29%), and Horner's syndrome (n=5, 15%). Advanced imaging was acquired in 53% of cases (n=18). Etiologies included idiopathic (n=18, 53%), endocrinopathy (n=6, 18%), otitis interna (n=4, 12%), head trauma (n=3, 9%), iatrogenic (post-TECA-LBO, n=1, 3%), brainstem mass (n=1, 3%), and an area of inflammation in the pterygopalatine fossa (n=1, 3%). Treatment for NKCS was initiated in most cases (n=30, 88%) including: oral pilocarpine 2% and lacrimostimulant (n=19), oral pilocarpine 2% only (n=3), or lacrimostimulant only (n=8). A mean time follow-up of 3.7months, median 3months (1-14) was available in 23 cases (68%). Eleven cases with follow-up were responsive (48%) with resolution of the clinical signs in a median time 4months (1-10), and all of them were treated with oral pilocarpine (±lacrimostimulant). Most cases presented as idiopathic NKCS; in others, an underlying cause of facial neuropathy was identified. All responsive cases were treated with oral pilocarpine 2%.

Experimental hydrops of labyrinth

Difficulties in approbation of drugs for the treatment of vestibular dysfunction are associated with a lack of knowledge of the mechanisms of its development. In particular, it is necessary to take into account the initial state of the vestibular analyzer, which significantly affects the research results. Therefore, the modeling of pathological processes that manifest in vestibular dysfunction is the optimal method for studying both its mechanisms and the effectiveness of medications for its relief. Endolymphatic hydrops is found in most diseases manifested by peripheral vestibular syndrome. We have proposed several models of endolymphatic hydrops in rats to study various aspects of its pathogenesis and approbate means of treating vestibular dysfunction.

Akutní závrať v pohotovostní službě ORL lékaře

Summary Introduction: Acute vertigo ranks among the common reasons for visiting the emergency department. The aim of this study was to evaluate the rate of peripheral vestibular syndrome (PVS) in patients with acute vertigo examined at the ENT emergency department and to compare the agreement of physical ENT examination with video-assisted vestibular testing. Methods: Patients eamined at the ENT emergency department from January to December 2019 were evaluated retrospectively. The patients who underwent basic ENT examination without video-assisted vestibular testing form group A. The patients who underwent basic ENT examination which was followed by video head impulse test (vHIT) and videonystagmography in the next four days form group B. Results: A total of 117 patients with acute vertigo were included in group A, PVS was found in 31 patients (27%). In total, 50 patients were included in group B; PVS was found in 15 patients (30%), vestibular neuronitis was dia­gnosed most often (10 patients). The difference in the dia­gnosis of PVS by basic ENT examination (27 patients, 54%) and by video-assisted vestibular testing (15 patients, 30%) was statistically significant (P = 0.0030). The gain of the lateral (P = 0.0101) and superior (P = 0.0043) semicircular canal proved to be statistically significant, while vHIT was lower in PVS in comparison to other causes of vertigo. Conclusion: After basic ENT examination, PVS as a cause of acute vertigo was dia­gnosed in 27%. Video-assisted vestibular testing proved a statistically significant lower incidence of PVS in comparison to basic ENT examination. Accessibility of video- -assisted vestibular testing in the emergency department might allow for higher accuracy in the dia­gnosis of acute vertigo. Key words acute vertigo – vestibular function tests – video head impulse test – videonystagmography

Cerebrospinal fluid analysis lacks diagnostic specificity in dogs with vestibular disease.

Although, vestibular syndrome is a common neurological presentation, little is known about the diagnostic value of cerebrospinal fluid (CSF) analysis in vestibular syndrome in dogs. Medical records were retrospectively reviewed, and dogs with vestibular disease that had undergone magnetic resonance imaging of the head, CSF analysis and were diagnosed with central or peripheral vestibular syndrome were included. Disorders affecting the central vestibular system included meningoencephalitis of unknown origin (MUO), brain neoplasia, ischaemic infarct, intracranial empyema or metronidazole toxicity. Disorders affecting the peripheral vestibular system included idiopathic vestibular disease, otitis media/interna or neoplasia affecting the inner ear structures. Total nucleated cell concentration (TNCC), total protein concentration (TP) and cytologic assessment were recorded. A total of 102 dogs met the inclusion criteria. The sensitivity and specificity of increased CSF TNCC to differentiate central from peripheral vestibular syndrome was 49% and 90%, while the sensitivity and specificity of increased TP was 58% and 39%, respectively. The TNCC and TP in dogs with MUO were significantly higher than in dogs with idiopathic vestibular disease (p=0.000 and p=0.004). MUO was associated with lymphocytic pleocytosis, while idiopathic vestibular disease and ischaemic infarct were associated with the presence of activated macrophages or normal cytology (p=0.000). Although consistent CSF abnormalities were observed in dogs with MUO, CSF analysis did not allow reliable differentiation between central and peripheral vestibular syndrome. CSF analysis is not reliable as the sole diagnostic technique in dogs with vestibular disease.

Clinical Features and Management of Drop Attacks in Menière's Disease. Special Emphasis on the Possible Occurrence of Vertigo After the Drop Attacks.

Tumarkin first described drop attacks (DA) in patients with a peripheral vestibular syndrome and speculated the role of a mechanical deformation of the otolith organs. We emphasized on the possible occurrence of vertigo/dizziness after a DA. In the light of the oculomotor examination of one patient right after the DA, we discussed on the mechanisms. We also described the management of DA. This study included patients with definite Meni�re's disease (MD) and at least one DA without associated neurological symptoms. Patients with vertigo/dizziness after the fall were not excluded. Fifteen patients with MD complained of DA that was complicated either by severe head trauma (n = 1) or various fractures (n = 4). Seven patients complained of vertigo/dizziness after the DA. In one patient, DA occurred in the waiting room with a vertical illusion of movement immediately after the fall and a predominant down beating nystagmus that later changed direction. Follow up was favorable in all patients after oral medication alone (n = 7), chemical labyrinthectomy (n = 7) or vestibular neurotomy (n = 1). We suggest that a subset of patients with MD can complain of vertigo after a DA. We conclude on the possible occurrence of a vertical mainly down beating nystagmus in MD. Since this latter nystagmus is likely related to a semicircular canal rather than an otolith dysfunction, we discuss on the mechanisms of DA followed by vertigo/dizziness. Due to the risk of trauma in DA, chemical labyrinthectomy is a reasonable and effective option although spontaneous remission is possible.

Fistulae of the Canal Lateral Due to Cholasteatomatous Otitis About 5 Cases

Our study is retrospective on 5 cases of fistulae of the lateral semi-circular duct (CSCL) complicating chronic cholesteatomatous otitis media, operated in the otolaryngology department of the CHU HASSAN II of Fez, over a period of 4 years from January 2014 to December 2017. The age of our patients ranged from 6 years to 65 years with a mean of 26 years, and a clear male predominance. The consultation period ranged from 1 year to 15 years. Othorrhea and vertigo were consistent in all our patients, combined with mixed deafness in 3 patients. The otoscopy revealed several aspects; going from image Typical a cholesteatoma of the middle ear with epidermal scales in the middle ear emerging from a perforation or a tympanic retraction pocket, or an attical cholesteatoma on a stage III retraction pocket. Ossicular lysis was evident in 3 of patients. Peripheral vestibular syndrome was noted in all of our patients. Neurological examination found a case of facial paralysis. Concerning the functional impairment; 2 of our patients had pure transmissive deafness, the remaining 03 patients had mixed deafness. Diagnosis labyrinthine fistulae has been clinically evoked and surgically confirmed. All our patients received preoperative CT scan. MRI has a complementary and fundamental role in the diagnosis of some internal ear disorders, it was requested in one patient. Treatment of fistulae (CSCL) was achieved by plugging the breach with temporal aponevrosis associated with the treatment of Chronic cholesteatomatous otitis. In our series, all our patients received general antibiotic therapy adapted to the antibiogram, 3 patients received treatment with open tympanoplasty wall down patients received tympanoplasty by closed technique. The surgical follow-ups were simple.

Effects of vestibular spontaneous nystagmus on visual smooth pursuit function

Objective: The aim of the study is to analyze the effects of vestibular spontaneous nystagmus(SN) on the smooth pursuit function of visual ocularmotor system. Methods: A total of 46 patients with acute unilateral peripheral vestibular syndrome with SN (26 cases of vestibular neuritis, 6 cases of Ramsay Hunt Syndrome (RHS) with vertigo, 14 cases of sudden deafness with vertigo) were included in this work. In the study group, the results of SPT and SN test with videonystagmography(VNG) were also reviewed. Taking SPT parameters, the influence of SN intensity on SPT gain, asymmetry and waveform and their correlation were analyzed.SPSS19.0 software was used for statistical analysis. Results: Among the 46 patients, there were 36 cases of SN pointing to the healthy side(SN intensity range of 2.68°/s-32.53°/s), and 10 cases of SN pointing to the affected side (SN intensity range of 2.66°/s-16.54°/s). SN intensity was divided into 3 groups, including light(0.50°/s-5.00°/s), medium(5.01°/s-10.00°/s) and strong(>10.01°/s), accounting for 14 cases(30.4%), 18 cases(39.1%) and 14 cases(30.4%), respectively. The differences of the gain of SPT to the fast phase and slow phase direction in the overall groups and light, medium and strong groups of SN intensity respectively were statistically significant(ttotal=13.338, tlight=6.184, tmedium=8.436, tstrong=8.477, all of P<0.001). The difference of SPT gain in SN fast phase direction between groups with different SN intensity was statistically significant(F=9.639, P<0.001),there was no statistically significant difference in SPT gain between the groups on the SN slow phase direction(F=1.137, P=0.330).The SN intensity significantly negatively correlated with the SPT gain of the fast phase direction of SN (r=-0.433, P=0.003), that was, the SPT gain on the fast phase direction of SN decreased with the increase of SN intensity. There was no significant correlation between SN intensity and the gain of SPT on the slow phase direction of SN (r=-0.061, P=0.687). SPT waveform analysis showed that type I, type II and type III accounted for 8 cases(17.4%), 21 cases(45.6%) and 17 cases(37.0%), respectively. The corresponding mean values of SN intensity were (3.71±0.69)°/s, (7.44±1.88)°/s, (20.04±5.53)°/s, respectively, without type IV wave. The intensity of SN was positively correlated with the asymmetric value of the gain of SPT left and right(r=0.450,P=0.002). That was, with the increase of SN strength, the asymmetric value also increased, and the worse the asymmetry of the gain of SPT left and right pursuit was, the worse the SPT waveform was. Conclusion: SPT gain, asymmetry and SPT waveforms are all affected by SN, and the greater the intensity of SN, the greater the influence on the three. When SN is strong, type III waves may occur, suggesting that acute peripheral vestibular syndrome can also affect the visual ocularmotor systems.

Ototoxic effects of hydroxychloroquine.

To present scientific evidence based on a systematic review of the literature (PRISMA), aiming to systematize evidence of the ototoxic effects of hydroxychloroquine (HCQ). The studies were selected using a combination based on the Medical Subject Headings (MeSH). The databases searched were MEDLINE (PubMed), LILACS, SciELO, and BIREME, encompassing articles from January 2010 to May 2020, with no restrictions of language and place of publication. A total of 148 articles with the potential to be included were retrieved. Of these, two answered the research question, which consisted of seeking evidence of the ototoxic effects of hydroxychloroquine. These studies scored 11 in their quality assessment with the modified protocol by Pithon et al.13. The studies reported possible ototoxicity of HCQ. Audiovestibular changes, such as hearing loss, peripheral vestibular syndrome, and tinnitus were evidenced in patients submitted to HCQ. The improvement in the audiological examinations and the regression in the vestibular syndrome after stopping the treatment with HCQ are strong arguments in favor of the ototoxicity caused by this medication. However, there are still divergences about the relationship between ototoxic effects and the use of HCQ.

Q-tip ear injury with stapes luxation into the vestibule-a case report

&lt;p&gt;Stapediovestibular luxation by Q-tip ear injury is a rare occurrence. The traumatic context associated with cochleovestibular symptoms should lead to a high index of suspiscion. Temporal bone CT scan confirms the diagnosis. The authors report a case of stapediovestibular luxation and discuss the management of this condition. An 8-year-old boy presented to our department for otalgia, hearing loss, and dizziness. The history revealed a penetrating right ear injury by Q-tip, which had occurred 5 days previously. ENT examination found a right peripheral vestibular syndrome with ipsilateral tympanic perforation. Tonal audiometry noted right cophosis. Temporal bone CT scan showed right side internal stapediovestibular dislocation. Middle ear inspection with oval window fistula repair and tympanic closure were performed. Postoperative outcomes showed complete resolution of vestibular symptoms without improvement of sensorineural hearing loss thresholds. Traumatic stapediovestibular dislocation by Q-tip ear injury is unusual. Early diagnosis, with precise lesion assessment and appropriate management resolve vestibular symptoms, prevent infectious complications. But, hearing outcomes are variable.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Ocular lateral deviation with brief removal of visual fixation differentiates central from peripheral vestibular syndrome.

Ocular lateral deviation (OLD) is a conjugate, ipsilesional, horizontal ocular deviation associated with brief (3-5s) closing of the eyes, commonly linked to the lateral medullary syndrome (LMS). There is limited information regarding OLD in patients with the acute vestibular syndrome (AVS). In one case series 40years ago OLD was suggested to be a central sign. Recently, horizontal ocular deviation on imaging (RadOLD) was frequently associated with anterior circulation stroke and horizontal gaze palsy. Similarly, RadOLD has been associated with posterior circulation stroke, e.g., LMS and cerebellar stroke, but without clinical correlation with OLD. This is a prospective, cross-sectional diagnostic study of 151 acute AVS patients. Patients had spontaneous nystagmus. Horizontal gaze paralysis was an exclusion criterion. We noted the effect of brief 3-5s eyelid closure on eye position, and then used the HINTS algorithm (the head-impulse test, nystagmus characteristics and skew deviation) and RadOLD, to establish a correlation between clinical and radiologic findings RESULTS: Of the 151 AVS patients, 100 had a central lesion and 51 a peripheral lesion; 29 of the central lesions were LMS, and 11 had OLD. Additionally, one lateral pontine syndrome had OLD. On opening the eyes 11 patients with OLD and LMS made multiple, hypometric corrective saccades to bring gaze back to straight ahead. 10/11 patients with LMS showed RadOLD. OLD with multiple hypometric corrective saccades on opening the eyes was infrequent but highly localizing and lateralizing. We emphasize how simple it is to test for OLD, with the caveat that to be specific, it must be present after just brief (3-5s) eyelid closure.

Vestibular Disorders.

Recent research findings have improved the understanding of the diagnosis, pathophysiology, genetics, etiology, and treatment of peripheral, central, and functional vestibular vertigo syndromes. A literature search, with special attention to the current classification, treatment trials, Cochrane analyses, and other meta-analyses. There are internationally accepted diagnostic criteria for benign positional paroxysmal vertigo, Menière's disease, bilateral vestibulopathy, vestibular paroxysmia, and functional dizziness. Whether an acute vestibular syndrome is central or peripheral can usually be determined rapidly on the basis of the history and the clinical examination. "Cere - bellar vertigo" is a clinically important entity. For bilateral vestibulopathy, balance training is an effective treatment. For Menière's disease, preventive treatment with betahistine (48 mg and 144 mg per day) is not superior to placebo. For vestibular paroxysmia, oxcarbazepine has been shown to be effective. Treatments that are probably effective for functional dizziness include vestibular rehabilitation, cognitive behavioral therapy, and serotonin reuptake inhibitors. The diagnostic assessment of vestibular syndromes is much easier for clinicians now that it has been internationally standardized. There is still a lack of randomized, controlled trials on the treatment of, for example, Menière's disease, vestibular migraine, and "cerebellar vertigo."