Unilateral Vestibulopathy Research Articles

Parameters of Off-Vertical Axis Rotation in Unilateral and Bilateral Vestibulopathy and Their Correlation with Vestibular Evoked Myogenic Potentials.

Off-vertical axis rotation (OVAR) is a laboratory test to assess the otolith function. This study aimed to analyze the parameters of OVAR in patients with unilateral vestibular hypofunction (UVH) and bilateral vestibulopathy (BVP), and to correlate the parameters of OVAR with those of VEMPs. Ten healthy volunteers, 41 UVH, and 13 BVP patients performed OVAR. Bias component (BIC) and modulation component (MOC) of UVH and BVP patients were compared with those of healthy controls. BIC and MOC were correlated with amplitude and interaural difference (IAD) of cervical VEMP (cVEMP) and ocular VEMP (oVEMP). In UVH patients, the direction of BICs to affected side rotation were reversed and the absolute value of BICs were decreased when they were compared to healthy controls. In BVP patients, BICs were markedly attenuated. MOCs were not changed in UVH and BVP patients. There was no statistically significant correlation between VEMPs and OVAR.

Signs of spatial neglect in unilateral peripheral vestibulopathy.

In this study, the question of whether egocentric representation of space is impaired in chronic unilateral vestibulopathies was examined. The objective was to test current theories attributing a predominant role to vestibular afferents in spatial cognition and to assess whether representational neglect signs are common in peripheral vestibular loss. The subjective straight-ahead (SSA) direction was investigated using a horizontal rod allowing the translation and rotation components of the body midline representation to be dissociated in 21 patients with unilateral vestibular loss (right, 13; left, eight) and in 12 healthy controls. Compared to the controls, the patients with unilateral vestibulopathy showed a translation bias of their SSA, without rotation bias. The translation bias was not lateralized towards the lesioned side as typically found for biases reported after unilateral vestibular loss. Rather, the SSA bias was rightward whatever the side of the vestibular loss. The translation bias correlated with the vestibular loss, as measured by caloric response and vestibulo-ocular reflex gain, but not with the subjective visual vertical or the residual spontaneous nystagmus. The present data suggest that the dysfunctions of neural networks involved in egocentred and allocentred representations of space are differentially compensated for in unilateral vestibular defective patients. In particular, they suggest that asymmetrical vestibular inputs to cortical regions lead to representational spatial disturbances as does defective cortical processing of vestibular inputs in spatial neglect after right hemisphere stroke. They also highlight the predominant role of symmetrical and unaltered vestibular inputs in spatial cognition.

Akut Unilateral Vestibülopatilerde Servikal Miyojenik Potansiyeller ile Video Baş Savurma Testlerinin Kalorik Teste Olan Katkılarının Değerlendirilmesi

Akut Unilateral Vestibülopatilerde Servikal Miyojenik Potansiyeller ile Video Baş Savurma Testlerinin Kalorik Teste Olan Katkılarının Değerlendirilmesi

Neutrophil-mediated immune response as a possible mechanism of acute unilateral vestibulopathy.

This study aimed to investigate the underlying pathogenesis of acute unilateral vestibulopathy (AUV) using gene expression profiling combined with bioinformatics analysis. Total RNA was extracted from the peripheral blood mononuclear cells of ten AUV patients in the acute phase and from ten controls. The differentially expressed genes (DEGs) between these two groups were screened using microarray analysis with the cut-off criteria (|fold changes| > 1.5 and p-value < 0.05). Functional enrichment analysis of DEGs was performed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis, and the protein-protein interaction (PPI) network was constructed using the STRING (Search Tool for the Retrieval of Interacting Genes) database. There were 57 DEGs (50 up-regulated and 7 down-regulated) identified in the AUV group. Functional enrichment analysis showed that most of the up-regulated DEGs were significantly enriched in terms related to the neutrophil-mediated immune pathway. From the PPI network, the top ten hub genes were extracted by calculating four topological properties, and most of them were related to the innate immune system, inflammatory processes and vascular disorders. The complete blood count tests showed that the neutrophil-to-lymphocyte ratio was significantly higher in the 72 AUV patients than in the age-matched controls (2.93±2.25 vs 1.54±0.61, p < 0.001). This study showed that the neutrophil-mediated immune pathway may contribute to the development of AUV by mediating inflammatory and thrombotic changes in the vestibular organ.

Satisfaction and Effect Research on Virtual Reality-Based Vestibular Exercise for the Elderly Patients with Chronic Unilateral Vestibulopathy

Satisfaction and Effect Research on Virtual Reality-Based Vestibular Exercise for the Elderly Patients with Chronic Unilateral Vestibulopathy

Unusual Vestibulo-Ocular Reflex Responses in Patients With Peripheral Vestibular Disorders Detected by the Caloric Step Stimulus Test.

The caloric step stimulus test consists of the changes in head position from the sitting to supine positions and continuous caloric irrigation. This test can provide a single labyrinth with a stimulus similar to constant head acceleration in rotational testing and, therefore, can evaluate vestibulo-ocular reflex (VOR) dynamics more precisely than can conventional methods. To assess the clinical utility of the test in the assessment of the VOR dynamics of diseases, we performed the test in patients with peripheral vestibular disorders, including sudden idiopathic hearing loss, vestibular neuritis, Meniere disease, vestibular Meniere disease, or chronic unilateral idiopathic vestibulopathy and normal controls. Slow-phase eye velocity (SPV) was measured with videonystagmography. We fitted the time course of SPV across 2 min to a mathematical model containing two exponential components and time constants: the caloric step VOR time constant (T1) and caloric step VOR adaptation time constant (T2). All responses of normal controls (n = 15 ears) were fit to the model. Several responses of the 101 ears of the patients differed from the time courses predicted by the model. We divided the data of 116 ears into four patterns based on SPV, T1, and T2. The thresholds for the classification were determined according to the lower limits of the capability of curve fitting for SPV and the upper limits of normal controls for T1 and T2. Seventy-eight ears followed pattern A (normal T1 and T2): the SPV trajectory formed a rapid rise with subsequent decay. Nineteen followed pattern B (normal T1 and prolonged T2): the SPV trajectory formed a rapid rise without decay. Six followed pattern C (prolonged T1 and T2): the SPV trajectory formed a slow rise. Thirteen ears followed pattern D: a low VOR response. There were no significant differences in time constants between the affected and healthy ears in patients with each disease. However, prolonged T1 and T2 were significantly more frequent in the affected ears than the healthy ears. In conclusion, the caloric step stimulus test can be potentially useful in detecting unusual VOR responses and thus reflect some pathological changes in the vestibular system.

Vestibular Screening Before Cochlear Implantation: Clinical Implications and Challenges in 409 Cochlear Implant Recipients.

Cochlear implantation (CI) carries a risk of loss of vestibular function following surgery. Thus, vestibular assessment presurgery is used to identify vestibulopathy that may contraindicate implantation and guide in selecting the candidate ear. The aim of this study was to evaluate the clinical implications of preoperative vestibular assessment, and to identify challenges in performing vestibular testing in patients with profound hearing loss, i.e., CI candidates. Retrospective study of all CI recipients implanted since the introduction of a vestibular screening program. Tertiary referral center in 2013. CI candidates routinely underwent testing with the video head impulse test (VHIT) and the cervical vestibular evoked myogenic potential (cVEMP) test as a part of the CI work up. Three hundred thirty-five individuals were screened before the first CI and 74 individuals before the second CI. In 301 cases (73.6%), the vestibular function was considered normal and consequently carried no contraindications for surgery or implications for choice of ear to be implanted. Bilateral vestibular loss was found in 43 cases (10.5%) and unilateral vestibular loss was found in 62 cases (15.2%). In the latter cases, evaluation of multiple variables was indicated to select candidate ear. In nine implanted patients (2.2%), a relative contraindication to operate based on an "only balancing" ear was overruled by other factors. Vestibular testing was challenged by various factors (e.g., neck immobility, eye tracking issues, communication, and other patient issues), limiting the vestibular data output. This resulted in omittance, testing failure, or interpretation uncertainty 24 times (5.9%) for VHIT and 65 times (15.9%) for cVEMP. Vestibular screening is an important part of the clinical workup with respect to selection of candidate ear for cochlear implantation, as 15.2% of CI candidates present with unilateral vestibulopathy. Challenges in performing the vestibular tests are not uncommon, as test failure occurred in 15.9% of cases for the cVEMP and 5.9% for the VHIT. The most common reasons for test failure were neck immobility, communication issues, and problems of pupil tracking.

Quantitative Evaluation of a New Posturo-Locomotor Phenotype in a Rodent Model of Acute Unilateral Vestibulopathy.

Vestibular pathologies are difficult to diagnose. Existing devices make it possible to quantify and follow the evolution of posturo-locomotor symptoms following vestibular loss in static conditions. However, today, there are no diagnostic tools allowing the quantitative and spontaneous analysis of these symptoms in dynamic situations. With this in mind, we used an open-field video tracking test aiming at identifying specific posturo-locomotor markers in a rodent model of vestibular pathology. Using Ethovision XT 14 software (Noldus), we identified and quantified several behavioral parameters typical of unilateral vestibular lesions in a rat model of vestibular pathology. The unilateral vestibular neurectomy (UVN) rat model reproduces the symptoms of acute unilateral peripheral vestibulopathy in humans. Our data show deficits in locomotion velocity, distance traveled and animal mobility in the first day after the injury. We also highlighted alterations in several parameters, such as head and body acceleration, locomotor pattern, and position of the body, as well as “circling” behavior after vestibular loss. Here, we provide an enriched posturo-locomotor phenotype specific to full and irreversible unilateral vestibular loss. This test helps to strengthen the quantitative evaluation of vestibular disorders in unilateral vestibular lesion rat model. It may also be useful for testing pharmacological compounds promoting the restoration of balance. Transfer of these novel evaluation parameters to human pathology may improve the diagnosis of acute unilateral vestibulopathies and could better follow the evolution of the symptoms upon pharmacological and physical rehabilitation.

A Systematic Review on Balance Performance in Patients With Bilateral Vestibulopathy.

Patients with bilateral vestibulopathy (BVP) have severe balance deficits, but it is unclear which balance measures are best suited to quantify their deficits and approximate the diversity of their self-reports. The purpose of this study was to explore measures of balance control for quantifying the performance of patients with BVP related to different balance domains, allowing targeted assessment of response to intervention. MEDLINE, Web of Science, and Embase were systematically searched on October 9, 2019. The Scottish Intercollegiate Guidelines Network checklist for case-control studies was applied to assess each individual study's risk of bias. Standardized mean differences (SMD) were calculated based on the extracted numeric data and reported according to the type of sensory perturbation in the balance tasks. Twelve studies (1.3%) met the eligibility criteria and were analyzed, including data of 176 patients with BVP, 196 patients with unilateral vestibulopathy, and 205 healthy controls between 18 and 92years old. In general, patients with BVP were either unable to maintain (or had reduced) balance during tasks with multisensory perturbations compared with healthy controls (range of mean SMD=1.52-6.92) and patients with unilateral vestibulopathy (range of absolute mean SMD=0.86-1.66). During clinical assessment to quantify balance control in patients with BVP, tasks involving multisensory perturbations should be implemented in the test protocol. As patients with BVP show difficulties with movement strategies, control of dynamics, orientation in space, and cognitive processing, clinicians should implement these aspects of balance control in their assessment protocol to fully comprehend the balance deficits in these patients.

A New and Faster Method to Assess Vestibular Compensation: A Cross-Sectional Study.

Characterize the state of vestibular compensation of subjects diagnosed with acute unilateral vestibulopathy (AUV) of peripheral origin according to the temporal organization pattern of the refixation saccades (Perez and Rey (PR) score). Retrospective cross-sectional study using previously collected clinical data from a tertiary referral center. Following the vestibular compensation criteria defined by Eisenman, we used the video head impulse test as the main vestibular function test and compared the results with other traditional tests: rotatory chair test (ROT), caloric test, videonystagmography, clinical situation (CLIN), and the Dizziness Handicap Inventory (DHI) questionnaire from 28 subjects (17 men, 11 women), average age 60.21 years, who were in a compensated and noncompensated vestibular situation. We used the PR score to measure the differences between the study groups. A cluster was developed to define a cutoff point that objectively distinguishes the vestibular compensation status. Significant differences in the PR score were found in the state of vestibular compensation in the ROT test (P = .01), DHI (P = .04), and CLIN (P = .023). The vestibular compensation criteria that groups the original variables (PR-CLUSTER) cutoff point was 55 (P = .019). The PR score is a measure of temporal organization of the refixation saccades that enables us to distinguish clearly and objectively the vestibular situation of subjects with AUV. We suggest its clinical application. NA Laryngoscope, 2020.

‘Excess anxiety’ and ‘less anxiety’: both depend on vestibular function

To present evidence of a functional interrelation between the vestibular and the anxiety systems based on a complex reciprocally organized network. The review focuses on the differential effects of various vestibular disorders, on psychiatric comorbidity, and on anxiety related to vertigo. Episodic vertigo syndromes such as vestibular migraine, vestibular paroxysmia, and Menière's disease are associated with a significant increase of psychiatric comorbidity, in particular anxiety/phobic disorders and depression. Chronic unilateral and bilateral vestibulopathy (BVP) do not exhibit a higher than normal psychiatric comorbidity. Anxiety related to the vertigo symptoms is also increased in episodic structural vestibular disorders but not in patients with chronic unilateral or bilateral loss of vestibular function. The lack of vertigo-related anxiety in BVP is a novel finding. Several studies have revealed special features related to anxiety in patients suffering from BVP: despite objectively impaired postural balance with frequent falls, they usually do not complain about fear of falling; they do not report an increased susceptibility to fear of heights; they do not have an increased psychiatric comorbidity; and they do not report increased anxiety related to the perceived vertigo. Subtle or moderate vestibular stimulation (by galvanic currents or use of a swing) may have beneficial effects on stress or mood state in healthy adults, and promote sleep in humans and rodents. The intimate structural and functional linkage of the vestibular and anxiety systems includes numerous nuclei, provincial and connector hubs, the thalamocortical network, and the cerebellum with many neural transmitter systems. The different involvement of emotional processes and anxiety - to the extent of 'excess anxiety' or 'less anxiety' - in structural vestibular disorders may be due to the specific dysfunction and whether the system activity is excited or diminished. Both psychiatric comorbidity and vertigo-related anxiety are maximal with excitation and minimal with loss of peripheral vestibular function.

Lesion Patterns and Possible Implications for Recovery in Acute Unilateral Vestibulopathy.

To assess patterns of end-organ involvement in acute unilateral vestibulopathy (AUV) and to define the recovery. Retrospective chart review. Tertiary academic referral hospital. Fifty-nine patients fulfilling clinical criteria for AUV and evaluated using the caloric vestibular test, video head impulse test, and both cervical and ocular vestibular evoked myogenic potentials, up to 10 days from symptoms onset were included. Vestibular tests and requirements for vestibular rehabilitation were analyzed. The most affected end-organ was the horizontal canal (97%), followed by the anterior canal (83%), utricle (73%), posterior canal (46%), and saccule (44%). Nineteen (32%) patients exhibited complete receptors lesion, while 13 (22%) exhibited damage to receptors connected with the superior division of the vestibular nerve (VN). The proportion of patients who underwent vestibular rehabilitation was higher in the latter two groups (58% for both). Partial involvement of the receptors innervated by both the division of the VN, rather than by its superior division, was detected in 22 and 24% of patients, respectively. Total or partial damage to receptors innervated by the inferior VN was not found. Deeper understanding of AUV may be achieved through identification of its patterns. Slightly more than one-half of AUV cases seemed to be associated with a nerve lesion, with a worse clinical outcome. The remaining patients exhibited selective involvement of vestibular receptors, more probably consistent with an intralabyrinthine lesion pattern and experienced better spontaneous recovery.

Acute Vestibular Syndrome.

The acute vestibular syndrome (AVS) is a label for presentations of new-onset severe dizziness, vertigo, or imbalance, with examination findings of nystagmus or gait unsteadiness. The prototypical AVS presentation is the acute unilateral vestibulopathy due to vestibular neuritis. Stroke is also a serious concern in patients with AVS. Most other peripheral vestibular disorders present as episodic or chronic syndromes. In this article, the diagnostic considerations, exam findings, and management of AVS are reviewed.

Clinical Application of Video Head Impulse Test in Acute Vestibular Syndrome

Acute unilateral vestibulopathy (AUV) is the recommended term [rather than the more widely used ‘vestibular neuritis (VN)’] for all pathologies involving sudden impairment of the unilateral peripheral vestibular function regardless of the exact location of the lesion. Acute vestibular syndrome (AVS) is an upper-level entity of AUV, which is the most common cause of AVS, and includes acute central vertigo. AVS typically presents with the symptoms of new onset continuous vertigo, gait instability, and nausea/vomiting lasting several days to weeks. The video head impulse test (vHIT) was recently developed and has been widely adopted at clinics and emergency centers. In this study, we will review the differential diagnosis of AVS using vHIT. In addition, we will describe the subtypes of VN and the use of vHIT for follow-up testing in AVS. Key words: Acute unilateral vestibulopathy ㆍ Acute vestibular syndrome ㆍ Vestibular neuritis ㆍ Video head impulse test

Efficacy of a Non-invasive Vestibular System Masking for Improving Outcomes Following Acute Unilateral Vestibulopathy

Efficacy of a Non-invasive Vestibular System Masking for Improving Outcomes Following Acute Unilateral Vestibulopathy

Mechanical and sensorineural vestibular dysfunction: a case study of “mixed” vestibulopathy

A diagnosis of hearing loss typically consists of categorizing the locus of involvement; conductive, sensorineural, retrocochlear, or mixed. It is this designation that provides guidance as to whether medical or a non-medical approach e.g. amplification is the preferred treatment. When a “mixed” loss occurs, a combination of medical and non-medical management strategies will be utilized. When vestibular dysfunction, is discussed, however, we rarely think about this combined causation. A unilateral vestibulopathy dysfunction (UVD) from a vestibular neuritis, may cause either hair cell damage and/or a neuropathy. This may be considered as a “sensorineural” dysfunction. The literature, and clinical experience, suggests, that an onset of Benign Paroxysmal Positional Vertigo (BPPV) often follows, within days or weeks. BPPV may be considered the “mechanical” component, requiring treatment with Canalith Repositioning. Such patients, therefore, may be considered to have a “mixed” dysfunction. This requires two different treatments in order to successfully extinguish or ameliorate two differing sets of functional impairments. We present a case report of a 52-year-old female patient with complaints of initial acute onset vertigo, positional dizziness, oscillopsia and visual provocation. Attending physician, suspected BPPV and referred her for testing. The evaluation confirmed a left ear BPPV-PC, in addition to a non-compensated left unilateral vestibular dysfunction (UVD). The BPPV was successfully cleared with Canalith Repositioning Maneuvers (CRM) at her first treatment visit. Based on her profile ensuring safety and no fall-risk, she was prescribed an individualized self-directed vestibular rehabilitation therapy home exercise program to address the non-BPPV related symptoms. She returned to The American Institute of Balance (AIB), at one-month, reporting complete amelioration of the movement and visually provoked symptoms. Post-therapy objective testing demonstrated compensation of the previously identified UVD. This case demonstrates, that for many patients presenting with BPPV symptoms, there may also be compounding underlying functional impairments. Without the benefit of a thorough evaluation, the “sensorineural” aspect of the “mixed” vestibular dysfunction, may go unresolved. This will further delay their recovery and return to a normal active lifestyle or employment.

Clinical diagnosis and treatment of chronic dizziness

Chronic dizziness is defined as a complex of symptoms lasting months or years, including oscillopsia, nystagmus, and postural instability. Diagnostic search includes peripheral vestibulopathy - chronic unilateral vestibulopathy resulting from vestibular neuronitis, schwannoma of the 8th pair of cranial nerves, medical or surgical ablation of the labyrinth, and bilateral vestibulopathy; central vestibulopathy - syndromes accompanied by central vertical nystagmus, small vessel disease in patients with chronic cerebral ischemia; general somatic diseases, peripheral polyneuropathy, side-effects of medications as well as persistent postural-perceptual dizziness. Often, when collecting an anamnesis, it is not possible to identify specific features of dizziness and instability, therefore, clinical and instrumental examination of the patient is of particular importance. In the otoneurological examination, the greatest attention is paid to static/coordination tests, oculomotor tests aimed at identifying signs of damage to the vestibulo-ocular reflex. The principles of treatment depend on the diagnosed cause of dizziness and instability and can, to varying degrees, combine pharmacotherapy, vestibular rehabilitation and psychotherapy, as well as correction of therapy for the underlying disease that caused vestibulopathy.

Síntomas y signos de la hipofunción vestibular unilateral y bilateral

Introducción y objetivo: La disfunción vestibular periférica implica a los órganos vestibulares o a los nervios vestibulares, produciendo una gran variedad de síntomas y signos clínicos. Método: Revisión narrativa. Discusión: El otoneurólogo es el encargado de realizar una evaluación exhaustiva para llegar a identificar el trastorno que presenta el paciente que acude con vértigo o desequilibrio. La clave diagnóstica es la anamnesis profunda completada con un cuidadoso examen otoneurológico. Además, las nuevas tecnologías de estudio que han surgido en este campo permiten un cambio en la definición, caracterización y tratamiento de estas patologías. Conclusiones: En la presente revisión narrativa se describirán los dos grandes grupos de deficiencia vestibular periférica: la vestibulopatía unilateral y bilateral.

Worldwide survey on laboratory testing of vestibular function.

The function of the peripheral vestibular system can nowadays be quantified. The video head impulse test (vHIT) and caloric irrigation are used for the semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) for the sacculus, and ocular vestibular evoked myogenic potentials (oVEMP) for the utriculus. Because there is no agreement on normal and pathologic values, we performed a worldwide survey. A web-based standardized survey questionnaire was used to collect data on "reference values" and "cutoff" values. Thirty-eight centers from all continents (except Africa) replied. "Reference values": vHIT: mean for the vestibulo-ocular reflex gain of the left horizontal canal 0.91 (range: 0.7-1.01) and of the left horizontal canal 0.92 (0.7-1.05); side difference 0.15 (0.25-0.3). Caloric irrigation: mean peak slow phase velocity of caloric-induced nystagmus for warm (44°C) water 18.65°/s (12-30°/s); cold (30°C) water 18.21°/s (10-25°/s). cVEMP: P13-N23 amplitude mean for the lower limit 28.67 μV (16-50 μV); upper limit 200 μV (50-350 μV). "Cutoff values": vHIT: side difference 0.26 (0.1-0.4), bilateral vestibulopathy <0.61 (0.3-0.8); unilateral vestibulopathy (UVP) <0.68 (0.4-0.8). Caloric irrigation pathologic side difference mean 25.93% (17.7%-40%) or 12°/sec (5-30°/s); side difference UVP 26.73% (20%-40%) or 29.8°/s (5-100°/s). cVEMP: P13/N23 amplitude mean lower cutoff 32.5 μV (15-50 μV), mean upper cutoff 125 μV (50-200 μV), asymmetry 36.08 μV (20-50 μV). This worldwide survey showed a large variability in terms of reference and pathologic cutoff values in the 38 centers included. Therefore, standardization of how to achieve these values and agreement on which values should be used is highly warranted to guarantee a high quality of vestibular testing and interpretation of clinical and scientific results.

Etiological spectrum of vertigo and dizziness: Clinic-based study from a specialty medical center in Dubai

Dizziness is a common complaint in neurological outpatients. Vestibular disorders are the most common cause of dizziness. There are few studies quantifying the frequency of vestibular disorders in Dubai population. The aim of this study is to report the etiological spectrum of vertigo and dizziness from a vertigo specialty clinic in Dubai. The study was conducted at Vertigo clinic, equipped with Video-oculography (VOG). All the consecutive patients suffering from dizziness visiting the Vertigo clinic in the last three months were included in the study. Detailed history taking and neurotological examination was performed in every patient. VOG, Neuroimaging studies and other investigations were done when it was felt appropriate. During the 3-month study period, 222 patients [141 males and 81 females, mean age 38 years, range 19–83 years] were enrolled in the study. The most frequent (Fig.1) causes were vestibular migraine (43.2%)- [definite:44.8% probable:55.2%] and BPPV (19.8%). This was followed by Meniere’s disease (7.2%) and persistent-postural-phobic dizziness (4.9% alone and 6.7% co-morbid). Other causes included: psychiatric causes (4%), acute unilateral vestibulopathy (3.1%), post-traumatic dizziness (3.1%), vestibular paroxysmia (2.7%), stroke (2.2%), drug-induced (1.3%), multiple sclerosis (0.45%) and other disorders (3.1%). In 4.5% of patients no cause could be established. Vestibular migraine is one of the most common cause of dizziness and vertigo. This is probably the largest study of Vertigo patients in Dubai population. The etiological spectrum of vertigo seen in this study is similar to the spectrum reported from other countries.