Vestibular Disorders

Background: Recent research findings have improved the understanding of the diagnosis, pathophysiology, genetics, etiology, and treatment of peripheral, central, and functional vestibular vertigo syndromes. Method: A literature search, with special attention to the current classification, treatment trials, Cochrane analyses, and other meta-analyses. Results: There are internationally accepted diagnostic criteria for benign positional paroxysmal vertigo, Meniere's disease, bilateral vestibulopathy, vestibular paroxysmia, and functional dizziness. Whether an acute vestibular syndrome is central or peripheral can usually be determined rapidly on the basis of the history and the clinical examination. "Cerebellar vertigo" is a clinically important entity. For bilateral vestibulopathy, balance training is an effective treatment. For Meniere's disease, preventive treatment with betahistine (48 mg and 144 mg per day) is not superior to placebo. For vestibular paroxysmia, oxcarbazepine has been shown to be effective. Treatments that are probably effective for functional dizziness include vestibular rehabilitation, cognitive behavioral therapy, and serotonin reuptake inhibitors. Conclusion: The diagnostic assessment of vestibular syndromes is much easier for clinicians now that it has been internationally standardized. There is still a lack of randomized, controlled trials on the treatment of, for example, Meniere's disease, vestibular migraine, and "cerebellar vertigo."