Interference between visual short-term memory (VSTM) and task-irrelevant sensory distractors is a well-documented phenomenon across a wide range of visual features. Although this sensory-memory interference is believed to result from neural interactions between mnemonic and sensory processing, the nature of the interfering signals remains unclear, particularly whether the interference originates from physical stimuli entering the retina or the resulting subjective perception. Here we addressed this question by leveraging perceptual invariance during smooth pursuit eye movements, where retinal motion induced by eye movements is perceptually suppressed. Distractors were presented as either physical object motion in world coordinates or apparent motion of a stationary background induced by eye movements, allowing us to generate identical retinal motion with distinct perception. Human observers (both female and male) were tasked with comparing the speeds of two sequentially presented motion stimuli while ignoring the distractor stimuli presented between them. Our results showed that the retinal motion distractor systematically biased the memorized motion speed. Crucially, the magnitude of the bias was comparable regardless of whether the retinal motion distractor reflected physical or apparent motion. Notably, the distraction effect of the eye movement-induced retinal motion was successfully replicated using a classifier trained on data from the physical motion condition. A further experiment confirmed that this distraction effect by the apparent motion was not due to eye movements themselves. These findings provide behavioral evidence that, at least for the feature of motion speed, perception is not required for the emergence of a bias in VSTM.

BackgroundOcular motor function, or eye movement, serves as a vital indicator of brain health and behavior. Recent advancements in technology have made eye tracking a powerful, quantitative, non‐invasive, and portable tool for studying cognition, brain health, and related diseases. This method allows for objective measurement without verbal or motor responses from the participant. However, it remains unclear which eye movement metrics are most sensitive or specific to various cognitive domains. Existing studies have focused on patients with neurodegenerative diseases or limited to selected eye movement metrics and cognitive assessments. In this study, we aimed to explore the relationships between a diverse array of eye movement metrics with cognitive impairment and neuropsychological performance, in well‐characterized community‐dwelling adults.MethodsIn 544 Baltimore Longitudinal Study of Aging participants (mean age=71 years[28‐99], 58%women, 25%Black, 5%cognitive impairment/dementia), we analyzed 51 eye movement measures (<5% missing) via a portable eye‐tracking device (Neurolign Dx100). We extracted principal components (PCA) on eye movement categories (saccade, smooth pursuit, motor‐related, optokinetic nystagmus, and vergence) and measurement types (accuracy, gain, latency, velocity, square‐wave jerks, and variability). Cognitive impairment was determined by consensus case conferences, using clinical and neuropsychological evaluations. We examined associations with cognitive impairment and various cognitive functions using logistic and linear regression, respectively, adjusted for age and sex.ResultsSaccadic eye movements and speed‐related measures (latency, velocity, variability) were associated with cognitive impairment (odds ratio=1.308, 1.427, 1.987, 0.727, respectively, all p <0.05). Saccades were also associated with the Mini‐Mental State Exam, executive function (Trail Making Test (TMT)‐part B), and visuo‐perceptual speed (Digit Symbol Substitution Test). Smooth pursuit, visual reaction time, and measures of gain and latency were associated with attention (TMT‐A), executive function, and visuo‐perceptual speed. Vergence, visual reaction time, and latency were related to manual dexterity (Pegboard performance)(all Bonferroni‐adjusted p <0.05). Other categories or types of measures were not associated with cognitive impairment or cognition.ConclusionSaccades and speed‐related eye movement metrics link to cognitive impairment. Specific eye movement categories and measures are associated with selected cognitive domains. Longitudinal studies are needed to determine whether these eye movement metrics can serve as early predictors of future cognitive decline and brain pathology.

Predictive control enables humans to anticipate future events by combining sensory feedback with internal models. In interception tasks, such mechanisms could allow the visual system to estimate future target positions, supporting timely and accurate motor responses. Here, we investigated predictive gaze behavior in a visuomotor task where participants used a joystick to intercept a moving target that rebounded within a circular arena. Eye movements were classified into fixations, smooth pursuit, and saccades using a velocity-based method. The arena's geometry constrained rebound angles and facilitated standardized trajectory analysis. Participants consistently deployed fixations aligned with the target's anticipated postrebound path, as confirmed by fixations that were closer to future than to current target positions. Moreover, saccade and fixation onsets were time-locked to the rebound event, reflecting anticipatory adjustments based on the statistical regularities of the task. Gaze alignment was modulated by the target's entry angle and velocity: steeper entries and higher speeds compressed fixation timing but increased spatial variability. Visual masking of the target disrupted predictive gaze, highlighting the critical role of target visibility in guiding anticipatory behavior. These findings demonstrate the crucial role of predictive fixations in visuomotor coordination, offering a broader understanding of anticipatory behaviors and their applications. Our task design offers a controlled platform to study anticipatory gaze strategies, with potential applications for clinical diagnostics, skill training, and human-computer interaction.NEW & NOTEWORTHY This study builds on previous research by demonstrating that predictive fixations align with future target trajectories during a dynamic interception task. Using a threshold-based classification of eye movements, it quantifies anticipatory gaze behavior before and after target rebounds. The findings show that entry and exit angles, target speed, and visual masking systematically influence predictive fixations. Together, these results underscore the critical role of predictive mechanisms in visuomotor control, particularly in adapting gaze behavior to dynamic and uncertain environments.

Eye-tracking for user experience analysis has traditionally relied on dedicated hardware, which is often costly and imposes restrictive operating conditions. As an alternative, solutions utilizing ordinary webcams have attracted significant interest due to their affordability and ease of use. However, a major limitation persists in these vision-based methods: sensitivity to head movements. Therefore, users are often required to maintain a rigid head position, leading to discomfort and potentially skewed results. To address this challenge, this paper proposes a robust eye-tracking methodology designed to accommodate head motion. Our core technique involves mapping the displacement of the pupil center from a dynamically updated reference point to estimate the gaze point. When head movement is detected, the system recalculates the head-pointing coordinate using estimated head pose and user-to-screen distance. This new head position and the corresponding pupil center are then established as the fresh benchmark for subsequent gaze point estimation, creating a continuous and adaptive correction loop. We conducted accuracy tests with 22 participants. The results demonstrate that our method surpasses the performance of many current methods, achieving mean gaze errors of 1.13 and 1.37 degrees in two testing modes. Further validation in a smooth pursuit task confirmed its efficacy in dynamic scenarios. Finally, we applied the method in a real-world gaming context, successfully extracting fixation counts and gaze heatmaps to analyze visual behavior and UX across different game modes, thereby verifying its practical utility.

Visual perception and user experience Optimization: Exploring interaction design through static-triggered smooth pursuit systems

BackgroundVarious oculomotor abnormalities have been reported among Parkinson’s disease (PD) patients. However, their direction- and frequency-specific alterations, developmental trajectory, as well as associations with levodopa responsiveness, remain poorly understood and controversial.MethodsWe studied eye movements via video nystagmography (VNG) in 45 PD patients and 22 HCs. PD patients underwent saccadic accuracy, saccadic latency, and smooth pursuit eye movement (SPEM) gain tests in the OFF and ON medication states (meds) via a levodopa challenge test (LCT).ResultsCompared with HCs, PD patients had lower saccadic accuracy, longer saccadic latency, and lower SPEM gain. Among them, a reduction of 10°/s horizontal SPEM gain was present in the Hoehn and Yahr (H&Y) 1–2 stage [rightward: 85.000 (83.000, 90.500)% vs. 93.882 ± 5.159%, P = 0.016; leftward: 82.545 ± 12.652% vs. 94.316 ± 3.215%, P = 0.027], which could differentiate between early PD patients and HCs with an AUC of 0.807. Levodopa treatment improved the 10°/s horizontal SPEM gain [rightward: 89.500 (81.000, 95.000)% vs. 85.000 (77.000, 91.000)%, Z = −2.422, P = 0.015; leftward: 89.000 (82.000, 93.500)% vs. 81.607 ± 13.634%, Z = −2.134, P = 0.033] and 40°/s downward SPEM gain [63.268 ± 22.778% vs. 55.452 ± 24.515%, t = −3.106, P = 0.004]. Motor symptoms were independent risk factors for reduced upward saccadic accuracy and 40°/s vertical SPEM gain, while an improvement in 40°/s downward SPEM gain was positively correlated with a decrease in the MDS–UPDRS III score (r = 0.331, P = 0.037).ConclusionsVNG-based multidimensional SPEM analysis holds promise as biomarkers to enable early PD detection, monitor disease progression, and optimize early precision interventions.Trial registration: The study was registered with the Chinese Clinical Trial Registry (Clinical Trial Registration No. ChiCTR1900022655, Date: April 20, 2019).

PurposeInfantile strabismus syndrome is a common disorder characterized by a chronic misalignment of the eyes that is present in infancy. The disorder is associated with a wide range of abnormalities including severe impairments of binocular vision, impaired depth perception, impaired motion perception, amblyopia, nystagmus, a loss of disparity vergence, asymmetrical smooth pursuit gain, and saccade disconjugacy. The chronic inability to direct both eyes to the same visual target forces the brain to decide which eye to bring to any given object of interest in the visual field. We wondered if different populations of saccade-related neurons in superior colliculus might be activated, depending on which eye is to be brought to the target. We hypothesized, therefore, that the height of the movement field peak might differ for right-eye-to-target versus left-eye-to-target saccades.MethodsThis study used single-unit, extracellular recording to investigate the bursts of saccade-related neurons in the superior colliculus in a nonhuman primate model of this disorder. Movement fields were plotted separately for saccades that brought the left eye or right eye to the target. Several statistical methods were used to compare the height of the peak between conditions.ResultsA majority of the isolated neurons showed significantly stronger bursts when a particular eye was directed to a visual target, compared to when the fellow eye was brought to the target.ConclusionsThese results imply that, in monkeys with strabismus, different (but overlapping) populations of burst neurons are active depending on which eye is directed to a visual target.

Understanding and accurately estimating cognitive workload is crucial for the development of adaptive, user-centered interactive systems across a variety of domains including augmented reality, automotive driving assistance, and intelligent tutoring systems. Cognitive workload assessment enables dynamic system adaptation to improve user experience and safety. In this work, we introduce a novel framework that leverages smooth pursuit eye movements as a non-invasive and temporally precise indicator of mental effort. A key innovation of our approach is the development of trajectory-independent algorithms that address a significant limitation of existing methods, which generally rely on a predefined or known stimulus trajectory. Our framework leverages two solutions to provide accurate cognitive load estimation, without requiring knowledge of the exact target path, based on Kalman filter and B-spline heuristic classifiers. This enables the application of our methods in more naturalistic and unconstrained environments where stimulus trajectories may be unknown. We evaluated these algorithms against classical supervised machine learning models on a publicly available benchmark dataset featuring diverse pursuit trajectories and varying cognitive workload conditions. The results demonstrate competitive performance along with robustness across different task complexities and trajectory types. Moreover, our framework supports real-time inference, making it viable for continuous cognitive workload monitoring. To further enhance deployment feasibility, we propose a federated learning architecture, allowing privacy-preserving adaptation of models across heterogeneous devices without the need to share raw gaze data. This scalable approach mitigates privacy concerns and facilitates collaborative model improvement in distributed real-world scenarios. Experimental findings confirm that metrics derived from smooth pursuit eye movements reliably reflect fluctuations in cognitive states induced by working memory load tasks, substantiating their use for real-time, continuous workload estimation. By integrating trajectory independence, robust classification techniques, and federated privacy-aware learning, our work advances the state of the art in adaptive human–computer interaction. This framework offers a scientifically grounded, privacy-conscious, and practically deployable solution for cognitive workload estimation that can be adapted to diverse application contexts.

Military service members training with heavy weapons systems are exposed to low-level blast (LLB) overpressure, sometimes resulting in acute symptoms similar to mild traumatic brain injury (mTBI). There is a need for a quick and effective screening tool to identify early deficits and changes associated with blast exposure and minimizing potential ensuing effects. Recently, researchers developed the modified Vestibular/Ocular Motor Screening (mVOMS), designed to assess signs and symptoms of mTBI. modified Vestibular/Ocular Motor Screening consists of four physical movement conditions: smooth pursuits, horizontal saccades, horizontal vestibular-ocular reflex, and visual motion sensitivity to capture the provocation of the vestibular system (headache, dizziness, nausea, fogginess). After completing each activity, service members were asked whether the symptoms were present or absent. Modified Vestibular/Ocular Motor Screening offers a practical solution as it can be administered in approximately 2 minutes and is 85% accurate in identifying mTBI. Similarly, military settings, where time is often constrained in addressing potential mTBI can benefit from the efficiency and reliability of mVOMS, making it well-suited for training settings; however, the use of mVOMS to detect acute blast exposure effects in service members has not been explored, which was the primary purpose of this study. A secondary purpose was to explore the relationship between mVOMS and self-reported mTBI symptoms without provocation by physical motion, as well as eye-tracking. This was a prospective cohort study design involving 42 male military personnel training with mortar systems and 15 male, healthy, unexposed controls. Participants reported demographics and over three separate visits, a self-reported symptoms questionnaire, mVOMS, and smooth pursuit eye tracking assessment. Independent samples t-tests and chi-square analyses, along with Pearson's and rank-biserial correlations, compared demographic and outcome variables between exposed and control groups from the three visits, including individual measures of blast exposure magnitude. A series of receiver operating characteristic (ROC) curves with area under the curve (AUC) were used to evaluate the accuracy of mVOMS, mTBI symptoms, and eye tracking to identify exposed from control groups. This study has been approved by the Walter Reed Army Institute of Research Institutional Review Board. Participants' mean age was 25 ± 3.42 years with mean duration of service 4 ± 2.43 years. Service members exposed to blast reported more symptoms after performing the mVOMS physical movement challenges. The discriminatory power of the change from pre-exposure in mVOMS (AUC = 0.72) was comparable with the change in self-reported symptoms. In contrast to the change from pre-exposure, post-exposure single timepoint evaluation revealed mVOMS is superior (AUC = 0.70) compared to self-reported symptoms (AUC = 0.51). Modified Vestibular/Ocular Motor Screening was also positively correlated with blast exposure measures suggesting that increasing blast exposure levels are associated with increasing mVOMS scores. These results demonstrate that mVOMS in individuals exposed to LLB elicits a response that may be more sensitive than self-report alone. Our data suggests that mVOMS may be useful to screen for mTBI symptomology in service members following blast exposure when administered as a single timepoint test, as it is quick, simple to interpret, and requires minimal training to administer.

Advances and challenges of anammox-based PN/A and PD/A coupled processes in treating diverse wastewater qualities: A review.

Two-month antipsychotic exposure induces domain-specific eye movement alterations in clinical high-risk individuals.

Central eye movement abnormalities in patients with SMA types II and III.

ABSTRACTBackgroundAmyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by the degeneration of both lower and upper motor neurons (UMN). Clinical heterogeneity manifests in subtypes such as bulbar‐onset ALS (bALS) and spinal‐onset ALS (sALS), with emerging evidence suggesting that oculomotor dysfunction may reflect broader multisystem involvement. This study aims to investigate oculomotor parameters across different ALS phenotypes and their associations with neuropsychological domains.MethodsA total of 46 patients meeting the Gold Coast Criteria for ALS were enrolled, alongside 23 age‐ and education‐matched healthy controls (HCs). Participants were assessed for demographic variables and clinical features, and underwent cognitive and oculomotor testing using the EyeKnow system. Eye movement performance was compared between groups, and correlations between oculomotor metrics and cognitive and clinical data were examined.ResultsALS patients displayed longer reaction times in anti‐saccade tasks (357.48 ± 61.28 ms vs. 316.10 ± 52.70 ms, p = 0.005) and significantly lower predictive saccade accuracy (86.77 ± 19.17% vs. 99.36 ± 2.22%, p < 0.001) compared to HCs. There is no significant difference in the eye movement parameters between sALS and bALS. Patients with bulbar involvement exhibited poorer performance in predictive saccade accuracy (77.53 ± 26.66% vs. 96.01 ± 4.92%, p < 0.001) and longer initial time in the smooth pursuit task (647.43 [402.14, 760.64] ms vs. 452.43 [131.62, 598.20] ms, U = 161.00, p = 0.037) compared to those without bulbar involvement. UMN involvement was associated with poorer performance across prosaccade, anti‐saccade, and predictive saccade tasks. No significant correlation between oculomotor metrics and cognitive tests or clinical data was detected.ConclusionsThe findings highlight the impact of bulbar and UMN involvement on oculomotor dysfunction in ALS, demonstrating distinct patterns across various phenotypes. Although oculomotor metrics show sensitivity to the pathophysiology of ALS, their effectiveness as independent biomarkers needs further validation through longitudinal studies that include larger cohorts, advanced neuroimaging techniques, and multimodal assessments to capture the complex interplay between motor, cognitive, and anatomical changes in this varied disease.

Strokes and blunt trauma can cause large changes in perception. It is rare, however, to have a sudden but persistent change to perception in the absence of trauma. Here we report a case of a 12-year-old male who reported a sudden-onset change in vision without any trauma, with akinetopsia-like symptoms: an inability to see motion. In contrast to classical cases of akinetopsia, informal testing revealed normal motion perception for simple stimuli, but difficulty in recognition of moving objects in visual clutter. Psychophysical testing confirmed normal random dot motion sensitivity and a large deficit in object recognition in clutter in moving displays, and surprisingly, in static displays. Oculomotor behavior showed both slowed saccades and difficulty in smooth pursuit. Anatomical and functional MRI showed largely intact retinotopic maps and robust responses to visual motion, including in canonical cortical motion processing areas. However, MRI imaging revealed a right lingual gyrus gray-white contrast blurring with corresponding severe focal FDG hypometabolism on PET, consistent with focal cortical dysplasia (FCD). We speculate that the abnormality in ventral cortex affects recognition in clutter, which manifests as a subjective experience of akinetopsia-like symptoms, especially in complex dynamic scenes.

BackgroundVisuomotor skills play a critical role in football performance, supporting players’ ability to perceive, decide, and act effectively in dynamic environments. Although Sport Vision Training (SVT) has shown potential to improve visual and perceptual-motor abilities, the evidence remains mixed and limited by methodological variability. Cost and accessibility also represent practical challenges. This study evaluates the impact of an 8-week field-based SVT protocol on visuomotor reaction time (VMRT) and oculomotor function in young recreational football players.MethodsA total of 35 football players (Under-12 and Under-13) participated in this quasi-experimental study. Participants underwent baseline orthoptic evaluations to ensure normal visual function. VMRT was assessed using BlazePod® devices, and oculomotor function was evaluated using the Northeastern State University College of Optometry (NSUCO) test. The SVT intervention was conducted twice weekly for8 weeks, integrated into football training. Generalized linear mixed models (GLMMs) and cumulative link models (CLMMs) were used for statistical analysis.ResultsSignificant improvements were observed in VMRT for upper-limb tasks (p < 0.001), while lower-limb reaction times showed no significant change. Oculomotor performance improved, particularly in saccadic precision (p = 0.02) and reduction of body and head movement during saccadic tasks (p < 0.001). No significant improvements were found in pursuit movement accuracy (p = 0.37).ConclusionThe field-based SVT protocol was associated with improvements in upper-limb VMRT and specific oculomotor functions in young footballers. While these findings suggest that sport-specific SVT may enhance key visual-motor skills relevant to football performance, the quasi-experimental design limits causal interpretations.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13102-025-01368-z.

Functional neurological disorders (FND) can include various sensory, motor or cognitive symptoms. Eye movement recordings, measured through video-oculography, could serve as biomarkers for characterizing these dysfunctions in FND. To identify oculomotor patterns that may help to support a positive diagnosis of FND. We conducted a retrospective analysis of video-oculography recordings performed between 2011 and 2023 in 149 patients with FND, focusing on horizontal and vertical prosaccades, smooth pursuit, and antisaccades. These data were compared with those obtained from 132 age and gender-matched healthy volunteers and 43 patients diagnosed with multiple sclerosis (MS). FND patients exhibited significantly increased mean saccade latencies in both horizontal and vertical prosaccade tasks compared to controls (t-test, P < 0.0001). Additionally, variability in horizontal and upward saccade latency was substantially greater in the FND group than in the control and MS groups (P < 0.0001). Vertical saccades in FND patients were hypometric (P < 0.0001) with increased variability of upward saccade amplitude (P < 0.0001). Both MS and FND patients had higher antisaccade error rates than controls (P < 0.0001). These findings suggest that video oculography may be useful in understanding the pathophysiology of FND and highlight its potential as a complementary tool to support diagnostic reasoning in complex clinical presentations.

Making accurate decisions requires the brain to maintain evolving representations of accumulated evidence. The population that maintains this evolving representation may change over the course of evidence accumulation. For example, intervening actions like eye movements and navigation can shift the set of neurons that encode subsequent inputs and outputs. A recent study showed that signals representing accumulated evidence are transferred between parietal neurons with different response fields, enabling continuous evidence integration across both smooth pursuit and saccadic eye movements. More generally, changes in the neural population representing accumulated evidence may result from a switch in the set of neurons representing the relevant behavioral output or a switch in the set of neurons receiving task-relevant information. Here, we present a model that achieves this flexible transfer of graded information without changing synaptic connectivity. Graded signals are widely broadcast throughout the population, with a dynamic gating mechanism controlling which neurons are receptive to this information. This mechanism supports a continuous decision process across changing frames of reference, offering a potentially general framework for cognitive continuity in dynamic environments.

Abstract Traditionally, colour vision assessment relies on the patient’s subjective response. The current study introduces an objective approach using eye movement analysis to explore the perception of moving chromatic stimuli. Chromatic sensitivity was assessed using Dynamic-Static Colour Vision Test (DSCVT) stimuli. A total of 20 (15 female and 5 male) participants (aged 18–28 years, 21.7 ± 2.2) were recruited for the study. During stimulus presentation, participants were instructed to focus on the chromatic stimuli and provide a subjective response at the end of the demonstration. Simultaneously, eye gaze coordinates were recorded to assess chromatic sensitivity objectively. Sensory thresholds were determined using the method of constant stimuli, with detection probabilities computed through psychometric function fitting. Smooth pursuit eye movements were analysed using algorithms developed by Larsson et al. [1] and Nyström et al. [2], enabling the objective identification of the direction in which tracking distance was the longest. Higher chromatic saturation increased smooth pursuit detection; however, inconsistencies in individual performance prevented consistent modelling of the psychometric function due to response variability. In cases where stimulus intensity exceeded threshold levels, correct responses were often given without tracking the object, limiting smooth pursuit-based assessment. Smooth pursuit movements alone were insufficient for severity classification of colour vision deficiencies; further research is needed using additional eye movement metrics.

Eye movements generate a perceptual challenge, that of distinguishing self-induced sensations from movement in the world. We ask about the mechanisms involved in suppressing eye movements towards self-induced sensation, ensuring visual stability. When tracking with the eyes an object moving against a textured background, the background retinal image moves in the opposite direction to the smooth pursuit eye movement. Optokinetic responses, such as optokinetic nystagmus or ocular tracking to this reafferent signal, must be suppressed to sustain the pursuit of the object of interest. We varied the contrast of a brief background motion signal to tell apart two plausible accounts of the suppression of optokinesis during pursuit; a visuomotor gain modulation account, which predicts that ocular tracking of background motion is suppressed in the same proportion irrespective of contrast, and a sensory attenuation account, which predicts that larger contrasts are needed to elicit the same response. Unexpectedly, neither account fit ocular tracking in the reafferent signal direction. The combination of contrast-dependent gating, with maximal suppression observed with higher contrasts, and either contrast gain or visuomotor gain modulation, provides a good fit for most observers’ data. Contrast-dependent gating promotes visuomotor stability in response to most salient signals, as a likely adaptation to the statistics of the environment.

Objective:The clinical significance of aural fullness in patients with vestibular migraine（VM） remains unclear, and it is yet to be determined whether VM with aural fullness represents a distinct subtype of VM; this study aimed to compare differences in demographic characteristics, clinical manifestations, audiological findings, and vestibular function tests between VM patients with and without aural fullness, and explore whether the former is a subtype of VM and whether it requires differentiated treatment. Methods:A total of 174 VM patients were enrolled, including 75 with aural fullness（aural fullness group） and 99 without aural fullness（non-aural fullness group）; demographic data, vertigo characteristics, medical history, family history, pure-tone audiometry, and vestibular function tests were thoroughly recorded, and independent samples t-test and chi-square test were used for inter-group comparisons. Results:①Regarding demographic characteristics, the age of the aural fullness group was significantly lower than that of the non-aural fullness group[（44.08±13.97） years vs. （49.45±16.05） years, P=0.020）, while the two groups showed consistent gender distribution（more females than males） with no statistically significant difference. ②For aural fullness characteristics, unilateral aural fullness accounted for 65.0% in the aural fullness group, significantly higher than bilateral aural fullness（35.0%, P<0.001）. ③In terms of vertigo characteristics, there were no statistically significant inter-group differences in the nature of attacks（rotational vertigo: 36.0% vs. 41.4%, P=0.463; dizziness: 21.3% vs. 11.1%, P=0.064; rotational vertigo or dizziness: 29.3% vs. 25.3%, P=0.548; dizziness with unsteady gait: 9.3% vs. 11.1%, Fisher P=0.806; visual oscillation with unsteady gait: 4.0% vs. 11.1%, Fisher P=0.086）, duration（several hours: 34.7% vs. 33.3%, P=0.841; several minutes: 22.7% vs. 21.2%, P=0.808; several seconds: 5.3% vs. 8.1%, Fisher P=0.557; several days: 9.3% vs. 9.1%, Fisher P=1.000; multiple combined patterns: 17.3% vs. 15.2%, P=0.686）, or incidence of nausea and vomiting（84.0% vs. 72.7%, P=0.071, no statistical significance）. ④No statistically significant inter-group differences were found in medical history and family history, including motion sickness history（8.0% vs. 4.0%, Fisher P=0.337）, headache history（22.7% vs. 34.3%, P=0.084）, and family history of dizziness（12.0% vs. 14.1%, P=0.666）. ⑤For audiological characteristics, 21.3%（16/75） of patients in the aural fullness group had low-frequency hearing loss, significantly higher than 5.1% in the non-aural fullness group（χ²=10.66, P=0.001）; among patients with unilateral aural fullness, 28.6%（14/49） had ipsilateral low-frequency hearing loss, significantly higher than 7.7%（2/26） of those with bilateral aural fullness（χ²=4.41, P=0.036）; however, there was no statistically significant difference in the rate of bilateral high-frequency hearing loss between the two groups（54.7%[41/75]vs. 50.5%[50/99], χ²=0.30, P=0.586）. ⑥In vestibular function tests, no statistically significant inter-group differences were observed in smooth pursuit type Ⅲ/Ⅳ（12.5% vs. 13.1%, P=0.913）, caloric test with CP>25%（31.2% vs. 37.4%, P=0.411）, abnormal video head impulse test（vHIT） rate（30.8% vs. 32.6%, P=0.865）, or abnormal vestibular evoked myogenic potential（VEMP） rate（53.8% vs. 38.9%, Fisher P=0.484）. Conclusion:VM patients with aural fullness have an earlier age of onset, with nearly 1/4 accompanied by low-frequency hearing loss; VM patients with and without aural fullness are highly consistent in gender distribution, nature/duration of vertigo, vestibular function impairment, and presence of bilateral high-frequency hearing loss, suggesting that the core clinical phenotypes of the two groups are consistent, while the former has an earlier age of onset and a higher proportion of unilateral hearing loss, which may be related to the pathological mechanism of VM and inner ear microcirculation disorders.