Posterior circulation ischemic stroke (PCIS) with vertigo is a common central vertigo disease that significantly hinders patients' motivation for rehabilitation and increases the recurrence rate and mortality among stroke patients due to recurrent episodes of vertigo. Acupuncture has shown promising therapeutic effects in the treatment of PCIS with vertigo, but its underlying mechanisms remain unclear. This study is designed to investigate the impact of acupuncture on cerebral hemodynamics and brain structure in PCIS patients vertigo, and to evaluate its clinical effectiveness in managing this condition.

The current state of medical practice is going through tremendous and rapid changes. There is an increasing prevalence of burnout among physicians, where they are questioning the value of practicing medicine. There is also a growing frustration among patients over reduced access to physicians, feeling rushed at appointments and generally feeling that they are not being heard. These conditions point to a sense among doctors and patients that the doctor-patient relationship is compromised without a viable pathway to repair this vital connection. In this paper, I want to show how applying philosophy, particularly, Martin Heidegger's discussion of angst and death can help to show a way for doctors to have a deeper ontological understanding of their patients' conditions, which can provide a bridge for doctors to re-establish a deep doctor-patient relationship. I will use vertigo as a paradigm condition of a disorder in which doctors have a poor understanding of their patients' condition. This leads to frustrating interactions with patients and breakdown of the doctor-patient relationship. Ménière's disease is a particular type of vertigo disorder which will serve as the foundation for this study which will examine the severe vertigo attacks and chronic disequilibrium these patients experience through the lens of Heidegger's highly technical phenomenological analysis of angst and death. Ménière's disease is an inner ear disorder that causes violent vertigo attacks and hearing loss followed by severe disequilibrium. During the attacks patients are incapacitated by the vertigo, and after the attack subsides, the disequilibrium makes life's normal pursuits meaningless. These patients understand the role of entities in their lives, but entities do not matter to them. Heidegger introduces the concept of for-the-sake-of-which to describe how entities in the world are interrelated with Dasein's purpose of disclosing a world. He provides a sense of for-the-sake-of-which where everyday entities are used to fulfill Dasein's activities which is an existentiell mode of for-the-sake-of-which. His famous example is the hammer in the workshop. He also gives a sense of for-the-sake-of-which where the totality of entities in the world are related to Dasein's ultimate goal of being a discloser of its world. This is Dasein's ultimate for-the-sake-of-which, which is an existential mode. In this paper I show that for-the-sakes-of-which can be thought of as having an existentiell and existential sense, and the existentiell for-the-sakes-of-which can be inauthentic or authentic. I will show how Heidegger's analysis of Dasein can be applied to concrete human existence, using the inner ear disorder, Ménière's Disease as an example. I am suggesting that the disequilibrium from Ménière's disease is a naturalized account of Heideggerian angst and is being-towards-death. I am also suggesting that the Ménière's attack is an experience of existential death because all possibilities and solicitations are impossible. I show that some Ménière's patients are able to take on authentic for-the-sake-of-which by becoming resolute and anticipating death.

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder among older adults, characterised by dizziness and imbalance caused by the displacement of otoconia into the semicircular canals. Although canalith repositioning manoeuvres are considered the standard treatment, their high recurrence rate and the need for frequent clinic visits highlight the demand for supplementary therapeutic approaches. This review examines the effectiveness of home-based vestibular rehabilitation and the associated challenges in managing patients with BPPV. A comprehensive search of databases including PubMed, Scopus, Science Direct, Web of Science, PEDro, Mendeley, and Google Scholar identified 251 records using keywords such as "BPPV" and "home-based exercise rehabilitation." Following the screening of 228 records and full-text review of 172 articles, 17 studies met the inclusion criteria. The total sample included 541 patients with BPPV, with intervention group sizes ranging from 10 to 154 and control group sizes from 10 to 151. Intervention durations varied between 1 and 24 weeks. The findings indicate that home-based rehabilitation can reduce dizziness, improve balance and gait, lower fall risk, and enhance quality of life. Digital tools such as telephone consultations and online platforms were frequently used to support adherence and monitor exercise performance. However, the effectiveness varied across studies, with some reporting substantial benefits and others showing limited improvements. This review highlights the potential of digital technologies in enhancing home-based vestibular rehabilitation, while also emphasising the need for further research to optimise protocols and assess long-term outcomes.

BackgroundVisual vertigo (VV) refers to dizziness or discomfort provoked by dynamic visual environments and is common after vestibular disorders. The Visual Vertigo Analogue Scale (VVAS) is a nine-item questionnaire developed to assess VV. However, no validated Japanese version has been available. This study aimed to translate the VVAS into Japanese (VVAS-J) and evaluate its reliability and validity.MethodsThe VVAS-J was translated and cross-culturally adapted according to standardized guidelines. The study included 168 patients with vestibular disorders and 73 healthy controls. Reliability was assessed by internal consistency and test-retest reliability using Cronbach's α, intraclass correlation coefficient [ICC(3,1)], and Cohen's κ. Validity was examined in terms of content, criterion-related, and construct validity. For criterion-related validity, VV Severity and VVAS Positive were calculated and analyzed in relation to the Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), and stabilometry. For construct validity, VV Severity and VVAS Positive were compared between patients and controls and across diagnostic subgroups.ResultsThe VVAS-J showed excellent internal consistency (Cronbach's α = 0.911) and good test-retest reliability (ICC = 0.87). VV Severity correlated strongly with the DHI (r = 0.62, p < 0.001) but weakly with the HADS and stabilometry. VV Severity and all items were significantly higher in patients with vestibular disorders than in controls, and highest in PPPD among diagnostic subgroups (p < 0.001).ConclusionThe VVAS-J demonstrated good reliability and validity, providing a simple, standardized tool to quantify VV in Japanese patients.

Background: Vestibular symptoms and objective vestibular dysfunction have been reported in patients with autoimmune and rheumatologic diseases, but available evidence remains fragmented and methodologically heterogeneous. Previous studies have often addressed audiovestibular involvement as a combined entity, limiting disease-specific interpretation of vestibular outcomes. Methods: A PRISMA 2020-based systematic review was conducted using predefined eligibility criteria targeting vestibular outcomes in autoimmune and systemic rheumatologic diseases. Observational studies reporting vestibular symptoms and/or objective vestibular test results were included. Vestibular data were extracted even when studies reported combined audiovestibular outcomes. Certainty of evidence was assessed using the GRADE approach. Results: Twenty-seven studies were included in the qualitative synthesis, comprising 14 primary observational studies and 13 reviews. Vestibular involvement was reported across multiple diseases, including systemic sclerosis, giant cell arteritis, ankylosing spondylitis, psoriatic arthritis, Behçet disease, primary Sjögren syndrome, rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and vasculitic disorders. Objective vestibular abnormalities were most frequently identified using caloric testing, balance integration measures, videonystagmography, and video head impulse testing. Systemic sclerosis and giant cell arteritis showed more consistently reported vestibular findings, although heterogeneity in assessment methods precluded quantitative synthesis. Conclusions: Vestibular involvement occurs across autoimmune and systemic inflammatory diseases, but overall certainty of evidence remains limited. Standardized vestibular assessment and longitudinal studies are needed to better define disease-specific vestibular phenotypes.

Reliable drug delivery to the inner ear is still an unmet clinical need, due to the blood cochlear barrier, which effectively protects this highly sensitive organ. To overcome this hurdle, miniaturized, biodegradable implants were prepared (0.3 mm in diameter), which can be administered into the cochlea via a tiny hole drilled into the round window. They were based on poly(lactic-co-glycolic acid) (PLGA) and prepared by hot melt extrusion. Three drugs were incorporated: (i) 20.0% dexamethasone with anti-inflammatory, anti-fibrotic and protective activity for hair cells (being critical for hearing); (ii) 5.7% lidocaine (free base) as local anesthetic drug and therapeutic potential to treat tinnitus or vertigo; and (iii) 2.1% curcuminoids for their anti-inflammatory and anti-oxidant activities. The implants were thoroughly characterized before and after exposure to artificial perilymph in vitro, by DSC, X-ray diffraction, GPC, optical microscopy, TGA and release measurements. In addition, they were implanted into gerbil cochlea, monitoring the resulting local drug concentrations. Importantly, the implants allowed for the simultaneous controlled release of all drugs. In vitro, lidocaine release was fastest (100% after 10 d), followed by dexamethasone (100% after 10 weeks). The slower release of dexamethasone can be explained by saturation effects within the implant. In vivo, drug release was faster, probably because of accelerated polymer degradation due to local drops in pH and/or the presence of esterases (e.g., 100% dexamethasone release in 2 weeks). Curcuminoids were not detectable in the release medium under the given conditions in vitro, nor in the perilymph in vivo, because of their very limited solubility in aqueous media. Visual observation suggests that they were released within 1-2 weeks in vivo (likely partitioning into lipid phases and/or being metabolized). No noteworthy changes in the animals' behavior or signs for tissue inflammation/damage were detected.