Background: Caloric testing provides quantitative measures of unilateral weakness (UW) and directional preponderance (DP). By contrast, skull vibration-induced nystagmus (SVINT) and the head-shaking test (HST) are bedside procedures that use different stimuli and operate within distinct temporal response domains. Objectives: This study was designed as a retrospective exploratory analysis of associations between categorical SVINT findings and caloric UW, and between categorical HST findings and caloric DP. Methods: We retrospectively evaluated 76 patients who underwent caloric testing, SVINT, and HST. Because the available records classified SVINT and HST only as present or absent, we restricted the analysis to associations between categorical findings and caloric classifications. Results: Pathological UW was associated with pathological SVINT, and pathological DP was associated with pathological HST. These findings are exploratory and do not demonstrate that the bedside procedures measure UW or DP, nor do they establish proportionality, physiological equivalence, interchangeability, or caloric-like quantitative information. Conclusions: SVINT and HST should therefore be interpreted as distinct and complementary bedside observations. Prospective studies with standardised quantitative eye-movement recordings are required to examine their temporal and physiological relationships with caloric responses.

Vestibular migraine (VM) is an underrecognized disorder characterized by episodic vertigo, often accompanied by headache. Despite its substantial prevalence and disease burden, its metabolic features remain poorly characterized, and serum biomarkers for diagnosis or activity assessment are lacking. We performed untargeted metabolomics in discovery (33 VM vs 30 healthy controls [HCs]) and replication (37 VM vs 27 HCs) cohorts, applying machine learning solely in the discovery cohort for marker selection. In the discovery cohort, 510 metabolites exhibited differential abundance (197 upregulated, 313 downregulated). Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis revealed enrichment trends for upregulated metabolites in cysteine/methionine, histidine, and phenylalanine metabolism. Machine learning identified three candidate metabolites─phenylethylamine, N-acetylserotonin, and cysteine-S-sulfate─each achieving an area under the curve > 0.9. In the discovery cohort, cysteine-S-sulfate correlated with vertigo Visual Analog Scale scores, and phenylethylamine correlated with Headache Impact Test-6 and Generalized Anxiety Disorder-7 (GAD-7) scores. In the replication cohort, all three markers maintained differential expression and discriminative performance; additionally, cysteine-S-sulfate correlated with Dizziness Handicap Inventory scores, and phenylethylamine with GAD-7 scores. This study elucidates the metabolic landscape of VM and identifies promising serum biomarkers, though these findings warrant further validation in larger, multicenter cohorts before clinical translation.

Ocular vestibular evoked myogenic potential (oVEMP) testing provides electrophysiological information on otolithic and superior vestibular pathway function, but its clinical interpretation often remains limited to a binary normal-or-abnormal judgment. This study developed and applied a structured oVEMP response-pattern protocol, together with an exploratory, study-specific composite abnormality-burden grade, to characterize vestibular dysfunction in patients with peripheral vestibular disorders. From February 2024 to December 2025, 110 adults with Ménière's disease, benign paroxysmal positional vertigo, sudden sensorineural hearing loss with vertigo, vestibular neuritis, or other peripheral vestibular injury underwent standardized clinical assessment and bilateral oVEMP testing. Parameters included N10 latency, P15 latency, N10-P15 amplitude, response threshold, interaural amplitude asymmetry ratio, 1,000/500 Hz amplitude ratio, waveform absence, and the composite grade. Abnormal oVEMP responses were found in 62.7% of patients. Ménière's disease showed a higher 1,000/500 Hz amplitude ratio, while the small heterogeneous vestibular neuritis/other peripheral vestibular injury composite group showed more absent responses and higher composite grades. Across all four analytical groups, response-pattern and grade distributions differed; however, sensitivity analyses restricted to the three larger diagnostically homogeneous groups attenuated these between-group differences. At 4 weeks, abnormal oVEMP responses, marked interaural asymmetry, and higher exploratory grades were associated with residual dizziness. These findings support structured oVEMP response-pattern analysis as a functional descriptive framework, but they do not establish diagnostic accuracy or validate the proposed grade as a universal severity scale.

Auditory neuropathy spectrum disorder (ANSD) is primarily considered a hearing disorder, with balance issues rarely reported. Although some studies have investigated vestibular abnormalities in ANSD in addition to auditory deficits, the neurological aspects have largely been overlooked. Subtle balance deficits in individuals with ANSD often go unnoticed, which has resulted in limited research in this area. The present study aims to describe a comprehensive battery of neurological and audio-vestibular tests in individuals with acquired ANSD who reported balance-related complaints but did not have a prior diagnosis of a neurological disorder, thus representing clinically under-recognized deficit. Fourteen patients with ANSD underwent a series of clinical assessments, including auditory brainstem response (ABR), cervical and ocular vestibular evoked myogenic potentials (VEMPs), the video head impulse test (vHIT), motor and sensory nerve conduction studies, somatosensory evoked potentials (SSEP), hematological investigations, and magnetic resonance imaging (MRI). All patients were Romberg-positive and showed an impaired tandem gait, despite largely preserved cranial nerves and motor examination findings on routine clinical testing. Auditory assessments revealed varying degrees of hearing loss, absent ABRs, and abnormal VEMPs and vHIT results, while MRI findings were unremarkable. Motor nerve conduction was normal in most patients; however, a few individuals exhibited reduced or absent sensory nerve potentials. In addition, SSEP latencies were abnormal in nine patients. The absence of VEMPs and abnormal vHIT findings suggest an underlying vestibulopathy, whereas nerve conduction and SSEP abnormalities indicate a possible somatosensory deficit in ANSD. These preliminary findings underscore the importance of a multidisciplinary approach to the evaluation of balance deficits in ANSD, an area in which evidence remains scarce.

Diagnostic errors in acute dizziness and vertigo contribute to high health care costs and poor patient outcomes, primarily due to insufficient clinician training in effective bedside examination skills. A critical barrier to improvement is the lack of scalable, high-quality training solutions. This article advocates for integration of technology to address this knowledge-to-practice gap. The potential of various technologies to standardize instruction and objectively assess complex psychomotor skills is examined. Ultimately, we argue that while technology can enhance universal training, it must complement, not replace, clinicians' ability to synthesize patient history with physical examination findings to improve patient outcomes.

Benign paroxysmal positional vertigo is the most prevalent peripheral vestibular disorder, yet important aspects of its diagnostic variability and treatment response remain incompletely understood. In recent years, advances in computational modeling have provided new opportunities to explore the biomechanical basis of otoconial displacement within the semicircular canals. This review examines the role of vestibular simulation technologies in enhancing both mechanistic understanding and clinical practice. Three-dimensional models that integrate labyrinthine anatomy, head kinematics, gravitational forces, and predicted ocular motor responses allow detailed visualization of debris behavior during positional testing and therapeutic maneuvers.

Dizziness and vertigo, common neurologic complaints, remain challenging to diagnose accurately in both emergency and outpatient settings. Although complex, these conditions frequently present with specific abnormalities of eye movement that contain precise signals allowing for localization and diagnosis. Recent advances in artificial intelligence (AI) and machine learning have enabled automated analysis of eye-movement recordings obtained using video-oculography and related technologies, reducing barriers to their clinical use. In this review, AI-based approaches to eye movement are analyzed to diagnose dizziness and vertigo, organized using several clinical diagnostic tasks, including benign paroxysmal positional vertigo, acute vestibular syndrome and stroke triage.

This article examines the current and future role of decision-support systems and automation in vestibular diagnosis across emergency, primary care, and specialty settings. Vestibular disorders are common but often misdiagnosed because of overlapping symptoms, challenging bedside examinations, and limitations of neuroimaging. Structured diagnostic approaches improve accuracy when correctly applied. Emerging technologies offer objective assessment of eye movements and may enhance diagnostic reliability. Large language models provide valuable support for clinical reasoning, education, and information retrieval but remain vulnerable to hallucinations and incorrect inputs. Future progress will depend on robust clinical data capture, eye-movement repositories, and validated artificial intelligence-supported diagnostic workflows.

Recent innovations in technology including apps that transform virtual vestibular rehabilitation are described. The use of telehealth in the rehabilitation of people with vestibular disorders is relatively new. The advantages of telehealth for vestibular rehabilitation are described. There have been significant advances in technology that permit the clinician to prescribe a precise vestibular exercise prescription in the home. With new advances in the fidelity of cell phones and improvements in streaming capabilities, viewing body and eye movements virtually has greatly improved. New technology is expanding capabilities to rehabilitate people with vestibular disorders safely with online monitoring via the cloud.