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Peripheral vestibular disorders

an update

Strupp, Michaela; Mandalà, Marcob; López-Escámez, Jose A.c,d

doi: 10.1097/WCO.0000000000000649
NEURO-OTOLOGY: Edited by Thomas Brandt

Purpose of review To provide an update on the most frequent peripheral vestibular disorders.

Recent findings The on-going classification of vestibular disorders by the Bárány Society represents major progress. The diagnosis of bilateral vestibulopathy (BVP) requires quantitative testing of vestibular function. ‘Acute unilateral peripheral vestibulopathy’ (AUPVP) is now preferred over ‘vestibular neuritis.’ Menière's disease is a set of disorders with a significant genetic contribution. The apogeotropic variant of horizontal canal benign paroxysmal positional vertigo (hcBPPV) and anterior canal BPPV (acBPPV) can be distinguished from a central vestibular lesion. Vestibular paroxysmia is now an internationally accepted clinical entity. The diagnosis of SCDS is based on conclusive findings.

Summary Diagnosis of BVP requires significantly reduced vestibular function. The clinical picture of AUPVP depends on how much the vestibular end organs or their innervation are affected. Menière's disease phenotype is a constellation of symptoms. Although diagnostic and therapeutic criteria for pc and hcBPPV are well defined, a number of less frequent and controversial are increasingly diagnosed and can be treated. Diagnosis of vestibular paroxysmia requires that a patient responds to treatment with a sodium channel blocker. The diagnosis of SCDS requires conclusive findings with various methods. There is still a great need for state-of-the-art randomized controlled treatment trials in most peripheral vestibular disorders.

aDepartment of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), Ludwig Maximilians University, Munich, Campus Grosshadern, Munich, Germany

bDepartment of Otology and Skull Base Surgery, University of Siena, Siena, Italy

cOtology & Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica – Pfizer/Universidad de Granada/ Junta de Andalucía (Genyo), PTS

dDepartment of Otolaryngology, Instituto de Investigación Biosanitaria, ibs. Granada, Hospital Universitario Virgen de las Nieves, Granada, Spain

Correspondence to Michael Strupp, MD, FRCP FANA, FEAN, Department of Neurology, Ludwig Maximilians University, Munich, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany. Tel: +49 89 4400 73678; fax: +49 89 4400 76673; e-mail:

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