Research in Vestibular Science

Volume 24 (1); March 2025

Review Articles

Recent advances in diagnostic and therapeutic strategies for management of dizzy patients in Japan: Noriaki Takeda; Res Vestib Sci. 2025;24(1):1-9. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2025.001

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Abstract PDF: The present review summarized the recent advances in diagnostic and therapeutic strategies for management of dizzy patients in Japan. Standardization of diagnosis, examination, and treatment of vestibular disorders and nationwide epidemiological surveys of vestibular disorders are high-priority projects of Japan Society for Equilibrium Research (JSER). JSER published clinical practice guidelines for Ménière’s disease, delayed endolymphatic hydrops, benign paroxysmal positional vertigo, vestibular neuritis, vestibular test battery, and vestibular rehabilitation. JSER published a video library of vestibular testing and nystagmus and abnormal eye movements. JSER performed nationwide surveys of Ménière’s disease, delayed endolymphatic hydrops, and bilateral vestibulopathy. Visualization of endolymphatic hydrops in gadolinium-enhanced magnetic resonance imaging (MRI) was developed in Japan. MRI of endolymphatic hydrops becomes an indispensable tool to diagnose Ménière’s disease. The new surgical procedure of endolymphatic sac surgery with steroid instillation and middle ear pressure therapy with a Japanese device become new therapeutic strategies for intractable Ménière’s disease in Japan. Neural and pharmacological mechanisms of static vestibular compensation were revealed in Japan. Diazepam accelerates the initial process of static vestibular compensation and short-term administration with diazepam is recommended for the treatment of acute vertigo in patients with unilateral vestibulopathy. Betahistine accelerates the late process of static vestibular compensation and long-term administration with betahistine is recommended for the treatment of subacute vertigo in patients with unilateral vestibulopathy. Vestibular rehabilitation is effective in developing dynamic vestibular compensation and beneficial for improving chronic dizziness in patients with unilateral vestibulopathy. Vestibular rehabilitation with a Japanese vestibular substitution device is a promising strategy for chronic dizziness in patients with unilateral vestibulopathy.

Models for response dynamics of vestibular end organs: a review: Jeong‑Yoon Choi; Res Vestib Sci. 2025;24(1):10-19. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2024.027

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Abstract PDF: The vestibular end organs, consisting of the semicircular canals and otoliths, sense physical variables related to head motion and generate neural signals according to their response dynamics. Therefore, understanding the dynamics is a crucial first step in interpreting vestibular responses under both normal and pathological conditions. This review addresses the response dynamics of vestibular organs using transfer functions. While the semicircular canals and otoliths are originally modeled as second-order overdamped systems, they can be approximated as first-order systems, when considering the range of head motion frequencies typically encountered during daily activities. This review also discusses the clinical implications of time constants in the transfer functions. In both the semicircular canals and otoliths, the dominant time constants are determined by their viscous-to-elastic properties. By analyzing changes in these properties under pathological conditions, the resulting alterations in system responses can be predicted. Such efforts may contribute to bridging the gap between mathematical modeling and clinical understanding.

Preventive medical treatment of vestibular migraine: a practical review: Jae-Hwan Choi, Kwang-Dong Choi, Eun Hye Oh, Seo-Young Choi; Res Vestib Sci. 2025;24(1):20-26. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2024.024

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Abstract PDF: This review explores the medical treatment options for vestibular migraine (VM), focusing on preventive strategies and their evidence-based efficacy. VM, characterized by recurrent dizziness associated with migraine, requires tailored management due to its distinct clinical features and pathophysiology. Most VM treatments are derived from migraine management protocols, utilizing medications such as BBs, CCBs, and antiepileptic drugs. Meta-analyses revealed that flunarizine, propranolol, and venlafaxine significantly reduced vertigo frequency and Dizziness Handicap Inventory scores, although the evidence was limited by small sample sizes and methodological inconsistencies. Flunarizine showed benefits in reducing vertiginous episodes but was less effective for headache. Venlafaxine demonstrated additional improvements in depressive symptoms. Observational studies also indicated potential efficacy for propranolol and valproate. Emerging therapies, such as calcitonin gene-related peptide monoclonal antibodies, showed promise in improving both vestibular and headache symptoms in small-scale trials, though further evidence is needed to establish their role in VM management. The selection of preventive medications for VM should be individualized, considering both the frequency and severity of vestibular and headache symptoms, as well as patient comorbidities and preferences. While existing migraine protocols offer some guidance, the need for VM-specific treatment strategies remains critical.

Oculomotor manifestations in inflammatory central nervous system demyelinating diseases: a narrative review: Eun-Jae Lee; Res Vestib Sci. 2025;24(1):27-36. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2024.022

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Abstract PDF: Inflammatory central nervous system (CNS) demyelinating diseases are a group of disorders in which inflammation within the CNS damages the myelin sheath, a protective and conductive layer surrounding nerve fiber in the brain and spinal cord, leading to various neurological symptoms. Common conditions include multiple sclerosis and neuromyelitis optica spectrum disorders, both characterized by relapses and progressive deterioration over time. Given their frequent involvement of the brainstem and cerebellum, these diseases often manifest with oculomotor findings, such as ocular misalignment and instability, providing valuable insights into lesion localization within specific anatomical regions. Recent studies suggest that these findings may also indicate broader pathological burdens, including potential cortical damage, positioning them as potential early biomarkers for disease progression. This review explores oculomotor findings in patients with CNS demyelinating diseases, examining their characteristics, underlying mechanisms, and clinical significance. It also highlights the potential role of these findings as disease biomarkers.

Original Article

Seasonal variation in vestibular neuritis in Korea: a nationwide population-based cohort study: Chul-Young Yoon, Young Jun Seo, Ji-Yun Park; Res Vestib Sci. 2025;24(1):37-45. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2025.006

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Abstract PDF: Objectives
This study was performed to investigate seasonal variation in the incidence of vestibular neuritis (VN) without recent steroid treatments using nationwide health insurance data. The aim of the study is to elucidate whether seasonal trends can inform optimized diagnostic and treatment strategies for VN.
Methods
A retrospective analysis was conducted using data from the Health Insurance Review and Assessment Service (HIRA) in South Korea from 2007 to 2022. Patients diagnosed with VN were identified using specific operational criteria. Seasonal trends were evaluated by analyzing monthly, quarterly, and seasonal variations in VN incidence, stratified by age and sex.
Results
Out of 237,673 VN patients identified, our analysis revealed significant seasonal variations in incidence, with a notable decline during winter months—especially in February—and an increase during the spring. These patterns were consistent across sex and age groups.
Conclusions
This nationwide study demonstrates that VN exhibits distinct seasonal variations that have significant implications for clinical practice. These results indicate a potential influence of seasonal factors on the occurrence of VN and contribute to more efficient allocation of healthcare resources. Future prospective studies are warranted to further elucidate the mechanisms behind these seasonal differences.

Case Reports

Miller Fisher syndrome initially presented as bilateral internuclear ophthalmoplegia: a case report: Sanghyun Kim, Jusuck Lee, Daewoong Bae; Res Vestib Sci. 2025;24(1):46-49. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2024.028

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Abstract PDF: Miller Fisher syndrome can present with various forms of ophthalmoplegia. This case report describes a 57-year-old woman who initially showed bilateral internuclear ophthalmoplegia (INO), with normal imaging and laboratory findings. Her neurologic symptoms progressed to include hyporeflexia and ataxia, leading to a diagnosis of Miller Fisher syndrome. Intravenous immunoglobulin treatment resulted in gradual improvement. This case report highlights the need to consider rare conditions like Miller Fisher syndrome in patients with INO-like features and unclear etiology.

Gaze-holding nystagmus in chronic progressive external ophthalmoplegia: a case report: Eugene Jung, Seo-Young Choi, Jae Hwan Choi, Kwang-Dong Choi; Res Vestib Sci. 2025;24(1):50-53. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2025.005

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Abstract PDF Supplementary Material: We report a patient with chronic progressive external ophthalmoplegia (CPEO) who developed bilateral horizontal gaze-holding nystagmus, a previously unreported phenomenon. Video-oculography showed marked slowing of horizontal and vertical saccades, and bilateral horizontal gaze-evoked nystagmus with decreasing-velocity slow-phases waveforms. Horizontal rebound nystagmus was also observed. No abnormalities were identified in the brainstem or cerebellum on brain magnetic resonance imaging. A genetic analysis demonstrated a heterozygous missense mutation c.311A>G (p. D104G, rs28999114) in the SLC25A4 gene. Twitch motoneurons of the global layer receive inputs from premotor areas involved in the generation of eye movement, such as saccadic burst neurons, while non-twitch motoneurons of the orbital layer receive inputs from the medullary structures concerned with gaze-holding. In our patient with CPEO, the presence of omnidirectional ophthalmoplegia and bilateral horizontal gaze-holding nystagmus may indicate the involvement of the global layers of all extraocular muscles, as well as the orbital layers of the horizontal extraocular muscles.

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