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Abstract Background Vertigo is a common presenting symptom in clinical practice, predominantly of vestibular etiology, and often medicated with betahistine, despite the lack of knowledge concerning its mechanism of action. This paper’s objective was to review the scientific evidence regarding the efficacy of betahistine on peripheral vertigo. Methods A systematic search of articles written in English, published within the past 10 years, was conducted in April 2024, on online evidence-based medicine databases, using the MeSH terms “betahistine,” “ménière disease,” “acute vestibular neuritis,” “paroxysmal vertigo,” “acute peripheral vestibulopathy,” and “labyrinthitis.” The Strength of Recommendation Taxonomy of the American Academy of Family Physicians was used to evaluate the level of evidence and strength of recommendation. Results This review included 12 articles for evidence analysis. Concerning Menière’s disease, despite contradictory results, three of the articles analyzed showed a positive effect of betahistine, which is in line with the recommendations of the European Academy of Otology and Neurotology and NICE guidelines, while the American Academy of Otorhinolaryngology guidelines suggest offering betahistine as maintenance therapy. For benign paroxysmal positional vertigo, the established treatment is repositioning maneuvers, and three of the five studies analyzed proved the addition of betahistine to be beneficial. In regard to peripheral vertigo from other causes, two out of three articles revealed a positive recommendation for the use of betahistine. Conclusion There is a potential benefit to the utilization of betahistine for various etiologies of peripheral vertigo. However, additional studies are required to establish more robust evidence.

Background: Vertigo is a common presenting symptom in clinical practice, predominantly of vestibular etiology, and often medicated with betahistine, despite the lack of knowledge concerning its mechanism of action. This paper's objective was to review the scientific evidence regarding the efficacy of betahistine on peripheral vertigo. Methods: A systematic search of articles written in English, published within the past 10 years, was conducted in April 2024, on online evidence-based medicine databases, using the MeSH terms "betahistine," "ménière disease," "acute vestibular neuritis," "paroxysmal vertigo," "acute peripheral vestibulopathy," and "labyrinthitis." The Strength of Recommendation Taxonomy of the American Academy of Family Physicians was used to evaluate the level of evidence and strength of recommendation. Results: This review included 12 articles for evidence analysis. Concerning Menière's disease, despite contradictory results, three of the articles analyzed showed a positive effect of betahistine, which is in line with the recommendations of the European Academy of Otology and Neurotology and NICE guidelines, while the American Academy of Otorhinolaryngology guidelines suggest offering betahistine as maintenance therapy. For benign paroxysmal positional vertigo, the established treatment is repositioning maneuvers, and three of the five studies analyzed proved the addition of betahistine to be beneficial. In regard to peripheral vertigo from other causes, two out of three articles revealed a positive recommendation for the use of betahistine. Conclusion: There is a potential benefit to the utilization of betahistine for various etiologies of peripheral vertigo. However, additional studies are required to establish more robust evidence. [ABSTRACT FROM AUTHOR]

Introduction: Video head-impulse tests (video-HITs) often fail to detect anterior inferior cerebellar artery (AICA) infarction due to peripheral and central vestibular system involvement. Anecdotal studies suggest that video-HITs may reveal bilateral impairment in AICA infarction. However, the diagnostic utility of videoHITs has not been established, particularly when compared to labyrinthitis, which accounts for the majority of acute audiovestibular syndrome (AAVS) cases. Methods: We reviewed the medical records of consecutive patients presenting with new-onset acute hearing loss and spontaneous vertigo (i.e., AAVS) between March 2018 and July 2023 at a tertiary hospital in South Korea. Video-HIT patterns were categorized as follows: (1) ipsilaterally positive, (2) contralaterally positive, (3) bilaterally normal, and (4) bilaterally positive. Results: Twenty-eight patients with AICA infarction (mean age±standard deviation  =  67±15  years; 14 men) and 51 with labyrinthitis (63±17  years, 26 men) were included in the analyses. Among the 28 patients with AICA infarction, 15 presented with AAVS in isolation, without other co-morbid neurologic deficits (15/28, 54%). The vestibulo-ocular reflex (VOR) gains of ipsilesional horizontal canals (HCs) ranged from 0.21 to 1.22 (median  =  0.81, interquartile range [IQR]  =  0.50–0.89). However, those for contralateral HC gain ranged from 0.57 to 1.19 (median  =  0.89 [IQR  =  0.73–0.97]). Collectively, HITs were bilaterally positive in 13 patients (including 12 patients with bilaterally positive HITs for the horizontal canal), normal in eight, ipsilesionally positive in six, and contralesionally positive in one patient with AICA infarction. The VOR gains were typically decreased ipsilaterally in 28 (28/51, 55%), normal in 17 (17/51, 33%), and decreased bilaterally in six patients with labyrinthitis (6/51, 12%). Logistic regression analysis revealed that bilaterally positive HITs (p  =  0.004) and multiple vascular risk factors (p  =  0.043) were more frequently associated with AICA infarction than labyrinthitis. Discussion: Among patients presenting with AAVS, bilaterally positive HITs can be indicative of AICA infarction in patients with multiple vascular risk factors. [ABSTRACT FROM AUTHOR]

Labyrinthitis ossificans is the formation of pathological new bone within the membranous labyrinth of the inner ear due to various local and systemic pathologies. Most commonly it occurs as a sequelae of meningitis spreading to the labyrinth, from the subarachnoid space via the cochlear aqueduct and the internal auditory canal. We are comparing three different etiological presentations of labyrinthitis ossificans; namely, tympanogenic, meningitic, and traumatic, together with their management in the light of recent advances.

Abstract Objective To expand our understanding of the pathophysiological mechanisms underlying vestibular neuritis and labyrinthitis by identifying any difference in the vestibulo‐ocular reflex for each semicircular canal. Study Design Retrospective analysis. Setting The Department of Otorhinolaryngology – Head and Neck Surgery, Chosun University Hospital, from January 2015 to December 2021. Methods We included 23 vestibular neuritis and 27 labyrinthitis patients who had been hospitalized. Pure‐tone audiometry, a bithermal caloric test, and a video head‐impulse test were performed within 5 days of symptom onset. Results In the vestibular neuritis group, mean vestibulo‐ocular reflex gains were decreased to 0.51 in the ipsilesional horizontal canal and 0.55 in anterior canal, leading to marked asymmetry, whereas the gain of the ipsilesional posterior canal was relatively preserved at 0.85. In the labyrinthitis group, the mean vestibulo‐ocular reflex gain was 0.72 in the ipsilesional horizontal canal, 0.73 in the ipsilesional anterior canal, and 0.55 in the ipsilesional posterior canal. We observed statistical differences in the vestibulo‐ocular reflex gain and incidence of corrective saccades on the ipsilesional side in three semicircular canals between the groups (p = .002 for horizontal canal, p = .003 for anterior canal, and p

Labyrinthitis ossificans is the formation of pathological new bone within the membranous labyrinth of the inner ear due to various local and systemic pathologies. Most commonly it occurs as a sequelae of meningitis spreading to the labyrinth, from the subarachnoid space via the cochlear aqueduct and the internal auditory canal. We are comparing three different etiological presentations of labyrinthitis ossificans; namely, tympanogenic, meningitic, and traumatic, together with their management in the light of recent advances. [ABSTRACT FROM AUTHOR]

Labyrinthitis ossificans is the formation of pathological new bone within the membranous labyrinth of the inner ear due to various local and systemic pathologies. Most commonly it occurs as a sequelae of meningitis spreading to the labyrinth, from the subarachnoid space via the cochlear aqueduct and the internal auditory canal. We are comparing three different etiological presentations of labyrinthitis ossificans; namely, tympanogenic, meningitic, and traumatic, together with their management in the light of recent advances. [ABSTRACT FROM AUTHOR]

BACKGROUND: Labyrinthitis is an inner ear disorder of unknown incidence, characterized by sudden hearing loss and concurrent vertigo. Cohort studies of patients diagnosed with labyrinthitis are nonexistent. This study aims to describe the clinical characteristics and prognosis of patients diagnosed with idiopathic labyrinthitis. METHODS: Patients with labyrinthitis in the absence of a clear viral, bacterial, or autoimmune pathogenesis were retrospectively identified from electronic patient files. Symptoms at presentation and results from vestibular testing were retrieved. The 9-item Vestibular Activity Avoidance Instrument, administered during follow-up interviews by telephone, was used to assess the presence of persistent balance problems and activity avoidance behavior. RESULTS: Sixty-one patients with idiopathic labyrinthitis were included. All patients had vestibular weakness at presentation. After a median of 61 months of follow-up (interquartile range 81), 72.5% of patients still experienced balance problems. Subjective hearing recovery only occurred in 20% of cases. CONCLUSION: Patients presenting in a tertiary dizziness clinic with idiopathic labyrinthitis have a poor prognosis for both hearing and balance function impairment. Prospective observational cohorts are required to establish objectifiable vestibular and audiological follow-up data. [ABSTRACT FROM AUTHOR]

Objective: To characterize our experience with super-absorbent polymer beads placed in the external auditory canal to better understand the damage caused and subsequent management required. Methods: Retrospective chart review of pediatric patients at 2 separate tertiary referral centers. Results: Seven patients were identified as having placed super-absorbent polymer beads in the external auditory canal, 6 of whom required removal under general anesthesia. Three patients did not suffer otologic trauma or hearing loss (average foreign body duration <72 hours). Four patients experienced severe otologic complications (average foreign body duration >1 week), all of whom were treated with otologic drops prior to bead identification. Of this severe complication group, 3 patients had restored hearing after surgical intervention, while 1 patient suffered profound hearing loss secondary to labyrinthitis ossificans. Conclusion: Early recognition of otologic foreign bodies is important, particularly if expansile water-bead is suspected. Depending on timeframe, water beads are highly destructive to the middle ear structures, and most patients will require surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: To expand our understanding of the pathophysiological mechanisms underlying vestibular neuritis and labyrinthitis by identifying any difference in the vestibulo‐ocular reflex for each semicircular canal. Study Design: Retrospective analysis. Setting: The Department of Otorhinolaryngology – Head and Neck Surgery, Chosun University Hospital, from January 2015 to December 2021. Methods: We included 23 vestibular neuritis and 27 labyrinthitis patients who had been hospitalized. Pure‐tone audiometry, a bithermal caloric test, and a video head‐impulse test were performed within 5 days of symptom onset. Results: In the vestibular neuritis group, mean vestibulo‐ocular reflex gains were decreased to 0.51 in the ipsilesional horizontal canal and 0.55 in anterior canal, leading to marked asymmetry, whereas the gain of the ipsilesional posterior canal was relatively preserved at 0.85. In the labyrinthitis group, the mean vestibulo‐ocular reflex gain was 0.72 in the ipsilesional horizontal canal, 0.73 in the ipsilesional anterior canal, and 0.55 in the ipsilesional posterior canal. We observed statistical differences in the vestibulo‐ocular reflex gain and incidence of corrective saccades on the ipsilesional side in three semicircular canals between the groups (p =.002 for horizontal canal, p =.003 for anterior canal, and p <.001 for posterior canal). The receiver operating characteristic curve showed that pure‐tone audiometry, ipsilesional posterior canal gain, and gain asymmetry of posterior canal were excellent parameters for distinguishing labyrinthitis from vestibular neuritis. Conclusion: Vestibular neuritis and labyrinthitis patients have different degrees and patterns of video head‐impulse test involvement in the three semicircular canals, suggesting that the two distinct disorders may have different etiologies. [ABSTRACT FROM AUTHOR]

COVID-19 is a disease caused by a new type of SARS virus. COVID-19 clinical symptoms are primarily related to the respiratory system but may also be involved in many others, including the nervous system. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be an aetiological factor responsible for balance disorders. Symptoms such as vertigo may coexist with other symptoms or be an isolated manifestation of the disease. Among other balance dysfunctions associated with COVID-19 are BBPV (benign paroxysmal positional vertigo), vestibular neuritis, acute labyrinthitis, acute cerebellitis, as well as Ménière’s disease. MRI, Videonystagmographic (VNG) and the Dix-Hallpike test are used to make a diagnosis. Improvements were observed after treatment with oral corticosteroids and vestibular physiotherapy along with intratympanic injection of dexamethasone. Antiemetics, antihistamines, anti-cholinergics and benzodiazepines drugs may be helpful in relieving symptoms. In addition, drugs used in scheduled treatment of COVID-19, such as azithromycin and hydroxychloroquine, may cause balance disorders due to their potential side effects. The following article presents cases of COVID-positive patients with balance disorders. The aim of this article was to raise awareness that nonspecific symptoms such as balance disorders may be the only manifesta-tion of COVID-19, which is important due to early diagnosis and administration of treatment.

Objective: This study aimed to determine anatomical landmarks for accurate and safe middle turn cochleostomy on cadaveric temporal bones. Methods: In 17 cadaveric wet adult temporal bones, cortical mastoidectomy was performed, followed by extended posterior tympanotomy through which a middle turn opening was created anterior to the stapes footplate. Micro-measurements of various lengths were taken from the cochleostomy to normal middle-ear anatomical landmarks using a digital microscope. Results: The mean length from the middle turn cochleostomy to the processus cochleariformis was 1.8 ± 0.3 mm and to the tympanic segment of the facial nerve was 2.2 ± 0.3 mm. The mean shortest length from the oval window to the osseous spiral lamina was 2.4 ± 0.3 mm and to the internal carotid artery was 5.0 ± 0.6 mm. The mean shortest length from the round window to the internal carotid artery was 4.3 ± 0.6 mm. Conclusion: A middle turn cochleostomy can be safely drilled by using the measured lengths in difficult cases. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyse whether referral for specialist balance testing influences diagnosis and management of patients with dizziness. Method: This was a retrospective study examining patients referred for vestibular function testing between 1 January 2018 and 30 June 2018. Results: A total of 101 patients were referred, with 69 patients (68.3 per cent) receiving a preliminary 'pre-vestibular function testing balance diagnosis', which included benign paroxysmal positional vertigo (32.7 per cent), Ménière's disease (13.8 per cent) and migraine (14.9 per cent). Following vestibular function testing, revised diagnoses were achieved for 54 patients (53.5 per cent), including benign paroxysmal positional vertigo (14.9 per cent), Ménière's disease (3.0 per cent) and migraine (10.9 per cent). Pre-vestibular function testing balance diagnoses were confirmed for 32.4 per cent of patients. If no pre-vestibular function testing suspected diagnosis was provided, vestibular function testing was significantly more likely to be inconclusive. Following vestibular function testing, 38.6 per cent were discharged, 21.7 per cent were referred to another specialty and treatment was commenced for 17.8 per cent of patients. Conclusion: Referral for vestibular function testing has a role when attempting to answer a clear clinical question. Diagnosing the underlying aetiology of complex imbalance is challenging, but diagnosis can be assisted by judicious use of vestibular function testing. [ABSTRACT FROM AUTHOR]

Abstract Background COVID-19 is the new version of the old coronavirus known since 1960, which caused the Middle East respiratory syndrome (MERS-CoV) in 2012 and the severe acute respiratory syndrome (SARS) in 2003. Symptoms included fever and cough, diarrhea and vomiting, and neurological symptoms like anosmia. Methods One hundred twenty-eight patients diagnosed as COVID-19 with audio-vestibular complaints were subjected to audio-vestibular assessment and were included in the study. Results In our study on COVID-19 patients who reported audio-vestibular complaints, hearing loss was found in 43.8% of patients in comparison to vertigo that represented 40.6% of cases. The most common type was sensorineural hearing loss representing 29.7% of patients and which was unilateral and sudden in 35.7% of them. Less commonly conductive hearing loss (CHL) was found in 14.1% of cases the most common form was bilateral mild to moderate CHL (83.3%) due to bilateral middle ear effusion. Among cases with vertigo, the most common etiology was benign paroxysmal positional vertigo (BPPV) (42.5%) then uncompensated vestibular neuritis (VN) (31.5%), and lastly, combined BPPV with VN (25%) of cases. Less frequently we found tinnitus in (13.3%) which was bilateral in (64.7%), labyrinthitis (5.5%), and acute VN 5.5%). The significant increase in the number of audiovestibular complaining cases that were observed in the course of the recurrent waves’ peaks pushed us to study the relationship between the pandemic and the audiovestibular system. The effect of COVID on AV systems is well noticed and management would be mandatory.

Sudden sensorineural hearing loss (SSNHL) is an otologic emergency. Sensorineural hearing loss needs to be distinguished from conductive when patients present with sudden hearing loss at the primary care level. Prompt diagnosis of sensorineural hearing loss with pure tone audiometry and immediate treatment by an otolaryngologist can improve the hearing outcome. To date, few case reports exist about SSNHL among post-COVID-19 patients, and none were reported in Malaysia. Here, we present two cases of SSNHL in patients after COVID-19 infection. We wish to highlight the association of SSNHL following COVID-19 infection for timely referral towards better audiology outcomes. Permanent hearing loss will lead to another negative impact on the long-term quality of life of COVID-19 patients.

We report magnetic resonance imaging (MRI) in a case with otosyphilis, which is a rare manifestation of neurosyphilis. A 50-year-old male presented with progressive hearing loss on the left side and recent-onset palsy of the left 7th and 12th cranial nerves. Computed tomography imaging showed destructive bone lesions involving the petrous temporal bone, middle ear, and mastoid region with a pathognomonic pattern of bone destruction depicted in the volume rendering technique images. MRI showed features of destructive bone lesions (gummatous lesion), meningoneuritis, and labyrinthitis. Pathological examination and treponemal antibody absorption test favored the diagnosis. Otosyphilis should be considered as a differential diagnosis in an adult patient with destructive lesions of the petrous temporal bone. To the best of our knowledge, MRI in otosyphilis has not been reported.

Background: Intra-aural tick infestations, though uncommon, pose a serious clinical challenge owing to the risk of acute labyrinthitis-an inflammatory condition of the inner ear. This inflammation can lead to severe complications such as sensorineural hearing loss, vertigo, and facial nerve palsy. Prompt recognition and management are crucial to prevent these adverse outcomes., Case Presentation: A 21-year-old female patient of Limbu ethnicity from Dharan presented with sudden-onset right-sided otalgia, accompanied by vertigo, emesis, and auditory impairment. Otoscopic examination revealed a tick lodged in the anteroinferior aspect of the external auditory canal, and audiological assessment indicated profound sensorineural hearing loss on the affected side. Treatment involved careful tick removal using suction and forceps, supplemented by pharmacotherapy including antiinflammatory agents, analgesics, systemic steroids, and prophylactic antibiotics. Her symptoms resolved completely within 4 weeks, with postinterventional audiometry confirming restored auditory acuity., Conclusion: This case underscores the importance of prompt clinical assessment and treatment in cases of aural tick infestation. The successful use of a multimodal approach highlights the effectiveness of comprehensive management. Further research is warranted to optimize treatment strategies and improve outcomes in similar cases., Competing Interests: Declarations. Ethics approval and consent to participate: Not required. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Competing interests: None., (© 2025. The Author(s).)

Labyrinthitis ossificans is a pathology consisting of calcification of the membranous labyrinth resulting in profound sensory deafness. It is usually due to an acute inflammatory process that progresses to ossification of the labyrinth. The clinical manifestations are irreversible hearing loss, dizziness and vomiting. It is diagnosed by computed tomography (CT) and magnetic resonance imaging (MRI). It is important to make the correct diagnosis before cochlear implantation, as ossification of the labyrinth can hinder or prevent the implantation of electrodes., (Universidad Nacional de Córdoba)

Resumen: Los pacientes con hipoacusia aguda o subaguda no resuelta tras el desarrollo de un cuadro infeccioso o inflamatorio del oído medio, precisan de una atención temprana, integrada y multidisciplinar, junto con el equipo de especialistas en otorrinolaringología, centrando este caso clínico en las consideraciones relevantes a la prevención y abordaje tempranos de la laberintitis aguda. La divulgación de este caso tiene como objetivo recordar a los profesionales la existencia de este proceso para evitar sus posibles secuelas y daños incapacitantes de forma permanente. Abstract: Acute or subacute unresolved hearing loss linked to an infectious or inflammatory condition of the middle ear needs early, integrated and multidisciplinary care. Authors stressed the utmost importance of prevention and early management of acute labyrinthitis. The disclosure of this case aims to remind health care providers the existence of this process to avoid sequelae and permanent and disabling damages.

A 47‐year‐old woman presented with the complaint of sudden hearing loss associated with vertigo. Serological testing was positive for IgM and negative for IgG COVID‐19 antibodies, with no other associated factors. Magnetic resonance imaging of the brain showed bilateral intralabyrinthine hemorrhage. This is a rare case of bilateral intralabylinthine hemorrhage after COVID‐19 infection. The mechanism is unclear, but clinicians should keep this case in mind when you see sudden hearing loss with vertigo, and early intervention should be considered. [ABSTRACT FROM AUTHOR]