Semicircular Canal Research Articles (Page 1)

The identification of the incisive canal, canalis sinuosus, and posterior superior alveolar canal minimizes the occurrence of surgical complications associated with neurovascular injuries. The aim of this study was to assess the prevalence of anatomical variations in the anterior and posterior maxillary regions using cone-beam computed tomography (CBCT). A total of 291 CBCT scans were evaluated for the presence and description of anatomical variations of the incisive canal (IC), alveolar extension of the canalis sinuosus (CS), and posterior superior alveolar canal (PSA). Regarding the IC, 74.23% of CBCT scans exhibited a single-channel pattern and normal diameter. Alveolar extension of the CS was detected in 17.15% of cases and was more frequent on the right side. The variation pattern of the PSA canal was detected in 15.46% of cases, with higher prevalence on the left side in females and on the right side in males. The molar region was the most common location of this extension bilaterally. Cone-beam computed tomography is a reliable and effective strategy for evaluating anatomical variations in the maxilla, including neurovascular structures such as the incisive canal, alveolar extension of the canalis sinuosus, and posterior superior alveolar canal.

To describe a case of advanced otosclerosis complicated by third window phenomenon and emphasize the importance of preoperative CT imaging in advanced or revision otosclerosis, not only for assessing ossicular status and superior semicircular canal dehiscence (SSCD) but also for detecting abnormal otic capsule demineralization that may contribute to third window pathology. A 52-year-old male with bilateral otosclerosis, mixed hearing loss, and multiple prior ear surgeries, including a right-sided bone-anchored hearing aid (BAHA), presented for revision surgery. The patient underwent right-sided BAHA abutment removal with ossicular reconstruction using a Lippy bucket-handle prosthesis and left-sided revision stapedotomy with a new prosthesis and cartilage graft. Postoperative hearing outcomes were assessed via audiograms, with CT imaging used to evaluate persistent hearing loss in the left ear. Right ear revision surgery improved hearing by 50 dB at 250 to 500 Hz, closing air-bone gaps. Left ear surgery resulted in a 10-dB worsening in the 3 to 6 kHz range. CT imaging revealed fenestral and retrofenestral otospongiosis with cochlear-perilymphatic continuity, indicating a third window phenomenon contributing to persistent hearing loss. In cases of persistent conductive hearing loss, third window phenomenon due to otospongiosis should be considered despite proper prosthesis placement and absence of SSCD or perilymph fistula.

Neandertals are known to possess very distinctive traits in their bony labyrinth morphology, such as an inferiorly positioned posterior canal and a very low number of turns in the cochlea. Hence, the inner ear has been often used to assess the Neandertal status of fragmentary fossils. However, the evolutionary processes leading to this "classic Neandertal" morphology are still debated. Middle Pleistocene earliest Neandertal specimens such as Reilingen and Ehringsdorf are key to resolving this issue; however, their phylogenetic affinities remain contentious. Here, we analyze the bony labyrinth of these two individuals to provide new insights into the evolution of the Neandertal clade. We employed diffeomorphic deformation analysis to study the semicircular canal and vestibule shape, and morphometric variables to analyze the cochlea, comparing them to a sample including Sima de los Huesos humans, Krapina Neandertals, and late Neandertals. Our results reveal that both Reilingen and Ehringsdorf possess almost a fully derived, late Neandertal-like inner ear morphology. This finding challenges a simple anagenetic model of trait accumulation and allows refining the mosaic pattern of inner ear evolution. The advanced morphology of these early specimens, coupled with the unique mosaic of features in the Krapina sample, suggests the existence of a highly variable Middle Pleistocene metapopulation, with the classic Neandertal labyrinthine morphology that emerged early in their evolution, but was fixed only post-Krapina, possibly after a bottleneck. This study underscores the complex, mosaic nature of Neandertal evolution, highlighting a disconnect between the evolutionary trajectories of the external cranium and the inner ear.

Vestibular implants are a promising treatment for patients with severe bilateral vestibulopathy. However, precise and minimally invasive access to the semicircular canals remains a key surgical challenge. To evaluate the anatomical feasibility of robotic keyhole access to the three semicircular canals for vestibular implantation using image-guided drilling. High-resolution computed tomography scans from 30 ears were analyzed to simulate drill trajectories to the superior, lateral, and posterior semicircular canals. Trajectories were evaluated for surgical accessibility, safety margins relative to critical structures, and approach angles suitable for electrode insertion. Mutually optimized entry points within a simple cortical mastoidectomy were identified. Safe access to the three canals was feasible in all cases. The lateral and posterior canals were consistently accessible at favorable semicircular canal entry angles. The superior canal required steeper semicircular canal entry angles but remained within acceptable limits. In all cases, three suitable trajectories could be planned to originate from a single 15 mm retroauricular mastoidectomy region. Robotic keyhole access to the semicircular canals is anatomically feasible across a range of patient anatomies. These findings support the clinical potential of minimally invasive, image-guided vestibular implantation.

This study investigated the efficacy of vestibular rehabilitation therapy (VRT) and Theta Binaural Beats (T-BB) in reducing dizziness and anxiety in patients with residual dizziness (RD) following successful canalith repositioning procedures (CRP) for posterior canal benign paroxysmal positional vertigo (BPPV). In a prospective controlled design, 56 adults (35 females), aged 18-60, with imbalance lasting ≥ 20 days after CRP were recruited from a tertiary care otolaryngology clinic. Participants were assigned to one of three groups: Cawthorne-Cooksey Exercises (CCE), Brandt-Daroff Exercises (BDE), or CCE with T-BB (CCE + BB). Interventions were home-based; CCE groups followed a six-week protocol, while BDE was delivered over four weeks. The Sensory Organization Test (SOT) was used for objective evaluation. Subjective outcomes included the Dizziness Handicap Inventory (DHI) and State-Trait Anxiety Inventory (STAI). All groups demonstrated significant improvement in SOT Vestibular and Composite scores (p < 0.05). The greatest improvements in ΔVisual, ΔVestibular, and ΔComposite scores were observed in the CCE + BB group, while the BDE group demonstrated the least progress across these domains. ΔDHI Total and Emotional scores improved in all groups; however, ΔDHI Functional and Physical subscales improved only in both CCE groups. STAI-II (Trait) scores decreased across all groups, while STAI-I (State) significantly decreased in both CCE groups but not in the BDE group. RD is often under-recognised due to the absence of detectable vestibular pathology, despite its psychological impact. This original study demonstrates that while CCE was more effective than BDE, the integration of T-BB further reduced anxiety and enhanced vestibular recovery, supporting the value of a personalized multimodal rehabilitation approach.

This report presents for the first time a case of triple otic capsule dehiscence (OCD) of the labyrinthine-vascular type, with 2 dehiscences treated simultaneously and effectively by a recently described endovascular approach. Case report. Single otology/neurotology clinic. A 47-year-old male with triple otic capsule dehiscence (OCD) and associated symptoms. Improvement in the Tinnitus Handicap Inventory (THI) and Dizziness Handicap Inventory (DHI) scores. The first OCD was located between the internal jugular vein (IJV) and the posterior semicircular canal (SCC), and the second OCD was located between the vestibular aqueduct (VA) and the IJV. The third OCD, situated between the superior SCC and the superior petrosal sinus, remained untreated since it was considered less contributive to the patient's symptoms. The procedure involved (1) stenting of the right jugular vein combined with (2) coiling of a small portion of the vein in contact with the homonymous vestibular aqueduct. Early clinical signs, along with the audio-vestibular assessment, also suggested the diagnosis of right-sided endolymphatic hydrops. The outcome was uneventful, and the long-term follow-up showed promising results as the menieriform-like vertigo attacks disappeared after the procedure. THI and DHI scores were significantly improved. Auditory symptoms, including tinnitus, also progressively improved, especially after the fitting of a hearing aid. Multiple OCD (not only dehiscence of the superior SCC) should be systematically looked for on high-resolution computed tomography, given that a combined endovascular approach could be carried out in multiple labyrinthine-vascular forms.

To investigate whether the severity of endolymphatic hydrops (EH) influences the audiovestibular effects of intratympanic gentamicin (ITG) in patients with unilateral Ménière disease (uMD). Forty patients in 2 different tertiary referral centers with uMD refractory to medical treatment underwent 3T MRI 4 hours after gadolinium administration. EH severity was evaluated qualitatively and quantitatively (volumetry). Audiovestibular function was assessed with the PTA, vHIT, cVEMP, and oVEMP before and 1 month after ITG. Associations were analyzed with Kruskal-Wallis tests, Pearson/Spearman correlations, and logistic regression models. After ITG, a significant vestibulo-ocular reflex gain reduction was observed in the horizontal (ΔGain: 30.72%) and posterior (ΔGain: 34.64%,) semicircular canals, while hearing showed nonsignificant minimal increase (ΔPTA: 5.88 dB). cVEMP responses were more frequently absent (P = 0.018), and the IAAR increased significantly (P = 0.003). The level of EH and its amount, as measured by the relative volume in the vestibule (vELRaff), both with perilymphatic enhancement, were all positively correlated with the amount of vestibular damage in both PSC and HSC; however, did not correlate with changes in PTA (P = 0.266). In contrast, cochlear EH showed no predictive value for posttreatment hearing loss. Endolymphatic herniation was significantly associated with cVEMP changes (P = 0.016). EH does not act as a barrier to gentamicin diffusion. MRI-based EH assessment may help predict treatment outcomes and guide safer ITG strategies.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, yet it remains underdiagnosed and undertreated in emergency departments (EDs). Despite evidence-based guidelines recommending bedside diagnostic maneuvers (Dix-Hallpike and supine roll test) and canalith repositioning maneuvers (CRMs), these are infrequently utilized, leading to unnecessary imaging, prolonged symptoms, and increased healthcare utilization. This study aimed to implement an educational strategy to improve the diagnosis and treatment of BPPV in the ED by increasing adherence to guideline-based practices. We conducted a multicenter interrupted time series study from August 2020 to September 2023. The intervention, developed using the CAN-Implement framework, included online training, quick-reference tools, and a mobile app. Due to the COVID-19 pandemic, in-person training was canceled. The primary clinical outcome was the proportion of patients receiving the appropriate CRM based on positional test results. Implementation outcomes included fidelity, appropriateness, adoption, penetration, and system impact, reported using the Standards for Reporting Implementation Studies (StaRI) guidelines. We included 1682 patients (1252 pre-intervention, 430 post-intervention). There was no significant change in the primary outcome (appropriate CRM use, OR = 1.08, 95% CI: 0.76-1.40). However, selective CT use improved (OR = 1.29, 95% CI: 1.09-1.49), supine roll testing increased from 14.2% to 23.5%, and neurology consults decreased from 7.1% to 4.0%. Documentation of diagnostic test descriptors improved, while neurological exam documentation declined. The intervention did not significantly increase appropriate CRM use but led to improvements in selective imaging, neurology consultation, and horizontal canal testing. Provision of educational tools alone was insufficient to overcome identified environmental barriers. To effectively improve BPPV management in the ED, future efforts should combine hands-on training with system-level supports and workflow integration.

Transverse Posterior Canal Stenosis as a Predictor of Redundant Nerve Roots in Lumbar Spinal Stenosis.

Effect of surgery on vestibular system in pediatric patients with otitis media with effusion.

Rationale:Vestibular schwannoma (VS) is a benign tumor commonly presenting with progressive hearing loss, tinnitus, and disequilibrium. However, in rare cases, it can mimic acute vestibular syndromes such as vestibular neuritis. Early recognition of such atypical presentations is essential for accurate diagnosis and timely management.Patient concerns:A 54-year-old woman experienced a sudden onset of sustained vertigo lasting 2 days without accompanying hearing loss or tinnitus. She had no prior history of vertigo.Diagnoses:Neurotological assessments showed direction-fixed, horizontal-torsional nystagmus. Vestibular function tests revealed right-sided canal paresis on caloric testing and reduced vestibulo-ocular reflex gains across all right semicircular canals. Audiometry showed symmetrical, mild high-frequency hearing loss. Brain magnetic resonance imaging identified a 0.4 cm intracanalicular lesion consistent with VS.Interventions:The patient received oral corticosteroids, betahistine, ginkgo biloba extract, and vestibular rehabilitation therapy.Outcomes:Vertigo symptoms improved within 2 weeks and resolved completely by 5 months. No recurrence of vertigo was observed during a 2-year follow-up. Hearing remained stable, and no surgical intervention was required due to the small tumor size.Lessons:VS can present with acute vestibular syndrome resembling vestibular neuritis, even in the absence of auditory symptoms. Comprehensive neurotological evaluation and high-resolution magnetic resonance imaging are crucial for differential diagnosis and management.

BackgroundVestibular evoked myogenic potentials (VEMPs) are widely used to assess the otolith organs; however, the clinical significance of otolith organ dysfunction is unclear.ObjectiveThe primary purpose was to determine the functional consequences of otolith dysfunction on postural stability and quality of life in U.S. Veterans.MethodsA prospective case-control design was used, and 124 participants (21-84years) were grouped based on comprehensive vestibular testing. Caloric and vertical canal video head impulse testing were used to determine semicircular canal function. Cervical and ocular VEMP testing determined otolith organ function. Three vestibular site-of-lesion groups (Otolith Only, Otolith + Canal, and Canal Only) and two control groups (Dizzy Control and Non-Dizzy Control) completed measures of quality of life and multiple measures of postural control.ResultsANCOVAs indicated significant group differences for measures of quality of life and postural stability. All vestibular groups (Otolith Only, Otolith + Canal, and Canal Only) reported significantly worse quality of life than Non-Dizzy Controls. The Otolith + Canal group performed significantly worse than the Otolith Only group and both control groups on the functional gait assessment and preferred gait speed.ConclusionsSimilar to isolated semicircular canal dysfunction, isolated otolith dysfunction may negatively impact quality of life, and in conjunction with semicircular canal dysfunction, may also negatively impact postural stability.

Ménière's Disease (MD) is a complex vestibular disorder, and its pathological mechanism has not been fully elucidated so far. Compare the positive rates of anti-myelin-associated antibodies between patients with MD and the normal control group, and analyze the clinical characteristics of MD patients with positive anti-myelin-associated antibodies. Between April 2020 and July 2020, a total of 66 patients diagnosed with definite MD and 42 healthy controls were recruited at Shandong Provincial ENT Hospital. A comprehensive auditory-vestibular function assessment was conducted for the MD patients, which included Pure Tone Audiometry, Speech Discrimination Score (SDS), Auditory Brainstem Response, vestibular-evoked myogenic potential (VEMP), caloric testing, video head impulse test, and inner ear Gadolinium MRI, among other examinations. Additionally, indirect immunofluorescence testing was employed to detect anti-myelin-associated antibodies in all participants, followed by a correlation analysis between the detected results and the clinical manifestations. Furthermore, the vestibular end organ of a MD patient who had undergone labyrinthectomy was obtained through surgery for transmission electron microscopy (TEM) examination, in order to observe the ultrastructure of the vestibular nerve and determine the presence of any demyelinating lesions. When compared with the control group, the positivity rate of antibodies related to central nervous system (CNS) demyelinating diseases in patients with MD did not exhibit a statistically significant difference (p = 0.217). In contrast, the positivity rate of antibodies associated with peripheral nerve demyelinating diseases showed a highly significant statistical difference (p < 0.001), the positivity rates of anti-sulfatide antibodies and anti-GM1 antibodies in the MD group were significantly higher than those in the control group (p < 0.001). Patients with positive anti-GM1 antibodies were found to be older (p = 0.014), yet they demonstrated higher SDS (p = 0.023), a lower degree of semicircular canal paresis (p = 0.017), and a reduced abnormal rate of cervical VEMP (p = 0.049). Conversely, no significant correlation was observed between the expression of anti-sulfatide antibodies and the clinical symptoms or auditory-vestibular function levels of the patients. TEM of the vestibular nerve tissue obtained from MD patients revealed distinct demyelinating lesions. There is a phenomenon of demyelination of the vestibular nerve in patients with MD, and the positive rate of anti-myelin-associated antibodies in the peripheral blood of these patients is significantly higher than that in the control group. Among them, anti-GM1 antibodies may be correlated with auditory and vestibular functions, and they are expected to become a biological marker for MD.

Abstract Taphrosphyini is a diverse and geographically widely distributed lineage of bothremydid pleurodiran turtles. The first neuroanatomical reconstruction of the Paleogene genus of Taphrosphyini Taphrosphys is presented here, based on the study of a skull of the Moroccan Paleocene species Taphrosphys ippolitoi . Some osseous characters hitherto undocumented for this taxon are recognized in this specimen. Thus, among other anatomical elements, the postorbitals are documented for first time in this taxon, and the columella auris is described for the first time within Taphrosphyini. The use of the CT methodology and the three-dimensional modelling software allowed us to generate the three-dimensional virtual reconstruction of an idealized skull of Taphrosphys ippolitoi . This allows us to recognize several internal cranial structures and compare them with those of the other species of this genus. Most neuroanatomical elements of Taphrosphys ippolitoi are documented here. In addition of characters shared with all other bothremydids, others, shared exclusively with some representatives of this clade, are recognized as evidence for evaluate its lifestyle. The enlarged nasal cavity and the relatively high and wide semicircular canals of the endosseous labyrinth, confirmed here for Taphrosphyini, are convergent with those of other pleurodires identified as marine forms, including the Nigeremydini bothremydids. Thus, these and other anatomical and neuroanatomical traits observed in Taphrosphys ippolitoi are recognized as adaptative responses to marine environments.

Objectives: This study aims to evaluate the relationship between the affected semicircular canal and nystagmus characteristics with the perception of dizziness in individuals diagnosed with posterior canal (P-BPPV) or lateral canal (L-BPPV) benign paroxysmal positional vertigo. Patients and Methods: In this prospective study, a total of 56 individuals (37 females, 19 males; mean age: 55.5±10.0 years; range, 32 to 78 years) diagnosed with BPPV according to the Bárány Society criteria were evaluated using videonystagmography between March 2025 and July 2025. Forty of these patients had P-BPPV, while 16 had L-BPPV. The duration, latency, and intensity of nystagmus were recorded. The severity of dizziness was assessed using the Visual Analog Scale (VAS), and dizziness-related quality of life was evaluated using the Turkish version of the Dizziness Handicap Inventory (DHI). Results: Left ear involvement was significantly more common in the L-BPPV group compared to the P-BPPV group (p&lt;0.05). Nystagmus duration was significantly longer in the L-BPPV group (p&lt;0.05). No significant differences were found between the groups in terms of other nystagmus parameters, the number of maneuvers and attacks, or VAS and DHI scores (p&gt;0.05). In the P-BPPV group, a weak but significant positive correlation was observed between nystagmus duration and VAS score (p&lt;0.05). Conclusion: These findings suggest that nystagmus characteristics may not fully reflect the clinical experience of the disease, and symptom perception may vary individually and be influenced by multiple factors.

Diagnosis and treatment of benign paroxysmal positional vertigo with lateral canal involvement.

Objective: To investigate the short-term effects and influencing factors of short-term personalized vestibular rehabilitation (ST-PVR) on acute peripheral vestibular syndrome (APVS). Methods: A randomized controlled study was conducted. APVS patients who visited the Department of Otolaryngology of Henan Provincial People's Hospital from April 2024 to February 2025 were enrolled and divided into vestibular rehabilitation group and control group using the random number table method. The two groups completed clinical evaluation at 2 and 6 weeks after treatment, including spontaneous nystagmus (NYS), Romberg test (ROM), head shake test (HTT), unilateral weakness (UW) and directional preponderance (DP) in temperature test, video head impulse test (vHIT), and dizziness handicap inventory scale (DHI), visual analogue scale for vertigo (VAS), and activities-specific balance confidence (ABC) scale. The clinical indicators and vestibular rehabilitation grading scores of the two groups at different treatment time points were compared, and a multiple linear regression model was established to analyze the relationship between the baseline variables of the vestibular rehabilitation group and the vestibular rehabilitation grading score at 6 weeks after rehabilitation. Results: A total of 33 patients aged 53 (45, 60) years were included in the vestibular rehabilitation group, including 18 males and 15 females. There were 32 cases aged 52 (47, 57) years in the control group, including 17 males and 15 females. No statistically significant differences of the baseline data between the two groups were detected (all P>0.05). At 2 weeks after treatment, the positive rate of NYS, ROM and HTT, and DP value, DHI and VAS were lower than those in the control group, and the mean gain values of abnormal semicircular canals for vHIT and ABC were higher than those in the control group (all P<0.001). The number of abnormal semicircular canals in the vestibular rehabilitation group was smaller than that in the control group at 6 weeks after treatment (P=0.002), and DHI, ABC and VAS were improved compared with the control group (all P<0.001). The rehabilitation grading score of the vestibular rehabilitation group was higher than that of the control group at 6 weeks after rehabilitation [22 (21, 24) vs 16 (15, 18), P<0.001], and the total proportion of complete recovery and basic rehabilitation was higher than that of the control group [100% (33/33) vs 59.4% (19/32), P<0.001]. Multiple linear regression analysis showed that the vHIT grading score (β=0.996, 95%CI: 0.138-1.853, P=0.024), the average gain value of the affected semicircular canals (β=6.221, 95%CI: 0.870-11.572, P=0.024) and the number of affected semicircular canals (β=-1.172, 95%CI:-1.967--0.377, P=0.005) were the influencing factors of vestibular rehabilitation grading score after 6 weeks of rehabilitation. Conclusions: ST-PVR can quickly improve vertigo symptoms and balance function in APVS patients, and basic recovery can be achieved within 6 weeks. The pre-rehabilitation vHIT result is a weighting factor affecting the vestibular rehabilitation effect, and its dynamic change can be used as a sensitive monitoring index for efficacy.

Seven patients with radiographically confirmed lateral semicircular canal malformations who visited the Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between April 2013 and July 2019 were retrospectively reviewed. Among them, five cases had bilateral malformations and two were unilateral, involving a total of 12 ears, of which five ears were sensorineural hearing loss and two ears were mixed hearing loss. Glycerol test was performed in three cases (five affected ears), with positive results in three ears. Electrocochleography was performed in three cases (five affected ears), and only one affected ear was abnormal. Episodic vertigo occurred in six cases (including one case of positional vertigo), and chronic dizziness occurred in one case. Spontaneous nystagmus and abnormal caloric test results were observed in two cases. Vestibular evoked myogenic potential test was performed in four cases, with abnormalities in three cases. Video head impulse test results were normal in all three cases examined. All patients received symptomatic treatment and had good clinical control. The current study indicates that the clinical presentation and audio-vestibular function test results of patients with LSCC malformations are heterogeneous, and thus imaging studies are recommended to confirm the diagnosis. Further investigations are warranted to determine the pathogenesis of this malformation and the underlying mechanisms of inner ear functional impairment.

The clinical data and diagnostic process of a cerebellar hemangioblastoma (HB) patient presenting with positional vertigo and nystagmus as initial symptomwere retrospectively analyzed. To identify studies involving patients with positional vertigo secondary to cerebellar tumors misdiagnosed as benign paroxysmal positional vertigo (BPPV), a comprehensive literature search was systematically performed in databases such as PubMed, Wanfang, CNKI, and etc., covering the period from January 2004 to December 2024. The patient presented with positional vertigo as the primary symptom.An initial diagnosis of anterior semicircular canal BPPV was made, but attempts at canalith repositioning therapy proved ineffective. Furtherbrain MRI revealed a cystic mass in the right cerebellum. Histopathological examination of the resected specimen confirmed HB. Twenty-eight patients were included in the literature review, nine of whom were ultimately diagnosed with HB, and lesions predominantly involved midline cerebellar structures, including the nodulus and uvula. Literature analysis revealed that misdiagnosis was most often attributable to isolated positional vertigo, in the absence of specific central nervous system symptoms. And the key differential diagnostic features distinguishing CPPV from BPPV and other disorders included the therapeutic efficacy of canalith repositioning maneuvers and characteristics of positional nystagmus. Clinicians should synthesizea comprehensive evaluation, incorporating medical history, physical examination, auditory-vestibular function tests, and neuroimaging, to identify differential diagnostic features andthereby establish an accurate diagnosis.

This systematic review aimed to establish normative vestibulo-ocular reflex (VOR) gain parameters for the Video Head Impulse Test (vHIT) using the EyeSeeCam system in healthy adults. Measurement variability highlights the need for standardization. To identify and synthesize studies reporting normative EyeSeeCam vHIT data in individuals aged 18 and older, focusing on horizontal, LARP (Left Anterior-Right Posterior), and RALP (Right Anterior-Left Posterior) canal gains. We searched PubMed, Scopus, and SciELO for papers published in the past decade. We excluded studies lacking predefined thresholds, involving vestibular pathologies, or using non-EyeSeeCam systems. We assessed the risk of bias using the QUADAS-2 tool and conducted a narrative synthesis. Nine out of 227 screened papers met the inclusion criteria (N=404). The normative VOR gain ranged from (based on minimum and maximum mean or cutoff values reported across studies) 0.76 to 1.25 (horizontal), 0.70 to 1.42 (LARP), and 0.70 to 1.3 (RALP). Two studies were assessed as high risk, 3 as moderate, and 4 as low risk, primarily due to incomplete demographic data or selective canal evaluation, which limits generalizability. This is the first review focusing exclusively on EyeSeeCam-based normative values. Despite methodological differences, horizontal canal gains consistently cluster around 0.80. Our synthesis and expert consensus propose 0.70 as a clinically acceptable lower cutoff for VOR gain across all semicircular canals. This threshold strikes a balance between sensitivity and specificity. Our findings highlight the need for standardized vHIT protocols and support the development of system-specific normative criteria.