Editorial: Challenges and Current Research Status of Vertigo/Vestibular Diseases, Volume III

Linglin Zhou¹Yujie Liu¹Yunxiao Zheng²Jian Xin¹Zixuan Yun³Shuhan Huang¹Nicolas Perez-Fernandez⁴Andrea Castellucci⁵Hubertus Axer⁶Sulin Zhang⁷Jun Wang^1*

• ¹Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
• ²Huazhong University of Science and Technology, Wuhan, China
• ³Shaanxi University of Chinese Medicine, Xianyang, China
• ⁴Universidad de Navarra, Pamplona, Spain
• ⁵Azienda Unita Sanitaria Locale - IRCCS Tecnologie Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
• ⁶Friedrich-Schiller-Universitat Jena, Jena, Germany
• ⁷Huazhong University of Science and Technology Tongji Medical College Union Hospital, Wuhan, China

Vertigo/vestibular diseases comprise a spectrum of clinical syndromes spanning peripheral and central etiologies, which significantly increase fall risk and substantially compromise patients' quality of life. This Research Topic collates 17 publications addressing the diagnosis, management, treatment, and pathophysiological mechanisms of prevalent vestibular pathologies, among others (Table 1). This field encompasses two studies on Benign Paroxysmal Positional Vertigo (BPPV). Xing et al. conducted a comparative analysis between supine roll test (SRT) and alternative positional tests for diagnosing horizontal semicircular canal BPPV (HSC-BPPV). Their analysis identified the reverse autorotation test (RART) as the most accurate tool, demonstrating significant advantages in nystagmus elicitation sensitivity and affected canal determination accuracy. Consequently, they recommend RART as the preferred alternative to SRT in clinical practice. The Tumarkin-like phenomenon refers to a transient vestibular crisis characterized by sudden dizziness, postural instability, and sensations of falling, which may occur during the final step of repositioning maneuvers for BPPV (1). Yang et al. explored the mechanisms and clinical significance of this phenomenon during the Epley and Semont maneuvers. Using virtual simulations and a literature review, their results indicated that in the Epley maneuver, the Tumarkin-like phenomenon frequently correlated with treatment failure, whereas in the Semont maneuver, it was typically associated with successful treatment. There are two studies focusing primarily on Ménière's disease (MD). Álvarez De Linera-Alperi et al. found that endolymphatic hydrops was more severe in the vestibule than cochlea in nearly 60% of cases, correlating with initial symptoms, but no significant differences in auditory or vestibular function tests during follow-up. This challenges the traditional cochleocentric progression theory and suggests a more complex pathophysiology of MD requiring further investigation. Persistent Postural-Perceptual Dizziness (PPPD) is a chronic functional vestibular disorder that commonly manifests secondary to acute or episodic vestibular syndromes. Yagi et al. demonstrated that patients with comorbid MD and PPPD exhibited more severe subjective symptoms relative to isolated MD. This evidence underscored the necessity of differentiating these conditions using clinical symptom scales, thereby enabling targeted therapeutic strategies specific to PPPD. This field includes two studies investigating acute vestibular syndrome (AVS). Kim et al. reported four cases of patients with selective otolith dysfunction presenting with acute spontaneous vertigo, a condition accounting for approximately 5% of AVS presentations yet easily overlooked. Comprehensive neurotologic evaluation combined with dedicated inner ear MRI facilitated detection of selective otolithic dysfunction, expanding the clinical spectrum of AVS. Furthermore, Acute audiovestibular syndrome (AAVS) is characterized by acute vertigo, tinnitus, aural fullness, or hearing loss persisting over 24 hours, which may result from benign inner ear disorders or posterior circulation strokes (2). Early differentiation is critical to minimize neurological sequelae and preserve auditory function. Kim et al. demonstrated that patients with anterior inferior cerebellar artery infarction exhibited bilateral positive video head impulse test (vHIT) more frequently than those with labyrinthitis, particularly among individuals with multiple vascular risk factors. Furthermore, two additional studies pertain to compensatory mechanisms of vestibular disorders. GABAergic neurons within medial vestibular nucleus (MVN) contribute to rebalancing of commissural system, thereby alleviating acute peripheral vestibular dysfunction syndrome (3, 4). However, the specific neural circuits providing synaptic input to these neurons remain unclear. Kong et al. identified 60 nuclei projecting to MVN GABAergic neurons in mice, primarily localized in the cerebellum and the medulla. Additionally, MVN GABAergic neurons were regulated by the contralateral MVN, lateral vestibular nucleus, superior vestibular nucleus, and inferior vestibular nucleus. These findings advance the understanding of vestibular dysfunction at the neural circuit level and may promote vestibular compensation strategies. Van Nechel et al. found that patients with bilateral vestibular deficiency (BVD) achieve functional gaze stability during active head movements by reducing head speed and utilizing predictive eye movements. The video Active Gaze Shift Test revealed compensatory mechanisms invisible to passive tests, offering insight into compensatory eye movements and symptom understanding. Additionally, four articles focus on Motion sickness (MS) and virtual reality (VR) in this topic. MS arises from vestibular dysfunction induced by sensory conflict between perceived and actual motion, manifesting as a constellation of autonomic and vestibular symptoms, including nausea, dizziness, vomiting, cephalalgia, and fatigue (5). Shi et al. demonstrated that two vestibular function training methods significantly alleviated MS symptoms. The electric rotating chair was superior to the visual-motion cage rotating chair in improving subjective discomfort. Subgroup analysis revealed that for low-susceptibility individuals, the electric rotating chair was more effective, while for high-susceptibility individuals, the visual motion cage rotating chair showed better improvement, indicating need for therapeutic individualization. Gálvez-García et al. reported that the combined application of transcutaneous vagus nerve stimulation (tVNS) and galvanic cutaneous stimulation (GCS) reduced simulator adaptation syndrome (SAS) symptoms more effectively than either intervention alone, suggesting a novel strategy for SAS management. Visually induced motion sickness (VIMS) has increased following the widespread adoption of VR. Wang et al. found that VR-based spatial cognition training significantly improved spatial abilities and reduced VIMS symptoms in the experimental group, with no improvement observed in controls. Guo et al. investigated the impact of age on spatial abilities across genders using VR technology, providing insights for occupational preference stratification. Moreover, within this topic, three articles center on dizziness. Cervicogenic dizziness (CGD), a debated clinical entity characterized by dizziness associated with cervical pain or dysfunction, arises from altered proprioceptive input originating in the cervical spine (6). De Hertogh et al. conducted a perspective review of CGD, covering its pathophysiology, diagnostic challenges, and therapeutic strategies. In Traditional Chinese Medicine, qi-blood deficiency is the dominant pattern of CGD, resulting in brain-marrow malnourishment and often accompanied by anxiety or depression. To rigorously evaluate a potential therapeutic intervention, Hou et al. conducted a research protocol aiming to determine the efficacy and safety of three-needle regulating the mind combined with umbilical needle (TNRM-UN) therapy for CGD patients with qi-blood deficiency. What’s more, Liang et al. demonstrated significant associations between homocysteine levels, hyperhomocysteinemia, and H-type hypertension with various symptomatic dizziness. Consequently, early detection and management of hyperhomocysteinemia and H-type hypertension are crucial for dizziness management and diagnosis. Perilymphatic Fistula (PLF) is an inner ear disorder involving abnormal leakage of perilymph into the middle ear. Currently, the diagnosis of PLF lacks internationally established criteria and relies on clinical assessment and functional testing. To address this gap, Situkho et al. developed a research protocol designed to systematically evaluate the accuracy of diagnostic tests for PLF. Complementarily, Strupp et al. performed a standardized survey across 188 international centers, revealing substantial heterogeneity in managing six peripheral vestibular disorders. These findings underscore substantial evidence gaps and highlight the urgent need for standardized therapeutic protocols supported by well-designed controlled trials to establish evidence-based care. In summary, this Research Topic assembles a series of articles on vertigo or vestibular diseases, delineating recent advances in the field to pave the way for the development of novel therapeutic and management strategies for these disorders.