Education Hub
Comprehensive vestibular medicine education for clinicians and patients
Vestibular Education Resources
A library of vestibular medicine resources — organised by who you are, not by pathology. Select your audience below to go straight to the content pitched at the right depth for you.
Most common conditions (7)
▼BPPV (Benign Paroxysmal Positional Vertigo)
One of the most common causes of vertigo. Brief spinning episodes triggered by head movements, caused by tiny crystals shifting in the inner ear. Highly treatable with simple repositioning manoeuvres.
Vestibular Migraine
A type of migraine that causes dizziness and vertigo. The most common vestibular condition we treat, and very manageable with the right approach.
Ménière's Disease
An inner ear condition causing vertigo attacks, hearing changes, and ringing in the ear. Manageable with diet, medication, and other treatments.
Vestibular Neuritis
A sudden episode of severe dizziness caused by a viral infection affecting the balance nerve. Recovery is usually good, and rehabilitation speeds it up.
Labyrinthitis
An inner ear infection causing dizziness and hearing changes. Most people recover fully with treatment and rehabilitation.
Post-Concussion Dizziness
Ongoing dizziness or unsteadiness after a concussion or head injury. It is common and real, often has more than one cause at once, and usually improves with the right, paced treatment.
Motion Sickness
Feeling sick in cars, boats, planes, on fairground rides, or from screens and virtual reality. It is a normal, very common and often inherited tendency — not a disease — and there is a lot that helps, from simple measures to medicines and gradual exposure that retrains the brain.
Moderately common conditions (10)
▼POTS (Postural Orthostatic Tachycardia Syndrome)
A condition where the heart races on standing, causing dizziness, lightheadedness and fatigue — common in young people and often after a viral illness. It is not dangerous, and it usually improves with fluids, extra salt, compression garments and a carefully paced return to exercise.
Orthostatic Hypotension
Feeling dizzy, lightheaded or faint when you stand up, caused by a brief drop in blood pressure. It is common, especially as we get older, usually not serious, and there is a lot that helps — from drinking more water and standing up slowly to simple medicines.
Mal de Débarquement Syndrome
A constant feeling of rocking or swaying — like still being on a boat — that often begins after a cruise or long trip. It is real and not dangerous, and usually improves with understanding and specialist balance retraining.
Visually Induced Dizziness
Dizziness or unsteadiness brought on by busy, moving visual surroundings — supermarket aisles, scrolling screens, traffic and patterned floors. It is real and common, and usually improves with gentle, gradual practice in those environments.
Bilateral Vestibulopathy
Reduced balance function in both inner ears, causing unsteadiness and blurred vision when moving. Balance retraining helps most people improve.
Brainstem Stroke & TIA
Dizziness can occasionally be a warning sign of a stroke or 'mini-stroke'. Sudden, severe or unusual symptoms need urgent medical attention.
Age-Related Balance Decline (Presbystasis)
A gradual loss of balance with ageing, as the inner-ear balance organs, the eyes and the position sensors in the legs all weaken together. It is common and not a stroke or anything sinister, and balance can be retrained — exercise such as Tai Chi, eye and hearing checks, a medicine review and home safety all lower the risk of falling.
Frequent Falls in Older Age
Falls become more common with age, usually because several small problems add up at once — the inner-ear balance system, eyesight, leg strength and sensation, blood pressure and some medicines. They are not just 'part of getting old', and most falls are preventable: balance and strength exercise, a medicine review, eye and home-safety checks, and treating any dizziness all lower the risk.
Cervicogenic Dizziness (Neck-Related Dizziness)
Dizziness and unsteadiness that comes from the neck rather than the inner ear, often together with neck pain or stiffness. It is diagnosed once other causes have been ruled out, and usually settles with hands-on neck treatment and balance exercises over a few months.
Balance Problems from Nerve Damage (Sensory Ataxia)
When the nerves that sense the position of your feet and legs are damaged — often from diabetes or other conditions — your balance suffers, especially in the dark or on uneven ground. Treating the cause, balance retraining, good footwear and simple home-safety steps all help reduce unsteadiness and falls.
Less common conditions (6)
▼Drug-Induced Vestibular Toxicity & Ataxia
Some medications can affect the inner ear or balance pathways, causing unsteadiness. Speak with your doctor before changing any medication.
Multiple Sclerosis
A condition affecting the brain and spinal cord that can cause dizziness, unsteadiness, and vision that seems to jump.
Superior Canal Dehiscence (SCD)
A condition where a small opening in the bone of the inner ear causes sensitivity to sound and pressure, and sometimes dizziness.
Vestibular Paroxysmia
Very brief, repeated spells of spinning caused by a blood vessel pressing on the balance nerve. Usually treatable with medication.
Cerebellar Ataxia
A condition affecting the part of the brain that controls balance and coordination, causing unsteadiness and clumsiness.
Ramsay Hunt Syndrome
A shingles infection affecting the ear that can cause vertigo, hearing changes, and facial weakness. Early treatment improves recovery.
Rare conditions (3)
▼Autoimmune Inner Ear Disease
A condition where the body's immune system affects the inner ear, causing dizziness and changes in hearing. It often responds well to treatment.
Enlarged Vestibular Aqueduct
A condition present from birth where a small channel in the inner ear is wider than usual, which can affect hearing and balance.
Arnold Chiari Malformation
A condition where the lower part of the brain sits slightly lower than usual, which can cause dizziness, headache, and balance problems.
1. Taking a dizziness history
A structured history is the single most useful diagnostic tool in dizziness. The TiTrATE approach — Timing, Triggers, Associated symptoms, Targeted Examination — distinguishes episodic vs continuous patterns, and spontaneous vs triggered vertigo. Most dizziness diagnoses are made from history alone.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
2. Bedside examination of the dizzy patient
Every dizzy patient needs: HINTS (Head Impulse, Nystagmus characterisation, Test of Skew), a Dix-Hallpike if positional vertigo is suspected, orthostatic blood pressure, and a focused neurological exam. A central HINTS pattern — normal head impulse, direction-changing nystagmus, or skew deviation — in an actively vertiginous patient is a red flag for posterior circulation stroke. This pattern is more sensitive for stroke than early MRI.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
3. Acute vertigo — identifying stroke risk
The acute vestibular syndrome (continuous vertigo >24 hours with nausea and unsteadiness) is vestibular neuritis in ~75% of cases, but up to 25% is posterior circulation stroke. ABCD2 score, HINTS, and vascular risk factors guide workup. Isolated vertigo can be the only stroke symptom, particularly with AICA or PICA territory infarcts.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
4. BPPV
BPPV causes brief episodes of positional vertigo (seconds, not minutes) triggered by head position changes — rolling over, lying flat, looking up. Diagnosis is by Dix-Hallpike (posterior canal, ~85% of BPPV) or supine roll test (lateral canal). Treatment is the Epley manoeuvre, effective in 80–90% after one to two treatments.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
5. Vestibular migraine
The most commonly missed vestibular diagnosis. Vestibular migraine causes episodic vertigo lasting minutes to days, often without headache during vertigo episodes. Triggers mirror migraine triggers (sleep, stress, hormonal cycle, specific foods). Diagnostic criteria (ICHD-3 / Bárány Society) require ≥5 episodes and a personal or family history of migraine.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
6. Vestibular neuritis & labyrinthitis
Acute peripheral vertigo lasting days, with unidirectional horizontal nystagmus, abnormal head impulse test to the affected side, and no hearing change (neuritis) or with hearing loss/tinnitus (labyrinthitis). Management is short-course corticosteroids within 72 hours, anti-emetics for 48–72 hours ONLY, and early vestibular rehabilitation within the first week — prolonged vestibular suppressants delay central compensation and are the single commonest management error.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
7. Ménière's disease
Triad of episodic vertigo (20 minutes to 12 hours), fluctuating low-frequency sensorineural hearing loss, and tinnitus / aural fullness in the affected ear. Diagnosis is clinical by Bárány Society 2015 criteria; an audiogram capturing low-tone SNHL on the affected side is the single most useful objective test. First-line management is lifestyle (low-salt diet, reduce caffeine and alcohol) plus betahistine and a thiazide diuretic. Escalation includes intratympanic dexamethasone, intratympanic gentamicin, and surgical options for refractory disease.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
8. PPPD (chronic functional dizziness)
Persistent Postural-Perceptual Dizziness presents as chronic non-spinning dizziness, unsteadiness, or non-vertiginous unsteadiness lasting ≥3 months. Exacerbated by upright posture, active or passive motion, and visually complex environments. Often triggered by a preceding vestibular event. Treatment is vestibular rehabilitation, SSRIs/SNRIs, and cognitive-behavioural therapy — not vestibular suppressants.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
9. Orthostatic & medication-related dizziness
Non-vertiginous dizziness on standing, often described as lightheadedness or pre-syncope. Active stand test: drop >20 mmHg systolic or >10 mmHg diastolic within 3 minutes (and check at 1, 3, 5, 10 min — single 1-minute readings miss initial and delayed OH). Five distinct syndromes — initial OH, classical OH, delayed OH, neurogenic OH, and POTS — distinguished by timing and HR response. Common culprits include antihypertensives, alpha-blockers, tricyclics, antipsychotics, opioids, and PDE-5 inhibitors. Autonomic causes (diabetic neuropathy, Parkinsonism, multi-system atrophy) need expert input.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
10. Dizziness in the elderly / falls
Dizziness in older adults is typically multifactorial — peripheral vestibular loss, orthostatic hypotension, polypharmacy, visual impairment, and lower-limb proprioceptive loss all contribute. Presbyvestibulopathy (age-related bilateral vestibular hypofunction) is a recognised diagnosis. A Timed Up & Go >12 seconds or inability to tandem stand for 10 seconds predicts falls risk.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
11. Sudden sensorineural hearing loss with vertigo
A true emergency. Sudden sensorineural hearing loss (>30 dB over 3 contiguous frequencies within 72 hours), particularly when accompanied by vertigo, requires urgent audiometry and high-dose oral corticosteroids within 72 hours for best outcome. Vertigo with SNHL narrows differential to labyrinthitis, vestibular schwannoma, or AICA territory stroke.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
12. Post-concussive dizziness
Dizziness is present in 30–60% of patients after mild traumatic brain injury. Common mechanisms include BPPV (check Dix-Hallpike in every post-concussive patient), vestibular migraine, cervicogenic contribution, and PPPD. Prolonged rest worsens outcomes — early supervised vestibular rehabilitation is now standard of care.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
13. Visual-induced dizziness
Dizziness, unsteadiness, or disorientation provoked by complex visual environments — supermarket aisles, crowds, scrolling screens, patterned carpets, highway driving. A key feature of PPPD and vestibular migraine, but also an independent presentation. Measured by the Visual Vertigo Analogue Scale (VVAS). Often missed because examination is normal between episodes.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
14. Referral pathways
The structured pathway turns "dizziness referral" into a precise clinical question matched to the right provider, in the right timeframe, with the right information. Three structural problems drive Australian referral inefficiency: no owning specialty, oversubscribed public outpatients, and uneven training in the bedside vestibular exam. Median time-to-diagnosis exceeds 18 months — most of that is referral inefficiency, not diagnostic difficulty. The single highest-yield change is to refer fewer patients, more selectively, based on the syndrome, not the symptom.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
2.1 Anatomy, Physiology, Embryology and Phylogeny of the Vestibular System
▼Before we can understand what goes wrong in vestibular disorders, we need to understand what the system looks like, how it works, how it forms, and where it came from. This section builds that foundation — from microscopic anatomy through to evolutionary origins.
Anatomy of the Vestibular System
The complete structural architecture of the inner ear — semicircular canals, otolith organs, membranous and bony labyrinths, vestibular nerve divisions, and central projections.
▶ Clinician Videos (10)
🎧 Clinician Audio (10)
Physiology of the Vestibular System
How the vestibular labyrinth converts motion into neural signals — hair cell transduction, canal mechanics, VOR circuitry, central processing, and the physiological basis of every clinical test.
▶ Clinician Videos (20)
🎧 Clinician Audio (20)
Anatomy and Physiology of the Vestibulo-Cerebellum
The flocculus, nodulus, and uvula as the brain's adaptive controller — VOR gain tuning, velocity storage regulation, cerebellar vestibular syndromes, and why cerebellar lesions mimic peripheral vertigo.
▶ Clinician Videos (5)
🎧 Clinician Audio (10)
Embryology of the Vestibular System
Development of the inner ear from otic placode to mature labyrinth — otocyst formation, semicircular canal morphogenesis, hair cell differentiation, innervation pathways, and congenital malformations as developmental timestamps.
▶ Clinician Videos (5) — coming soon
🎧 Clinician Audio (5)
Phylogenetic Development of the Vestibular System
Evolution of balance sensing from choanoflagellate mechanosensors and invertebrate statocysts through jawless fish, the gnathostome revolution, land conquest, avian flight mastery, and mammalian refinements — ending with evolutionary explanations for BPPV, motion sickness, and presbyvestibulopathy.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
2.2 Clinical Assessment of the Dizzy Patient
▼Having explored the fundamentals of vestibular anatomy, physiology, and development, we now turn to the clinical assessment of this system — from structured history taking and bedside examination through to specialised vestibular function tests used in everyday practice.
Approach to the Dizzy Patient
A structured diagnostic framework for the dizzy patient — from initial symptom triage through to targeted investigation. Covers the episodic versus persistent paradigm, the acute vestibular syndrome, HINTS examination, and systematic algorithms for differentiating inner ear, central, and systemic causes at the bedside.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
Vestibular Symptom Classification
The international classification of vestibular symptoms provides a common language for clinicians — defining vertigo, dizziness, unsteadiness, and vestibulo-visual symptoms with precision. Understanding these definitions is fundamental to accurate history taking, correct coding, and meaningful communication between clinicians.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
History Taking in Vestibular Medicine
The vestibular history is the cornerstone of diagnosis — in most cases, a structured history alone will point you to the correct diagnosis before a single test is performed. Covers symptom characterisation, temporal profile, triggers, associated features, and the key questions that differentiate peripheral from central pathology.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
Bedside Clinical Examination in Vestibular Medicine
The systematic bedside vestibular examination — covering nystagmus assessment, the bedside Head Impulse Test, the HINTS protocol for acute vestibular syndrome, positional testing (Dix-Hallpike and Supine Roll), head shaking and vibration-induced nystagmus, ocular motor assessment, dynamic visual acuity, otoscopy, and cardiovascular evaluation. The essential toolkit for every vestibular encounter.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
Examination of Balance and Gait
Romberg test and its modifications, Fukuda stepping test, tandem gait, dynamic gait index, and computerised dynamic posturography. How to systematically differentiate vestibular, cerebellar, and proprioceptive contributions to gait instability.
▶ Clinician Videos (6)
🎧 Clinician Audio (4)
2.3 Vestibular Function Testing
▼The vestibular function testing section covers the full diagnostic laboratory battery — from oculomotor assessment and VOR testing to otolith function and positional manoeuvres. Expand each sub-section below to access the clinical resources, videos, cheat sheets, and literature reviews for that testing domain.
👁 Oculomotor Assessment
▼Oculomotor testing is the cornerstone of the vestibular laboratory assessment. It reveals whether pathology is peripheral or central by quantifying gaze stability, saccadic accuracy, smooth pursuit gain, optokinetic responses, and VOR suppression — each with a distinct neural substrate and clinical signature.
Oculomotor Testing — Overview
The full battery of videonystagmography (VNG) oculomotor subtests: clinical rationale, recording principles, and a systematic framework for synthesis and interpretation across the oculomotor system.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
Gaze Holding & Nystagmus Examination
Bedside and laboratory assessment of spontaneous and gaze-evoked nystagmus. Alexander's Law, fixation suppression, direction-changing versus direction-fixed nystagmus, and the neurophysiology of gaze stability.
Saccade Testing
Quantification of saccadic latency, velocity, and accuracy in VNG recording. Hypometric and hypermetric saccades, predictive saccades, and localising value for frontal, parietal, and cerebellar pathology.
Smooth Pursuit Testing
Gain and symmetry analysis of smooth pursuit in VNG. Age-related decline, drug effects, and localising significance of pursuit gain asymmetry — with particular relevance to cerebellar and cerebral hemisphere lesions.
Optokinetic Nystagmus (OKN)
Full-field optokinetic stimulation and its role in the vestibular laboratory. OKN asymmetry as a sign of cortical and brainstem dysfunction, with clinical correlation to smooth pursuit and velocity storage abnormalities.
VOR Suppression Testing
Assessment of the ability to suppress the VOR during combined head and target rotation. Failure of VOR suppression localises to the flocculus and vestibulocerebellum, complementing smooth pursuit and OKN findings.
Specialised Oculomotor Tests
Advanced oculomotor battery including antisaccade testing, memory-guided saccades, and vergence assessment. These tests extend localisation beyond standard VNG and are particularly relevant in evaluating frontal and cerebellar dysfunction.
🔄 VOR & Canal Assessment
▼Canal-specific VOR testing provides quantitative, frequency-dependent measures of semicircular canal function. Together with the bedside HINTS battery, these tests form the backbone of the diagnostic workup in acute and chronic vestibular presentations.
Video Head Impulse Test (vHIT)
High-acceleration VOR testing using video goggles to detect semicircular canal hypofunction. Covers gain calculation, catch-up saccades (overt and covert), canal-specific testing, and interpretation in peripheral versus central pathology.
▶ Clinician Videos (3) — coming soon
VOR Testing & HINTS Examination
The vestibulo-ocular reflex as a diagnostic tool — from the three-neuron arc to advanced clinical localisation. Includes the HINTS bedside triad (Head Impulse, Nystagmus, Test of Skew) for differentiating posterior circulation stroke from peripheral vestibular neuritis in acute vestibular syndrome.
▶ Clinician Videos (6) — coming soon
Caloric Testing
Bithermal caloric stimulation of the horizontal semicircular canal. Canal paresis formula (Jongkees), directional preponderance, interpretation of unilateral versus bilateral weakness, and the complementary relationship between calorics and vHIT.
▶ Clinician Videos (3) — coming soon
Rotational Chair Testing
Sinusoidal harmonic acceleration testing of the VOR across a range of frequencies. Particularly valuable in bilateral vestibulopathy where calorics may be absent, and in medicolegal assessment of vestibular loss.
🔬 Otolith & Otoconial Assessment
▼The otolith organs — utricle and saccule — are assessed through a dedicated suite of clinical and laboratory tests. These provide canal-independent measures of linear acceleration sensing and gravitational orientation, with direct relevance to Ménière's disease, SCD, and bilateral vestibulopathy.
Otoconial Structure, SVV & Skew Deviation
Anatomy and physiology of the macular organs, otolith neural pathways, and bedside assessment of otoconial function. Includes the Subjective Visual Vertical (SVV), goggle-based SVV technology, and the ocular tilt reaction with skew deviation as signs of utricular pathway dysfunction.
▶ Clinician Videos (6) — coming soon
VEMP Testing (cVEMP and oVEMP)
Cervical VEMP assesses saccular function and the inferior vestibular nerve. Ocular VEMP assesses utricular function and the superior vestibular nerve. Threshold, amplitude, and asymmetry ratio interpretation in Ménière's disease, SCD, and neuritis.
▶ Clinician Videos (4) — coming soon
👤 Positional & Manoeuvre Testing
▼Positional testing identifies canalith repositioning disorders and differentiates BPPV subtypes from central positional nystagmus. Correct technique and nystagmus pattern recognition are the keys to accurate canal identification and effective treatment.
Dix-Hallpike Test
The standard diagnostic manoeuvre for posterior semicircular canal BPPV. Patient positioning, head angle optimisation, nystagmus characteristics (upbeat-torsional, latency, fatigability), and differentiation from central positional nystagmus.
Supine Roll Test
Diagnosis of horizontal (lateral) semicircular canal BPPV. Head roll technique, geotropic versus apogeotropic nystagmus patterns, canalith versus cupulolithiasis variants, and canal conversion following Epley manoeuvre.
2.4 Diseases and Conditions Affecting the Vestibular System
▼This section covers the full spectrum of diseases and conditions encountered in vestibular medicine — from inner ear pathology and central disorders through to functional, systemic, and rare conditions. Expand each sub-section below to access condition-specific resources.
Inner Ear Peripheral Pathology
▼The inner ear is the source of the vast majority of vestibular disorders encountered in clinical practice. This section covers the conditions you will see most often — from the extremely common to the frequently missed — each with a structured approach to diagnosis and management.
BPPV (Benign Paroxysmal Positional Vertigo)
One of the most common vestibular diagnoses — second only to vestibular migraine. Brief episodes of vertigo triggered by specific head movements, caused by displaced otoconia within the semicircular canals. Vestibular Physician deep review covers mechanism, Bárány Society criteria, all canal variants, repositioning manoeuvres, refractory disease, and surgical options.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Ménière's Disease
Inner ear disorder causing episodes of vertigo, hearing loss, tinnitus, and aural fullness. Diagnosis hinges on the symptom tetrad, audiometric evidence of low-frequency hearing loss, and exclusion of mimics.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Vestibular Neuritis
Sudden severe vertigo caused by inflammation of the vestibular nerve, typically following a viral infection.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Superior Canal Dehiscence (SCD)
A rare condition caused by an opening in the bone overlying the superior semicircular canal.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Labyrinthitis
Inflammation of both the vestibular and cochlear portions of the inner ear, causing acute vertigo alongside hearing loss and tinnitus. This six-part series covers aetiology (viral, bacterial, autoimmune, vascular), clinical features, HINTS Plus examination, systematic investigation, differential diagnosis from AICA stroke, and aetiology-stratified management including corticosteroids and vestibular rehabilitation.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Vestibular Schwannoma
A benign schwannoma arising from the vestibular nerve, accounting for 80–90% of CPA masses. Presents with insidious asymmetric SNHL (95%), unilateral tinnitus (70%), and imbalance. Diagnosis: gadolinium MRI. Management is Koos-grade guided: active surveillance for Grade I–II, stereotactic radiosurgery for Grade I–III, microsurgery for Grade III–IV with brainstem compression.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Bilateral Vestibulopathy
Loss of balance function in both inner ears, causing chronic unsteadiness and oscillopsia.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Enlarged Vestibular Aqueduct
A congenital inner ear abnormality associated with hearing loss and vestibular symptoms.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Autoimmune Disease of the Inner Ear
Immune-mediated damage to the inner ear causing progressive hearing loss and vestibular dysfunction.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Vestibular Paroxysmia
Brief, recurrent attacks of vertigo caused by neurovascular compression of the vestibular nerve.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Ramsay Hunt Syndrome
Herpes zoster reactivation in the geniculate ganglion causing acute facial palsy, otalgia, auricular vesicles, and concurrent audiovestibular dysfunction. A time-critical diagnosis — antiviral therapy within 72 hours significantly improves facial nerve recovery. Vestibular involvement is frequently underrecognised.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
Central Vestibular Disorders
▼When the brain rather than the inner ear is the origin of dizziness, the clinical picture changes — and the stakes are higher. This section addresses the central causes of vestibular symptoms, from vestibular migraine through to posterior fossa pathology, with a focus on distinguishing central from peripheral disease.
Vestibular Migraine
A type of migraine causing episodes of vertigo, dizziness, and motion sensitivity — the most common vestibular diagnosis.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Cerebellar Ataxia
Balance and coordination problems caused by cerebellar dysfunction, including degenerative and acquired causes.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Drug-Induced Vestibular Toxicity & Ataxia
Ototoxic and cerebellotoxic drugs — aminoglycosides, platinum agents, loop diuretics, antiepileptics, lithium and more — causing bilateral vestibular hypofunction and ataxia.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
Brainstem Stroke & TIA
Vascular events affecting the brainstem that present with acute vertigo, nystagmus, and imbalance.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Arnold Chiari Malformation
Structural defect at the base of the skull causing cerebellar herniation, dizziness, and balance issues.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Multiple Sclerosis
Autoimmune demyelinating disease that can cause vertigo, nystagmus, and balance dysfunction.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Cervical Arterial Dissection
Vertebral and internal carotid artery dissection can present with dizziness, vertigo, neck pain, and Horner syndrome — and carries a significant risk of posterior circulation stroke. A critical diagnosis not to miss in any acute vestibular presentation, particularly in younger patients or those with recent neck trauma or manipulation.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Vestibular Processing Disorders
▼Vestibular processing disorders are real, disabling, and increasingly recognised — yet frequently misunderstood or dismissed. This section examines the conditions where vestibular symptoms arise from altered sensory processing rather than structural damage, and explores evidence-based frameworks for diagnosis and treatment.
PPPD (Persistent Postural-Perceptual Dizziness)
Chronic dizziness worsened by upright posture, movement, and complex visual environments.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Visually Induced Dizziness
Dizziness triggered by complex or moving visual patterns, screens, and busy environments.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Mal de Débarquement Syndrome
Persistent sensation of rocking or swaying, often following travel by sea, air, or land.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Post-Concussion Dizziness
Persistent dizziness and balance problems following head injury or concussion. A multi-mechanism syndrome — traumatic BPPV, labyrinthine concussion, central pathway injury, autonomic dysfunction, and PPPD often coexist and require independent identification and treatment.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Anxiety-Related Dizziness
Dizziness driven by anxiety disorders, panic attacks, or hyperventilation syndrome.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Motion Sickness Susceptibility
A universal vestibular trait, not a disease — but clinically critical in vestibular migraine, PPPD, MdDS, post-concussive dizziness, and visually-induced dizziness where it predicts symptom burden and treatment response. Sensory-conflict theory (Reason & Brand 1975) underpins susceptibility; MSSQ-Short and VIMSSQ-Short are the clinic-ready screening tools. Management spans behavioural habituation, graded visual exposure, vestibular rehabilitation, and targeted pharmacotherapy (scopolamine, cinnarizine).
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Systemic & Multisensory Balance Disorders
▼Dizziness and imbalance are not always vestibular in origin. Many systemic conditions — cardiovascular, metabolic, neurological, and multisensory — can present to a vestibular clinic. This section equips clinicians to recognise and manage the broader differential when the inner ear is not the culprit.
POTS (Postural Orthostatic Tachycardia Syndrome)
Excessive heart rate increase upon standing causing dizziness, lightheadedness, and fatigue.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Orthostatic Hypotension
A drop in blood pressure upon standing, causing dizziness, lightheadedness, and risk of falls.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Age-Related Balance Decline (Presbystasis)
Progressive balance deterioration with ageing, involving multiple sensory and motor systems.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Cervicogenic Dizziness
Dizziness and unsteadiness arising from the neck — cervical proprioceptive dysfunction and cervical spine pathology — diagnosed by exclusion and managed with manual therapy and sensorimotor rehabilitation.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Peripheral Neuropathy & Sensory Ataxia
Nerve damage affecting proprioception and balance, common in diabetes and other systemic conditions.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Frequent Falls in the Elderly
Multifactorial falls risk in older adults involving vestibular, visual, proprioceptive, and cardiovascular factors.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
Interesting Cases and Miscellaneous Diseases in Vestibular Clinics
▼Content coming soon — interesting cases and uploads for this section will be added progressively.
Vestibular clinics attract the unusual. This section gathers the rarer diagnoses, fascinating presentations, and conditions that don't fit neatly into standard categories — cases that sharpen clinical thinking and remind us how broad and complex the field of vestibular medicine truly is.
1. Acute Post-Viral Cerebellar Ataxia (PVCA) Coming soon
An immune-mediated cerebellar syndrome following viral infection, most common in children but also seen in adults. Presents with acute gait ataxia, nystagmus, and truncal instability. Mimics posterior fossa stroke. Prognosis is generally good but requires careful central vestibular assessment.
▶ Clinician Videos (6) — coming soon
2. Waardenburg Syndrome Coming soon
A rare autosomal dominant neurocristopathy causing sensorineural hearing loss, vestibular dysfunction, pigmentation anomalies (white forelock, heterochromia iridis), and dystopia canthorum. Four subtypes (WS1–WS4) based on associated features. Genetic basis involves PAX3, MITF, SOX10 and other genes.
▶ Clinician Videos (3) — coming soon
3. Wilson's Disease Coming soon
Autosomal recessive copper metabolism disorder (ATP7B mutation) causing hepatic and neurological dysfunction. Neurological features can include cerebellar ataxia, tremor, dysarthria, and balance disturbance. Kayser-Fleischer rings are pathognomonic. Treatable with copper chelation if diagnosed early.
4. Carotid Sinus Hypersensitivity Coming soon
Exaggerated baroreceptor response to carotid sinus stimulation causing syncope or presyncope. Relevant in vestibular clinics as a differential diagnosis for episodic dizziness and falls in older patients. Three types: cardioinhibitory, vasodepressor, and mixed. Often underdiagnosed.
5. Superior Oblique Myokymia Coming soon
A rare condition caused by spontaneous, repetitive firing of the trochlear nerve producing monocular oscillopsia, vertical/torsional diplopia, and head tilt. Episodes are brief (seconds) and may be triggered by downgaze. Responds well to carbamazepine or memantine. MRI may show neurovascular compression of CN IV.
6. Palatal Myoclonus Coming soon
Rhythmic palatal movements caused by lesions in the Guillain-Mollaret triangle (dentate nucleus, red nucleus, inferior olivary nucleus). Symptomatic type causes objective pulsatile tinnitus; essential type is idiopathic. Relevant as a rare cause of rhythmic sound-associated dizziness.
7. Stapedius Myoclonus Coming soon
Involuntary rhythmic contractions of the stapedius muscle causing objective tinnitus, fluctuating hearing, and aural fullness. Often confused with Ménière's disease or palatal myoclonus. Can be identified on tympanometry as rhythmic impedance fluctuations synchronous with the perceived sound.
1. The HINTS Exam — A Stroke Triage Tool
The three-component bedside exam (Head Impulse, Nystagmus, Test of Skew) that outperforms CT in the first 48 hours for posterior fossa stroke. The single most important vestibular skill for emergency clinicians.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
2. Acute Vestibular Syndrome — Stroke vs Neuritis
Differentiating posterior fossa stroke from vestibular neuritis in the patient with acute sustained vertigo, nystagmus, and gait instability. Covers the dangerous clinical mimics and red flags that demand imaging.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
3. BPPV in the Emergency Department
Rapid bedside diagnosis and treatment of benign paroxysmal positional vertigo — the most common cause of vertigo presenting to ED. Covers Dix-Hallpike, supine roll, and canalith repositioning manoeuvres.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
4. Posterior Circulation Stroke — Vascular Anatomy for ED
Key vertebrobasilar anatomy relevant to dizziness presentations. AICA, PICA, and basilar artery syndromes mapped to clinical signs. When to suspect stroke even with a normal CT.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
5. Episodic Vestibular Syndrome — ED Triage
Framework for the patient with recurrent vertigo episodes: vestibular migraine, Ménière's disease, TIA, and cardiac causes. When to discharge safely and when to escalate.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
6. Nystagmus Interpretation for Emergency Clinicians
A practical field guide to nystagmus direction, fixation suppression, and gaze-evoked patterns. How to distinguish peripheral from central nystagmus at the bedside without specialist equipment.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
7. Vestibular Emergencies — What Not to Miss
High-stakes diagnoses presenting as dizziness: cerebellar haemorrhage, vertebral artery dissection, Wernicke's encephalopathy, carbon monoxide poisoning. Time-critical presentations where dizziness is a red flag.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
8. Syncope vs Vertigo — Sorting It Out in ED
Distinguishing true vertigo from presyncope, orthostatic hypotension, and cardiac arrhythmia. The overlap syndromes (carotid sinus hypersensitivity, POTS) and when to involve cardiology.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
9. Head Impulse Test — Technique and Pitfalls
Correct bedside HIT technique, common errors, and clinical interpretation. How to avoid false negatives in early stroke and false positives in BPPV and medication effects.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
10. Disposition Decisions — Safe Discharge After Dizziness
Evidence-based criteria for safe ED discharge of dizzy patients. TiTrATE risk stratification, the five convergent criteria for defensible discharge, documentation that protects the clinician, outpatient referral pathways, and the medicolegal risk of missed posterior fossa stroke.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
VRT Principles & Evidence Base
Foundational principles of vestibular rehabilitation: neuroplasticity mechanisms, evidence base, and exercise prescription frameworks.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
Gaze Stabilisation Training
VOR adaptation training — exercise prescription, dose-response, and progression for gaze instability.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
BPPV — All Variants (Physio focus)
Recognising and treating posterior, horizontal, and anterior canal BPPV with the appropriate repositioning manoeuvre.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
Balance & Gait Rehabilitation
Sensory-integration assessment, progressive balance training, and gait re-education for vestibular patients.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
Bilateral Vestibulopathy Rehab
Substitution-based rehabilitation strategies for patients with bilateral vestibular hypofunction.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
Cervicogenic Dizziness
Diagnostic criteria, cervical assessment, and combined manual-therapy plus exercise approach.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
Concussion / mTBI Vestibular Rehab
Vestibular rehabilitation for post-concussive dizziness — VOMS, sub-symptom dosing, and return-to-activity progression.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
Functional Dizziness — Physio Approach
Physio approach to functional dizziness and PPPD-spectrum presentations — graded exposure and habituation.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
Outcome Measures in VRT
Patient-reported and performance-based outcome tools, MCIDs, and re-test frequency for VRT.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
PPPD — Rehab Component
PPPD-specific rehabilitation programme — VRT plus CBT-informed structure for chronic functional dizziness.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
VFT Interpretation (Physio lens)
Reading vHIT, caloric, and VEMP reports to guide exercise selection and rehabilitation planning.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
Vestibular Migraine — Rehab
Trigger management, cautious dosing, and co-management of vestibular migraine in the rehab setting.
▶ Clinician Videos (4)
🎧 Clinician Audio (4)
PVM01. Normal Vestibular Development
Understanding normal vestibular maturation from birth through adolescence is essential for identifying pathological deviations. This topic covers developmental milestones, normative testing data, and age-appropriate clinical expectations.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM02. Benign Paroxysmal Vertigo of Childhood
BPVC is the most common cause of episodic vertigo in young children, characterised by brief attacks of dizziness without hearing loss or tinnitus. It is closely related to migraine and typically resolves with age.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM03. Vestibular Migraine in Children
Vestibular migraine is the leading cause of recurrent vertigo in children and adolescents. Recognition requires awareness of episodic vestibular symptoms that may precede or occur independently of headache.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM04. BPPV in Children
Although rare compared to adults, BPPV occurs in paediatric patients and is frequently underdiagnosed. Canal repositioning manoeuvres are effective but require age-appropriate technique and patient cooperation.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM05. Vestibular Neuritis and Labyrinthitis in Children
Acute unilateral vestibular loss in children presents differently from adults. This topic covers the clinical features, diagnosis, and management of viral vestibular injury in the paediatric age group.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM06. Central Causes and Posterior Fossa Pathology
Posterior fossa tumours, demyelination, and cerebellar disorders require urgent recognition. This topic equips clinicians with the red flag features distinguishing central from peripheral vestibular pathology in children.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM07. Enlarged Vestibular Aqueduct Syndrome
EVA is one of the most common identifiable causes of sensorineural hearing loss and vestibular dysfunction in children. Early identification enables appropriate management and counselling to prevent progression.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM08. Syndromic Vestibular Disorders
Usher syndrome, CHARGE, Waardenburg, Pendred syndrome and other genetic conditions carry significant vestibular morbidity. This topic covers vestibular features, screening priorities, and multidisciplinary management.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM09. Ototoxicity and Drug-Induced Vestibular Dysfunction
Aminoglycosides, platinum-based chemotherapy, and other ototoxic agents pose particular risks in children. Monitoring protocols, early detection strategies, and rehabilitation are covered in depth.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM10. Otitis Media and Vestibular Dysfunction
Chronic and recurrent otitis media can produce subtle but clinically significant vestibular impairment in children. This topic examines the mechanisms, detection, and management of otitis media-related vestibular dysfunction.
▶ Clinician Videos (5)
🎧 Clinician Audio (5)
PVM11. Concussion and Post-Traumatic Vestibular Dysfunction
Vestibular dysfunction is one of the most persistent sequelae of paediatric concussion. This topic covers post-traumatic vestibulopathy, assessment protocols, and evidence-based rehabilitation strategies.