Education Hub
Vestibular medicine education for clinicians and patients
Vestibular Education Resources
A library of vestibular medicine resources — organised by who you are, not by pathology. Search any topic to see which audiences cover it and jump straight in — or browse by audience below.
Popular:
420+videos
390+podcast episodes
95+literature reviews
100+cheat sheets
55+patient leaflets
Over 1,000 free resources — choose your audience below to dive in.
01
Patients
Plain-language videos, audio content, and downloadable leaflets — vestibular conditions explained without jargon.
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Most common conditions (7)
BPPV · Vestibular Migraine · Ménière's Disease · Vestibular Neuritis · Labyrinthitis · Post-Concussion Dizziness · Motion Sickness
BPPV (Benign Paroxysmal Positional Vertigo)
Brief spinning episodes triggered by head movement — often resolves with repositioning treatment.
Vestibular Migraine
Migraine causing dizziness and vertigo — common; often improves with migraine treatment and trigger management.
Ménière's Disease
Vertigo attacks with hearing changes and ringing — treatment aims to reduce attack frequency and severity.
Vestibular Neuritis
Sudden severe dizziness after a viral infection — most people improve over weeks, and rehabilitation can help.
Labyrinthitis
Inner ear infection causing dizziness and hearing changes.
Post-Concussion Dizziness
Dizziness after head injury — often improves with paced, supervised rehabilitation.
Motion Sickness
Feeling sick in cars, boats, planes or from screens.
Moderately common conditions (12)
POTS · Orthostatic Hypotension · Mal de Débarquement · Visually Induced Dizziness · Bilateral Vestibulopathy · Brainstem Stroke & TIA · Presbystasis · Frequent Falls · Cervicogenic Dizziness · Sensory Ataxia · PPPD · Anxiety-Related Dizziness
POTS (Postural Orthostatic Tachycardia Syndrome)
Racing heart on standing, causing dizziness and fatigue.
Orthostatic Hypotension
Dizziness on standing from a brief blood pressure drop.
Mal de Débarquement Syndrome
Constant rocking sensation, often after a boat or plane trip.
Visually Induced Dizziness
Dizziness triggered by busy, moving visual surroundings.
Bilateral Vestibulopathy
Reduced balance function in both ears, causing unsteadiness.
Brainstem Stroke & TIA
Dizziness can occasionally warn of stroke — know the signs.
Age-Related Balance Decline (Presbystasis)
Gradual loss of balance with ageing — balance can often be improved with targeted training.
Frequent Falls in Older Age
Falls usually have several small causes — risk can often be reduced with assessment and training.
Cervicogenic Dizziness (Neck-Related Dizziness)
Dizziness from the neck, often with stiffness or pain.
Balance Problems from Nerve Damage (Sensory Ataxia)
Unsteadiness from nerve damage in the feet and legs.
PPPD (Persistent Postural-Perceptual Dizziness)
Persistent dizziness and unsteadiness, often worse when upright or in busy places — often improves with rehabilitation and, where appropriate, medication.
Anxiety-Related Dizziness
Dizziness linked to anxiety, panic or over-breathing — common; often improves with treatment of the underlying anxiety.
Less common conditions (6)
Drug-Induced Vestibular Toxicity · Multiple Sclerosis · Superior Canal Dehiscence · Vestibular Paroxysmia · Cerebellar Ataxia · Ramsay Hunt Syndrome
Drug-Induced Vestibular Toxicity & Ataxia
Some medications can affect balance — review before stopping anything.
Multiple Sclerosis
Can cause dizziness, unsteadiness and visual problems.
Superior Canal Dehiscence (SCD)
A small bone opening causing sound- and pressure-triggered dizziness.
Vestibular Paroxysmia
Very brief repeated spinning spells — often responds to medication.
Cerebellar Ataxia
Balance and coordination problems from the brain's control centre.
Ramsay Hunt Syndrome
Shingles of the ear causing vertigo and facial weakness.
Rare conditions (5)
Autoimmune Inner Ear Disease · Enlarged Vestibular Aqueduct · Arnold Chiari Malformation · Vestibular Schwannoma · Cervical Arterial Dissection
Autoimmune Inner Ear Disease
Immune system affecting the inner ear — hearing and balance.
Enlarged Vestibular Aqueduct
A wider-than-usual inner ear channel, present from birth.
Arnold Chiari Malformation
The lower brain sits slightly low, sometimes causing dizziness.
Vestibular Schwannoma (Acoustic Neuroma)
A benign, slow-growing tumour on the balance nerve, affecting hearing and balance.
Cervical Arterial Dissection
A tear in a neck artery that can cause dizziness and neck pain — needs urgent care.
02
General Clinicians
14 topics — the GP vestibular curriculum from history and examination through to referral pathways. Videos, podcasts, cheat sheets & literature reviews.
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1. Taking a dizziness history
TiTrATE history framework — most dizziness diagnoses are made here.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
2. Bedside examination of the dizzy patient
HINTS, Dix-Hallpike, orthostatics and focused neurology at the bedside.
▶ GP Clinician Videos (3)
1The 60-Second Read — Inspection and GaitWhy the first 60 seconds discriminate peripheral from central2HINTS and Dix-Hallpike at the BedsideOculomotor and positional tests — when and how to use them3Bringing It All Together — Orthostatic BP, Red Flags and ReferralFull bedside synthesis for the general clinician
🎧 GP Clinician Audio (3)
1Before You Touch the Patient — Inspection, Gait & the 60-Second ReadWhy bedside still outperforms early MRI in AVS2HINTS, HINTS-Plus & Dix-Hallpike — The Oculomotor and Positional ExamThe counter-intuitive head impulse and Dix-Hallpike pitfalls3Orthostatic BP, Focused Neuro, Red Flags & When to ReferSynthesis, documentation, and escalation
3. Acute vertigo — identifying stroke risk
Separating vestibular neuritis from posterior circulation stroke.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
4. BPPV
Dix-Hallpike diagnosis and Epley repositioning — symptom resolution in the large majority of cases; recurrence is common.
▶ GP Clinician Videos (3)
1Recognising BPPV — The Classic HistoryPathophysiology, five-feature history, pseudo-constant pattern2Diagnostic Manoeuvres — Dix-Hallpike & Supine RollCorrect technique, nystagmus interpretation, red flags3Treatment — Epley, Lateral Canal & Follow-UpEpley step-by-step, Gufoni, outcomes, referral triggers
🎧 GP Clinician Audio (3)
5. Vestibular migraine
The most missed vestibular diagnosis — episodic vertigo, often headache-free.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
6. Vestibular neuritis & labyrinthitis
Days of vertigo with abnormal head impulse — steroids and rehab.
▶ GP Clinician Videos (3)
1Recognising Acute Vestibular SyndromeHINTS-plus, neuritis vs labyrinthitis, when normal head impulse is a stroke red flag2Managing the Acute PresentationSteroids <72 h, symptom control, and the suppressant trap3Recovery, Rehab, and Long-Term Outlook4-phase rehab, modifiable predictors, secondary BPPV & PPPD
🎧 GP Clinician Audio (3)
1Recognising Acute Vestibular SyndromeHINTS-plus, Bárány criteria, separating peripheral from central2Managing the Acute PresentationSteroids, suppressant trap, labyrinthitis & sudden SNHL3Recovery, Rehab, and Long-Term OutlookRehab progression, BPPV (10–15%), PPPD (20–30%), reopening recurrent cases
7. Ménière's disease
Episodic vertigo, fluctuating hearing loss, tinnitus and fullness.
▶ GP Clinician Videos (3)
1Recognising Ménière's — Pattern, Tetrad, Bárány CriteriaWhy the audiogram is the diagnosis-defining test2Differential and InvestigationsMénière's vs vestibular migraine; what to order, what to skip3Stepwise Management and When to ReferLifestyle, betahistine, diuretics, intratympanic options, red flags
🎧 GP Clinician Audio (3)
8. PPPD (chronic functional dizziness)
Chronic non-spinning dizziness worsened by posture and visual motion.
▶ GP Clinician Videos (3)
1Recognising PPPD — The Diagnosis Most Clinicians MissBárány criteria, the three-exacerbator fingerprint, and patient language2The Three-Pillar TreatmentVestibular rehab, SSRI/SNRI dosing, and CBT3Pitfalls, Patient Communication and When to ReferThe six pitfalls, the "car alarm" framing, and referral criteria
🎧 GP Clinician Audio (3)
9. Orthostatic & medication-related dizziness
Lightheadedness on standing — blood pressure, medications and deprescribing.
▶ GP Clinician Videos (3)
1The Five Orthostatic Syndromes in Six MinutesInitial, classical, delayed, neurogenic OH and POTS — distinguished by the active stand test2The Active Stand Test and the Medication ReviewThe 10-minute bedside test, common errors, and the stop / switch / reduce framework3Stepwise Management — From Salt to MidodrineLifestyle, first-line pharmacotherapy, and when to refer
🎧 GP Clinician Audio (3)
1Recognising Orthostatic Dizziness — The Diagnosis Hiding in Plain SightPrevalence, the cardiovascular reflex, and the five orthostatic syndromes2The Active Stand Test and the Five-Minute Medication ReviewThe bedside test done properly and the structured medication review3Treating Orthostatic Intolerance — Lifestyle, Pharmacotherapy & ReferralNon-pharmacological measures, midodrine and fludrocortisone, red flags and referral
10. Dizziness in the elderly / falls
Multifactorial dizziness and falls risk in older adults.
▶ GP Clinician Videos (3)
🎧 GP Clinician Audio (3)
11. Sudden sensorineural hearing loss with vertigo
Sudden hearing loss with vertigo — a true emergency.
▶ GP Clinician Videos (3)
1Recognising the Otological EmergencyDefinition, the 72-hour window, Weber to the good ear, central red flags2Treatment Within 72 Hours — Steroids and the Phone Call to ENTPractical prescribing, intratympanic, MRI IAM, and the working ENT script3Central Causes and the Long GameAICA stroke, vestibular schwannoma, autoimmune disease, and rehabilitation
🎧 GP Clinician Audio (3)
1Recognising the Otological EmergencyThe 72-hour window, the bedside pattern, why HINTS is less reliable here2Treatment Within 72 HoursPrednisolone, monitoring, intratympanic salvage, and the phone-call script3Central Causes and the Long GameAICA, schwannoma, autoimmune disease, rehab, contralateral ear protection
12. Post-concussive dizziness
Dizziness after mTBI — early supervised rehabilitation is standard.
▶ GP Clinician Videos (3)
1Recognising Post-Concussive Dizziness — Mechanisms and Why It MattersSix mechanisms, the three commonly missed, why early activity beats prolonged rest2The Bedside Assessment — Catching Traumatic BPPV and the Other High-Yield DiagnosesDix-Hallpike + supine roll on every patient; VM, cervicogenic, autonomic screen3Management, Rehabilitation and Referral — Preventing ChronicityMechanism-specific treatment, staged return-to-activity, the 4-week referral trigger
🎧 GP Clinician Audio (3)
1Recognising Post-Concussive Dizziness — Mechanisms and Why It Matters30–60% incidence, six mechanisms, why prolonged rest worsens outcomes2The Bedside Assessment — Catching Traumatic BPPV and the Other High-Yield DiagnosesWhy every post-concussive patient needs Dix-Hallpike + supine roll, plus the missed diagnoses3Management, Rehabilitation and Referral — Preventing ChronicityMechanism-specific treatment, staged return-to-activity, Austroads driving advice, the 4-week trigger
13. Visual-induced dizziness
Dizziness provoked by complex visual environments — supermarkets, screens, scrolling.
▶ GP Clinician Videos (3)
1Recognising Visual-Induced DizzinessThe visually-quiet exam, five-feature trigger inventory, why it's missed2Mechanism and the VVASVisual-vestibular mismatch, visual dependence, bedside provocation, 9-item VVAS3Treating Visual-Induced Dizziness4-phase visual habituation, SSRI/SNRI overlay, screen & driving scripts, referral
🎧 GP Clinician Audio (3)
14. Referral pathways
Who to refer, where, how urgently — with red flags.
▶ GP Clinician Videos (3)
1The Referral Problem and the Workforce MapWhy dizziness is mis-referred and the six providers in Australian vestibular care2Choosing the Right ProviderVestibular medicine doctor, ENT, neurology, or stay in primary care3Writing the Letter and Communicating UrgencyEight letter components, four urgency tiers, and closing the loop
🎧 GP Clinician Audio (3)
1The Referral Problem and the Workforce MapWhy dizziness is mis-referred and the Australian vestibular workforce2Choosing the Right ProviderMatch the syndrome to the provider — vestibular medicine doctor, ENT, neurology3The Letter, Urgency, and Closing the LoopEight letter components, urgency tiers, and 4–6 week safety-net
03
Vestibular Clinicians
Deep-dive anatomy, physiology, vestibular function testing and advanced clinical examination, plus the full range of vestibular disorders — grouped into peripheral (inner ear), central, processing, and systemic & multisensory balance disorders.
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2.1 Anatomy, Physiology, Embryology and Phylogeny of the Vestibular System
▼How the system looks, works, forms, and evolved — the foundation.
Anatomy of the Vestibular System
Canals, otolith organs, labyrinth and central vestibular pathways.
▶ Clinician Videos (10)
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Introduction to Anatomy
An overview of the vestibular system's structural organisation — a roadmap for the anatomy series
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Inner Ear Fluid System
Endolymph and perilymph compartments, ionic composition, stria vascularis production, and relevance to Ménière's disease
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Canal Geometry
3D orientation of the three semicircular canals, their planes relative to the head, and the basis of coplanar push-pull pairing
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Sensory End-Organs
Ampullary cristae, utricular and saccular maculae — structural organisation, the striola, and functional specialisation of each end-organ
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Hair Cells
Type I and Type II vestibular hair cell morphology, stereocilia bundles, kinocilium orientation, and directional polarisation vectors
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Efferent System & Vasculature
The efferent vestibular system, its modulatory role on hair cell sensitivity, and blood supply to the membranous labyrinth
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Scarpa's Ganglion & Vestibular Nerve Complex
Bipolar neuron anatomy, Scarpa's ganglion location, vestibular nerve fascicles, and central projections to the brainstem vestibular nuclei
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VOR & Cerebellar Integration
The three-neuron VOR arc, contributions of the cerebellar flocculus and nodulus, and the anatomical basis of gaze stabilisation
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Vestibulospinal Pathways
Lateral and medial vestibulospinal tracts, their roles in axial and limb muscle tone, and integration with postural reflexes
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Vestibulo-Autonomic Links
Connections between vestibular nuclei and autonomic centres — the anatomical basis for motion sickness, nausea, and cardiovascular vestibular responses
🎧 Clinician Audio (10)
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Vestibular Anatomy Predicts Clinical Syndromes
How anatomical knowledge maps directly to diagnostic precision at the bedside
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Microscopic Mechanics of the Vestibular System
Hair cell types, mechano-electrical transduction, and peripheral vestibular function
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How Semicircular Canal Geometry Controls Balance
Three-dimensional canal architecture and its role in angular motion detection
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Microanatomy of Vestibular Sensory Organs
Maculae, cristae, and the structural basis of otolith and canal function
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The Potassium Battery Powering Human Balance
Endolymph composition, ion transport, and why potassium drives vestibular signalling
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The Brain's Internal Map of Gravity
Utricular and saccular function, otolith signalling, and gravitational orientation
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How Vascular Anatomy Identifies Vestibular Strokes
Posterior circulation territories and the anatomical basis of central vestibular syndromes
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The Neural Map of Dizziness Symptoms
Vestibular pathways, symptom localisation, and central processing of balance signals
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The Neural Mechanics of Stable Vision
The vestibulo-ocular reflex, gaze stabilisation, and its clinical implications
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Mapping Symptoms to Vestibular Anatomy
Bringing the series together — from structure to syndrome at the bedside
Physiology of the Vestibular System
How the labyrinth converts motion into neural signals.
▶ Clinician Videos (20)
1
The Vestibular Labyrinth
Anatomy, sensor divisions and foundations for physiology
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Semicircular Canal Mechanics
Endolymph inertia, cupula deflection and the angular VOR
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Ewald's Laws
Ampullopetal vs ampullofugal flow and canal plane responses
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The Line of Polarity Reversal
Otolith macula organisation and directional coding
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The Clinical Payoff
From hair bundle mechanics to millisecond reflexes
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TMC1 and TMC2
Molecular identity of the mechanotransduction channel
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Slow Adaptation
The myosin motor and transducer channel recalibration
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Type I vs Type II Hair Cells
Membrane time constant, gK,L and receptor divergence
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The Calyx Paradox
Type I hair cells, ephaptic coupling and ultra-fast transmission
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Regular vs Irregular Afferents
The coefficient of variation and clinical implications
11
Clinical Tests as Frequency Probes
What each test reveals about vestibular function
12
The Two Integrators
Time and space in vestibular processing
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Receptor Kinetics in the Vestibular Nucleus
AMPA, NMDA and synaptic integration
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Postural and Autonomic Reflexes
Vestibular control of blood pressure and posture
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Specialised Modules
Cerebellar compartments for gaze and gravity
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Distributed Vestibular Islands
Thalamic processing and cortical projections
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When the Frame Fails
Vestibulocortical disorders and clinical identification
18
The Cognitive GPS
Grid cells and spatial navigation
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Mechanisms of Substitution
Sensory re-weighting and vestibular rehabilitation
20
Vestibular System Summary
The complete vestibular pathway — series finale
🎧 Clinician Audio (20)
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Your Body's Primary Inertial Guidance SystemOverview of the vestibular labyrinth — canals, otoliths, and bilateral push-pull
2
Semicircular Canal Biophysics and Clinical TestingTorsion pendulum model, cupular time constant, and frequency tuning
3
Ewald's Laws and Nystagmus PatternsCanal stimulation, excitation asymmetry, and bedside nystagmus prediction
4
Distinguishing Head Tilt from Linear AccelerationThe tilt-translation problem, LPR, and otolith directional coding
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Microscopic Trapdoors and the Speed of BalanceTip links, MET channels, and the 5–10 ms VOR latency cascade
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TMC Proteins and the Molecular Balance PoreTMC1/2 as the MET channel — genetics, gene therapy, and calcium permeability
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How the Inner Ear Adapts to GravityFast and slow adaptation — calcium feedback and myosin-1c recalibration
8
Temporal Filtering in Vestibular Hair CellsType I vs Type II hair cells — gK,L conductance and frequency band encoding
9
The Potassium Trap Behind Your Fastest ReflexesEphaptic coupling at the calyx — K⁺ accumulation and ultra-fast transmission
10
Regular and Irregular Vestibular Nerve SignalsCV as a population marker — caloric vs vHIT dissociation explained
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The Vestibular System Is a Frequency FilterFull frequency map — caloric to cVEMP, each test's physiological window
12
How the Vestibular Nuclei Calculate MotionTemporal and spatial integration — velocity storage and post-rotational nystagmus
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How Pharmacology Reshapes Vestibular Timing CircuitsAMPA vs NMDA kinetics — why suppressants slow compensation
14
How Your Brain Recalibrates BalanceVestibulospinal tracts, autonomic reflexes, falls, and rehabilitation
15
The Cerebellum as a Predictive EngineFlocculus, nodulus, VOR gain adaptation, and cerebellar vestibular syndrome
16
Vestibulo-Ocular Reflex: Physiology and Clinical TestingThree-neuron arc to cortex — vHIT, rotational chair, fixation suppression
17
Why Your Brain Miscalculates GravityPIVC, subjective visual vertical, and the cortical basis of PPPD
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How Your Inner Ear Maps RealityGrid cells, head direction cells, path integration, and cognitive navigation
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Debugging the Brain's Vestibular SoftwareVOR adaptation, sensory substitution, and predicting compensation outcomes
20
The Vestibular System Signal PipelineSeries finale — the complete cascade from stereocilium to spatial perception
Anatomy and Physiology of the Vestibulo-Cerebellum
Flocculus, nodulus and uvula — the brain's adaptive controller.
▶ Clinician Videos (5)
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Vestibulocerebellum ExplainerIntroduction and overview of the vestibulocerebellum
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The Architecture of the VestibulocerebellumStructural anatomy of the vestibulocerebellum
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Nodulus — The Timing ControllerVelocity storage regulation and timing functions of the nodulus
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The Cerebellar CircuitNeural circuitry and connections of the cerebellum
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Clinical Syndromes of the VestibulocerebellumCerebellar vestibular syndromes and clinical presentations
🎧 Clinician Audio (10)
1
Clinical Geography of the VestibulocerebellumFlocculonodular lobe, vermis zones, peduncles, and vascular territories
2
Cerebellar Landmarks for Vestibular DiagnosisDeep cerebellar nuclei, Larsell lobule system, and anatomical localisation
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Microscopic Circuitry of Vestibular AdaptationPurkinje cells, climbing fibres, granule cells, and the Marr-Albus-Ito model
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Why Cerebellar Lesions Mimic Vestibular DiseaseAICA vs PICA stroke patterns, HINTS exam, and central red flags
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Vestibulocerebellar Anatomy and Clinical SignsFlocculus, nodulus, uvula — structure mapped to clinical syndrome
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Evolutionary Hardware of Cerebellar BalanceArchicerebellum, paleocerebellum, neocerebellum — phylogenetic organisation
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Mapping Cerebellar Anatomy to Clinical SignsSpinocerebellum, cerebrocerebellum, and their vestibular relevance
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Ocular Motor Signs of Cerebellar PathologyGEN, downbeat nystagmus, saccadic pursuit, VOR suppression failure
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Detecting Cerebellar Strokes through Eye MovementsHINTS bedside exam, normal HIT with nystagmus, skew deviation
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Spotting Cerebellar Disease in Dizzy PatientsClinical integration — when to suspect cerebellar pathology in the dizzy patient
Embryology of the Vestibular System
From otic placode to mature labyrinth.
▶ Clinician Videos — Coming Soon
📄 Clinician Cheat Sheet
📚 Clinician Detailed Literature Review
🎧 Clinician Audio (5)
1
The Embryonic Blueprint of Vestibular AnatomyOtic placode induction, otocyst formation, and the molecular signals initiating inner ear development
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Sculpting the Inner Ear OrgansSemicircular canal morphogenesis, cochlear coiling, and otolith organ patterning
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Bio-Engineering Vestibular Hair Cells and OtoconiaHair cell differentiation, stereocilia assembly, otoconial crystallisation, and Atoh1 signalling
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Vestibular Wiring: From Nerve to CortexScarpa's ganglion formation, central pathway development, and vestibular nucleus maturation
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Inner Ear Malformations as Developmental TimestampsCongenital anomalies mapped to embryological stages — clinical imaging correlates
Phylogenetic Development of the Vestibular System
Evolution of balance sensing — statocysts to human vestibulopathy.
▶ Clinician Videos (5)
1
Deep OriginsChoanoflagellate hair cell homology, statocysts, and the molecular toolkit conserved for 600 million years
2
The Gnathostome RevolutionHow jaw evolution created the horizontal canal and split the ancestral macula into distinct otolith organs
3
Conquering LandWater-to-land transition, neck evolution, the vestibulo-collic reflex, and amphibian-reptilian innovations
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Flight and SpeedAvian canal mastery, the paratympanic organ, calyx synapses, and the cochlear divorce
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Evolutionary MedicineWhy BPPV, motion sickness, and presbyvestibulopathy are evolutionary trade-offs — the inner ear as a palimpsest
🎧 Clinician Audio (5)
1Deep Origins — Your Inner Ear Is Ancient Aquatic HardwareChoanoflagellate hair cell homology, statocysts, and the molecular toolkit conserved for 600 million years
2The Gnathostome Revolution — How Jaws Built the Inner EarHow jaw evolution created the horizontal canal and split the ancestral macula into distinct otolith organs
3Conquering Land — How Evolution Solved the Bobblehead ProblemTetrapod adaptations: lateral line loss, the VCR, and the Papilla Amphibiorum
4Flight and Speed — Avian Mastery and Mammalian RefinementsBird canal geometry, the floccular recess, calyx nerve endings, and the cochlear divorce
5Evolutionary Medicine — Why Evolution Made Us DizzyBPPV, motion sickness, and presbyvestibulopathy as evolutionary trade-offs
2.2 Clinical Assessment of the Dizzy Patient
▼From fundamentals to the clinical assessment of the dizzy patient.
Approach to the Dizzy Patient
A structured diagnostic framework from triage to diagnosis.
▶ Clinician Videos (5)
1
The TiTrATE Framework
A paradigm shift in dizziness diagnosis — timing, triggers, and targeted examination
2
HINTS+ Bedside Assessment
The gold standard for distinguishing stroke from vestibular neuritis in acute vertigo
3
Episodic Vestibular Syndrome
From BPPV to vestibular migraine — duration-based differential and bedside assessment
4
Chronic Vestibular Syndrome
PPPD, bilateral vestibular failure, and the role of rehabilitation
5
Integrated Management & Diagnostic Pitfalls
Bringing TiTrATE and HINTS+ together — common errors and management pathways
🎧 Clinician Audio (5)
1The TiTrATE FrameworkA paradigm shift in dizziness diagnosis — timing, triggers, targeted examination
2HINTS+ Bedside AssessmentThe gold standard for distinguishing stroke from vestibular neuritis in acute vertigo
3Episodic Vestibular SyndromeFrom BPPV to vestibular migraine — duration-based differential and bedside assessment
4Chronic Vestibular SyndromePPPD, bilateral vestibular failure, and the role of rehabilitation
5Integrated Management & Diagnostic PitfallsBringing TiTrATE and HINTS+ together — common errors and management pathways
Vestibular Symptom Classification
The international vocabulary of vestibular symptoms.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
1The Bárány Society Framework4 symptom categories — replacing imprecise dizziness labels with precise clinical terms
2Spontaneous vs TriggeredThe spontaneous/triggered axis and its diagnostic power at the bedside
3From Classification to ClinicApplying the Bárány framework to history taking, red flags, and plain language
History Taking in Vestibular Medicine
The structured vestibular history — the cornerstone of diagnosis.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
1Why History is the Most Powerful Vestibular Diagnostic ToolThe case for structured history taking as the cornerstone of vestibular diagnosis
2HPC, Triggers & Associated SymptomsThe clinical deep dive into the history of presenting complaint
3Red Flags, Medications, PMH & The 10-Minute WorkflowStructured red flag screening and the complete vestibular history workflow
Bedside Clinical Examination in Vestibular Medicine
Systematic nystagmus, HINTS, positional and gait assessment.
▶ Clinician Videos (5)
1Overview & PrinciplesSystematic framework for the 10-minute bedside vestibular examination
2Nystagmus Assessment at the BedsideSpontaneous, gaze-evoked, and positional nystagmus — peripheral vs central
3The bHIT and HINTS ExaminationHead impulse test, HINTS protocol, and acute vestibular syndrome triage
4Positional Testing — Dix-Hallpike and Supine RollBPPV diagnosis, canal identification, and nystagmus interpretation
5Bedside Examination SynthesisIntegrating all findings into a unified diagnostic formulation
🎧 Clinician Audio (5)
1Bedside Examination of the Vestibular PatientA systematic framework for the bedside vestibular examination
2Ocular Motor ExaminationAssessing eye movements, nystagmus, and ocular alignment at the bedside
3Head Shaking and Vibration-Induced NystagmusProvocative tests for detecting peripheral vestibular asymmetry
4Cardiovascular Assessment and Orthostatic HypotensionCardiovascular contributions to dizziness and bedside assessment
5Gait, Balance, and Cervical Spine AssessmentGait and balance testing, Romberg, and cervical spine evaluation
Examination of Balance and Gait
Romberg, Fukuda, tandem gait and dynamic gait index.
▶ Clinician Videos (6)
🎧 Clinician Audio (4)
1The Neural Hard-Wiring of BalanceVOR and vestibulospinal reflex arcs, multisensory integration, and postural control
2Bedside Balance TestsRomberg, foam Romberg, tandem gait, Fukuda stepping test, and retropulsion assessment
3Distinguishing Peripheral from Central DizzinessClinical framework for differentiating peripheral and central causes via balance findings
4Acute Vestibular Syndrome and Bilateral VestibulopathyHINTS+ examination, stroke vs neuritis, and gait profile of bilateral vestibulopathy
2.3 Vestibular Function Testing
▼The full diagnostic laboratory battery, organised by what each test measures.
Oculomotor Assessment
▼Does pathology sit in the labyrinth, brainstem or cerebellum?
Oculomotor Testing — Overview
The full VNG oculomotor battery and its rationale.
Gaze Holding & Nystagmus Examination
Spontaneous and gaze-evoked nystagmus; Alexander's law.
Saccade Testing
Latency, velocity and accuracy — hypometric and slowed saccades.
Smooth Pursuit Testing
Gain and symmetry; age and drug effects.
Optokinetic Nystagmus (OKN)
Full-field optokinetic stimulation and asymmetry interpretation.
VOR Suppression Testing
Suppressing the VOR during combined head-target rotation.
Specialised Oculomotor Tests
Antisaccades, memory-guided saccades and vergence testing.
VOR & Canal Assessment
▼Quantitative, frequency-specific measures of canal and VOR function.
Video Head Impulse Test (vHIT)
High-acceleration VOR testing for canal hypofunction.
VOR Testing & HINTS Examination
From the three-neuron arc to advanced clinical use.
Caloric Testing
Bithermal stimulation; canal paresis and directional preponderance.
Rotational Chair Testing
VOR testing across frequencies — bilateral loss and children.
Otolith & Otoconial Assessment
▼Clinical and laboratory assessment of the utricle and saccule.
Otoconial Structure, SVV & Skew Deviation
Macular organs, otolith pathways, SVV and skew deviation.
VEMP Testing (cVEMP and oVEMP)
cVEMP: saccule and inferior nerve; oVEMP: utricle and superior nerve.
Positional & Manoeuvre Testing
▼Identifying BPPV subtypes and separating them from central mimics.
Dix-Hallpike Test
The standard diagnostic manoeuvre for posterior canal BPPV.
Supine Roll Test
Lateral canal BPPV — geotropic versus apogeotropic patterns.
2.4 Diseases and Conditions Affecting the Vestibular System
▼The full spectrum of vestibular disease, organised by origin.
Inner Ear Peripheral Pathology
BPPV · Ménière's Disease · Vestibular Neuritis · Superior Canal Dehiscence · Labyrinthitis · Vestibular Schwannoma · Bilateral Vestibulopathy · Enlarged Vestibular Aqueduct · Autoimmune Inner Ear Disease · Vestibular Paroxysmia · Ramsay Hunt Syndrome
Most vestibular disorders begin here — the peripheral labyrinth.
BPPV (Benign Paroxysmal Positional Vertigo)
Otoconial displacement, canal variants, manoeuvres and repositioning.
▶ Clinician Videos (6)
1Mechanism & EpidemiologyOtoconia biology, canalithiasis vs cupulolithiasis, anatomy of canal distribution
2Clinical Patterns by CanalPosterior, horizontal (geotropic and apogeotropic), anterior, and atypical variants
3Diagnosis & InvestigationsBárány criteria, provocation technique, video-Frenzel and VNG, imaging indications, common errors
4Differentials & MimicsCentral positional vertigo, vestibular migraine, SCD, perilymph fistula, orthostatic, PPPD overlay
5Repositioning, Adjuncts & SurgeryEpley, Semont, Lempert, Gufoni, Yacovino; refractory disease; PC-occlusion surgery
6Prognosis & Future DirectionsRecurrence, special populations, guidelines, telemedicine, future directions
🎧 Clinician Audio (6)
1Mechanism & EpidemiologyOtoconia biology, canalithiasis vs cupulolithiasis, anatomy of canal distribution
2Clinical Patterns by CanalPosterior, horizontal (geotropic and apogeotropic), anterior, and atypical variants
3Diagnosis & InvestigationsBárány criteria, provocation technique, video-Frenzel and VNG, imaging indications, common errors
4Differentials & MimicsCentral positional vertigo, vestibular migraine, SCD, perilymph fistula, orthostatic, PPPD overlay
5Repositioning, Adjuncts & SurgeryEpley, Semont, Lempert, Gufoni, Yacovino; refractory disease; PC-occlusion surgery
6Prognosis & Future DirectionsRecurrence, special populations, guidelines, telemedicine, future directions
Ménière's Disease
Endolymphatic hydrops — diagnosis, staging and stepped management.
▶ Clinician Videos (6)
1Introduction, History & EpidemiologyMénière 1861 to the 2015 Bárány criteria; prevalence, demographics, migraine overlap, bilateral conversion
2Pathophysiology & Endolymphatic HydropsHydrops mechanism, Schuknecht rupture vs drainage failure, multifactorial aetiology
3Clinical Features, Bárány Criteria & InvestigationsClassical tetrad; 20 min–12 h window; audiogram, vHIT/calorics, VEMPs, MRI hydrops imaging
4Differential Diagnosis & the MD–Vestibular Migraine OverlapVM coexistence 30–40%, schwannoma, AIED, otosyphilis, third-window syndromes, PPPD
5Medical Management — Lifestyle, Pharmacology & Intratympanic TherapySalt, betahistine, diuretics, IT dexamethasone, the gentamicin trade-off
6Surgical Options, Prognosis & Future DirectionsSac decompression, vestibular neurectomy, labyrinthectomy; natural history; future directions
🎧 Clinician Audio (6)
1Introduction, History & EpidemiologyMénière 1861 to the 2015 Bárány criteria; prevalence, demographics, migraine overlap, bilateral conversion
2Pathophysiology & Endolymphatic HydropsHydrops mechanism, Schuknecht rupture vs drainage failure, multifactorial aetiology
3Clinical Features, Bárány Criteria & InvestigationsClassical tetrad; 20 min–12 h window; audiogram, vHIT/calorics, VEMPs, MRI hydrops imaging
4Differential Diagnosis & the MD–Vestibular Migraine OverlapVM coexistence 30–40%, schwannoma, AIED, otosyphilis, third-window syndromes, PPPD
5Medical Management — Lifestyle, Pharmacology & Intratympanic TherapySalt, betahistine, diuretics, IT dexamethasone, the gentamicin trade-off
6Surgical Options, Prognosis & Future DirectionsSac decompression, vestibular neurectomy, labyrinthectomy; natural history; future directions
Vestibular Neuritis
Acute vestibular nerve inflammation, typically post-viral.
▶ Clinician Videos (6)
1Introduction and EpidemiologyIncidence, risk factors and disease burden of vestibular neuritis / AUVP2Pathophysiology: HSV-1, Viral and Inflammatory MechanismsViral reactivation, Scarpa's ganglion involvement and immune-mediated injury3Clinical Features and AUVP SubtypesSuperior, inferior and pan-VN presentations; symptom pattern and examination findings4Diagnosis: HINTS Exam and InvestigationsHINTS protocol, caloric testing, vHIT and role of MRI/DWI5Differential Diagnosis and Medical ManagementDistinguishing stroke, corticosteroid evidence and vestibular suppressants6Rehabilitation, Prognosis and Future DirectionsVRT evidence, secondary BPPV, PPPD risk and long-term outcomes
🎧 Clinician Audio (6)
1Introduction and EpidemiologyIncidence, risk factors and disease burden of vestibular neuritis / AUVP2Pathophysiology: HSV-1, Viral and Inflammatory MechanismsViral reactivation, Scarpa's ganglion involvement and immune-mediated injury3Clinical Features and AUVP SubtypesSuperior, inferior and pan-VN presentations; symptom pattern and examination findings4Diagnosis: HINTS Exam and InvestigationsHINTS protocol, caloric testing, vHIT and role of MRI/DWI5Differential Diagnosis and Medical ManagementDistinguishing stroke, corticosteroid evidence and vestibular suppressants6Rehabilitation, Prognosis and Future DirectionsVRT evidence, secondary BPPV, PPPD risk and long-term outcomes
Superior Canal Dehiscence (SCD)
Bone dehiscence over the superior canal — sound- and pressure-induced vertigo.
▶ Clinician Videos (6)
1History, Epidemiology & the Third Window ConceptMinor's 1998 landmark paper, third window model, superior canal anatomy2Pathophysiology of SCDS: Third Window MechanicsTullio phenomenon, Hennebert sign, endolymph displacement mechanics3Diagnosing SCDS: CT Imaging and AudiometryAir-bone gap, CT temporal bone protocol, three-pillar framework4VEMP Testing and Differential DiagnosiscVEMP/oVEMP thresholds, otosclerosis vs SCDS, perilymphatic fistula5Management: Conservative to SurgicalTrigger avoidance, middle cranial fossa repair, transmastoid approach6Prognosis and Outcomes After SCDS TreatmentSurgical outcomes, persistent symptoms, contralateral ear management
🎧 Clinician Audio (6)
1History, Epidemiology and the Third Window ConceptLloyd Minor's discovery, third window hypothesis, anatomy of the superior canal2The Third Mobile Window and PathophysiologyTullio phenomenon, Hennebert sign, ampullofugal mechanics3Clinical Features — Autophony, Tullio and HennebertAutophony, hyperacusis, air-bone gap, brain fog, diagnostic delay4Diagnosing SCDS — The Three-Pillar FrameworkAudiometry, cVEMP/oVEMP thresholds, CT temporal bone protocol5Differential Diagnosis — The Great MimickerOtosclerosis, perilymphatic fistula, enlarged vestibular aqueduct, Ménière's6Management and PrognosisConservative measures, middle cranial fossa repair, surgical outcomes
Labyrinthitis
Combined cochleovestibular inflammation — vertigo with hearing loss.
▶ Clinician Videos (6)
1Epidemiology, Anatomy and the Blood-Labyrinth BarrierIncidence, inner ear anatomy, and the blood-labyrinth barrier2Aetiology — Viral, Bacterial, Autoimmune and VascularHSV-1 reactivation, bacterial labyrinthitis, autoimmune, and vascular labyrinthine ischaemia3Clinical Features, HINTS Plus and Natural HistoryVestibulocochlear features, bedside HINTS Plus, and recovery trajectory4Investigation Strategy — Audiometry, Vestibular Testing and ImagingSystematic investigation and role of MRI with gadolinium5Differential Diagnosis — Stroke and Clinical MimicsAICA stroke, vascular labyrinthine ischaemia, and distinguishing features6Management, Rehabilitation and PrognosisAetiology-stratified treatment, vestibular rehabilitation, and emerging therapies
🎧 Clinician Audio (6)
1Epidemiology, Anatomy and the Blood-Labyrinth BarrierIncidence, inner ear anatomy, and the blood-labyrinth barrier2Aetiology — Viral, Bacterial, Autoimmune and VascularHSV-1 reactivation, bacterial labyrinthitis, autoimmune, and vascular labyrinthine ischaemia3Clinical Features, HINTS Plus and Natural HistoryVestibulocochlear features, bedside HINTS Plus, and recovery trajectory4Investigation Strategy — Audiometry, Vestibular Testing and ImagingSystematic investigation and role of MRI with gadolinium5Differential Diagnosis — Stroke and Clinical MimicsAICA stroke, vascular labyrinthine ischaemia, and distinguishing features6Management, Rehabilitation and PrognosisAetiology-stratified treatment, vestibular rehabilitation, and emerging therapies
Vestibular Schwannoma
Benign vestibular nerve tumour — the most common CPA mass.
▶ Clinician Videos (6)
1Epidemiology, Aetiology and PathophysiologyNF2 gene, merlin loss, Rac1/Ras/mTOR activation and AICA cochlear compression2Clinical Presentation and Diagnostic InvestigationsAsymmetric SNHL (95%), gadolinium MRI gold standard, vHIT, calorics, cVEMP3Grading, Classification and Active SurveillanceKoos I–IV, MRI at 6 months then annual, 50% stable at 5 years4Stereotactic Radiosurgery12–13 Gy single fraction, 90%+ control at 10 years, pseudoprogression in 20%5Microsurgical ManagementTL / RS / MF approaches, NTR preferred over GTR, CN VII preservation 95%+6NF2, Rehabilitation and Quality of LifeBevacizumab (40–60% hearing stabilisation), vestibular rehab, QoL monitoring
🎧 Clinician Audio (6)
1Epidemiology, Aetiology and PathophysiologyNF2 gene, merlin loss, Rac1/Ras/mTOR, growth behaviour: 50% stable, 30% slow, 20% rapid2Clinical Presentation and Diagnostic InvestigationsAsymmetric SNHL (95%), gadolinium MRI gold standard, vHIT, calorics, cVEMP3Grading, Classification and Active SurveillanceKoos I–IV, MRI at 6 months, annual ×5, biennial — 50% stable at 5 years4Stereotactic Radiosurgery12–13 Gy, 90%+ control at 10 years, pseudoprogression in 20%, CN VII preservation 97–99%5Microsurgical ManagementTL / RS / MF approaches, NTR preferred over GTR, CN VII preservation 95%+6NF2, Rehabilitation and Quality of LifeBevacizumab (40–60% hearing stabilisation), VR, DHI, THI, HADS, Berg Balance Scale
Bilateral Vestibulopathy
Loss of balance function in both inner ears, causing chronic unsteadiness and oscillopsia.
▶ Clinician Videos (6)
🎧 Clinician Audio (6)
1Overview, Epidemiology and the Bárány CriteriaDefinition, prevalence, Bárány Society criteria, and the hidden burden of BVP2Pathophysiology and Aetiology of BVPBilateral hair cell loss, central compensation failure, ototoxic, genetic and idiopathic causes3Clinical Features, Oscillopsia and Functional ImpactThe gaze-stabilisation failure, dark and uneven surface vulnerability, and quality of life4Investigations — vHIT, Calorics and NeuroimagingThe vestibular test battery, caloric asymmetry, vHIT gains, and when to image5Differential Diagnosis and Diagnostic PitfallsDistinguishing BVP from cerebellar ataxia, PPPD, and the ototoxicity mimics6Management, Rehabilitation and PrognosisVRT evidence, fall prevention, ototoxin avoidance, and gene therapy horizons
Enlarged Vestibular Aqueduct
A congenital inner ear abnormality associated with hearing loss and vestibular symptoms.
▶ Clinician Videos (6)
1Epidemiology & the Third WindowDefinitions, prevalence and the third-window air-bone gap2Pathophysiology & GeneticsSLC26A4, pendrin, Pendred syndrome and DFNB43Clinical Features & Differential DiagnosisHearing-loss profile, vestibular features and key mimics4Diagnosis — Criteria & InvestigationsValvassori/Cincinnati criteria and the audiovestibular-genetic workup5Management — Rehabilitation & Cochlear ImplantationMonitoring, hearing aids, cochlear implants and VRT6Precipitants, Prognosis & Future DirectionsAvoidable triggers, natural history and paediatric care
🎧 Clinician Audio (6)
1Epidemiology & the Third WindowDefinitions, prevalence and the third-window air-bone gap2Pathophysiology & GeneticsSLC26A4, pendrin, Pendred syndrome and DFNB43Clinical Features & Differential DiagnosisHearing-loss profile, vestibular features and key mimics4Diagnosis — Criteria & InvestigationsValvassori/Cincinnati criteria and the audiovestibular-genetic workup5Management — Rehabilitation & Cochlear ImplantationMonitoring, hearing aids, cochlear implants and VRT6Precipitants, Prognosis & Future DirectionsAvoidable triggers, natural history and paediatric care
Autoimmune Disease of the Inner Ear
Immune-mediated damage to the inner ear causing progressive hearing loss and vestibular dysfunction.
▶ Clinician Videos (6)
1History & OverviewDefining AIED; immune basis; historical arc and epidemiology2DiagnosisHughes criteria, the weeks-to-months tempo, and the steroid trial3Differential DiagnosisMénière's, otosyphilis, ANCA vasculitis, Cogan's, schwannoma4ManagementCorticosteroid induction, steroid-sparing agents, and biologics5Prognosis & Controversies (Part 1)Bimodal outlook, relapse, monitoring, special populations6Prognosis & Controversies (Part 2)Controversies, the guidelines gap, and future directions
🎧 Clinician Audio (6)
1Defining AIEDDefinition, immune basis, history and epidemiology2Pathophysiology & Clinical Red FlagsImmune mechanisms, histopathology, red flags, systemic screen3Diagnosis of AIEDHughes criteria, the tempo, and the mandatory MRI4Tempo, Serology & Steroid ResponseDiscriminating tempo, anti-HSP70 limits, the steroid trial5Treatment: Steroid Trial & BeyondCorticosteroids, steroid-sparing agents, biologics6Long-Term OutlookPrognosis, relapse, monitoring, special populations
Vestibular Paroxysmia
Brief, recurrent attacks of vertigo caused by neurovascular compression of the vestibular nerve.
▶ Clinician Videos (6)
1History & ConceptsJannetta’s concept, Brandt & Dieterich, prevalence and onset2Pathology & FeaturesNeurovascular cross-compression and ephaptic transmission3Diagnosis & WorkupBárány 2016 criteria, MRI, and the diagnostic trial4Differential DiagnosisSeparating VP from BPPV, Ménière’s and central mimics5Management & TreatmentCarbamazepine/oxcarbazepine, lacosamide, and MVD6Controversies & PrognosisDrug-defined criteria, surgery threshold, and outlook
🎧 Clinician Audio (6)
1Introduction, History & EpidemiologyJannetta’s concept, Brandt & Dieterich, prevalence and onset2PathophysiologyNeurovascular cross-compression and ephaptic transmission3Diagnosis & WorkupBárány 2016 criteria, MRI, and the diagnostic trial4Differential DiagnosisSeparating VP from BPPV, Ménière’s and central mimics5ManagementCarbamazepine/oxcarbazepine, lacosamide, and MVD6Controversies & PrognosisDrug-defined criteria, surgery threshold, and outlook
Ramsay Hunt Syndrome
Geniculate zoster — facial palsy, otalgia and vestibulocochlear involvement.
▶ Clinician Videos (4)
1Recognising RHS: Triad & Zoster Sine HerpeteThe clinical triad, zoster sine herpete, and facial nerve topodiagnosis
2Mechanism & the Audiovestibular LimbVZV reactivation in the geniculate ganglion; why vertigo and hearing loss can precede the palsy
3Diagnosis & InvestigationsSaliva VZV PCR; vHIT and VEMP; imaging to exclude mimics
4Management & Prognosis: The 72-Hour WindowAntivirals and steroids within 72 hours; prognosis and the zoster vaccine
🎧 Clinician Audio (4)
1Recognising RHS: Triad & Zoster Sine HerpeteThe clinical triad, zoster sine herpete, and facial nerve topodiagnosis
2Mechanism & the Audiovestibular LimbVZV reactivation in the geniculate ganglion; why vertigo and hearing loss can precede the palsy
3Diagnosis & InvestigationsSaliva VZV PCR; vHIT and VEMP; imaging to exclude mimics
4Management & Prognosis: The 72-Hour WindowAntivirals and steroids within 72 hours; prognosis and the zoster vaccine
Central Vestibular Disorders
Vestibular Migraine · Cerebellar Ataxia · Drug-Induced Vestibular Toxicity · Brainstem Stroke & TIA · Arnold Chiari Malformation · Multiple Sclerosis · Cervical Arterial Dissection
When the brain, not the ear, is the origin.
Vestibular Migraine
Episodic vertigo and motion sensitivity — the most common central vestibulopathy.
▶ Clinician Videos (6)
1Introduction, History & EpidemiologyWhat VM is, its prevalence, and who it affects2Pathophysiology & MechanismsTrigeminovascular activation and the central vestibular network3Clinical Features & the Acephalgic ProblemThe phenotype and why headache is often absent4Diagnosis & the Bárány CriteriaThe classification criteria and how they are structured5Investigations & Differential DiagnosisProportionate workup and the Ménière's overlap6Management, Prognosis & ControversiesLifestyle, prophylaxis, outlook, and open questions
🎧 Clinician Audio (6)
1Introduction, History & EpidemiologyWhat VM is, its prevalence, and who it affects2Pathophysiology & MechanismsTrigeminovascular activation and the central vestibular network3Clinical Features & the Acephalgic ProblemThe phenotype and why headache is often absent4Diagnosis & the Bárány CriteriaThe classification criteria and how they are structured5Investigations & Differential DiagnosisProportionate workup and the Ménière's overlap6Management, Prognosis & ControversiesLifestyle, prophylaxis, outlook, and open questions
Cerebellar Ataxia
Balance and coordination problems caused by cerebellar dysfunction, including degenerative and acquired causes.
▶ Clinician Videos (6)
1Introduction, History & EpidemiologyDefining cerebellar ataxia, its history, and prevalence2Pathophysiology & Cerebellar CircuitryFunctional zones, Purkinje cells, and the final common pathway3Clinical Features & Onset PatternsCardinal signs, onset tempo, and the bedside differential4Classification, Genetics & InvestigationsThe genetic groups and a tiered work-up5Management & Treatable CausesRehabilitation, drugs, and the reversible ataxias6Prognosis & Future DirectionsOutlook by cause and the research horizon
🎧 Clinician Audio (6)
1Introduction, History & EpidemiologyDefining cerebellar ataxia, its history, and prevalence2Pathophysiology & Cerebellar CircuitryFunctional zones, Purkinje cells, and the final common pathway3Clinical Features & Onset PatternsCardinal signs, onset tempo, and the bedside differential4Classification, Genetics & InvestigationsThe genetic groups and a tiered work-up5Management & Treatable CausesRehabilitation, drugs, and the reversible ataxias6Prognosis & Future DirectionsOutlook by cause and the research horizon
Drug-Induced Vestibular Toxicity & Ataxia
Aminoglycosides, platinum agents and other vestibulotoxic drugs.
▶ Clinician Videos (3)
1
Mechanisms and the Offending Agents
Two anatomical targets and the aminoglycoside mechanism
2
Recognition, Diagnosis and Monitoring
Peripheral vs central, causality, and the monitoring battery
3
Management, Prevention and Rehabilitation
Drug modification, otoprotection, MT-RNR1, and rehabilitation
🎧 Clinician Audio (3)
1
Mechanisms and the Offending Agents
Two anatomical targets and the aminoglycoside mechanism
2
Recognition, Diagnosis and Monitoring
Peripheral vs central, causality, and the monitoring battery
3
Management, Prevention and Rehabilitation
Drug modification, otoprotection, MT-RNR1, and rehabilitation
Brainstem Stroke & TIA
Vascular events affecting the brainstem that present with acute vertigo, nystagmus, and imbalance.
▶ Clinician Videos (6)
1Introduction, Epidemiology & Vascular AnatomyBurden, misdiagnosis, and the vertebrobasilar supply2Clinical Syndromes by Vascular TerritoryWallenberg, AICA, cerebellar and top-of-basilar3The Acute Vestibular Syndrome & HINTSBedside discrimination of stroke from neuritis4Investigations, Imaging & Vertebrobasilar TIAMRI pitfalls, vessel imaging and the TIA warning5Acute Management & Secondary PreventionReperfusion, antithrombotics and cerebellar swelling6Differential Diagnosis, Prognosis & Future DirectionsMimics, outcomes and the emerging eye-ECG
🎧 Clinician Audio (6)
1Introduction, Epidemiology & Vascular AnatomyBurden, misdiagnosis, and the vertebrobasilar supply2Clinical Syndromes by Vascular TerritoryWallenberg, AICA, cerebellar and top-of-basilar3The Acute Vestibular Syndrome & HINTSBedside discrimination of stroke from neuritis4Investigations, Imaging & Vertebrobasilar TIAMRI pitfalls, vessel imaging and the TIA warning5Acute Management & Secondary PreventionReperfusion, antithrombotics and cerebellar swelling6Differential Diagnosis, Prognosis & Future DirectionsMimics, outcomes and the emerging eye-ECG
Arnold Chiari Malformation
Cerebellar herniation causing dizziness and balance dysfunction.
▶ Clinician Videos (6)
1Introduction, History & EpidemiologyTerminology, prevalence, and the vestibular signal
2Pathophysiology — Hindbrain Herniation & CSF DynamicsPosterior fossa crowding, the pistoning tonsil, and syrinx formation
3Clinical Features & the Central Vestibular SyndromeCough headache, downbeat nystagmus, and the vestibular-predominant pitfall
4Classification, Diagnosis & InvestigationsRadiological thresholds, the syndrome-versus-scan rule, and imaging work-up
5Differential Diagnosis & Conservative ManagementReversible mimics, and the evidence for watchful waiting
6Surgical Decompression, Prognosis & ControversiesDecompression, the duraplasty debate, prognosis and open questions
🎧 Clinician Audio (6)
1Introduction, History & EpidemiologyTerminology, prevalence, and the vestibular signal
2Pathophysiology — Hindbrain Herniation & CSF DynamicsPosterior fossa crowding, the pistoning tonsil, and syrinx formation
3Clinical Features & the Central Vestibular SyndromeCough headache, downbeat nystagmus, and the vestibular-predominant pitfall
4Classification, Diagnosis & InvestigationsRadiological thresholds, the syndrome-versus-scan rule, and imaging work-up
5Differential Diagnosis & Conservative ManagementReversible mimics, and the evidence for watchful waiting
6Surgical Decompression, Prognosis & ControversiesDecompression, the duraplasty debate, prognosis and open questions
Multiple Sclerosis
Autoimmune demyelinating disease that can cause vertigo, nystagmus, and balance dysfunction.
▶ Clinician Videos (6)
1Introduction, History & EpidemiologyWhy MS matters to the vestibular medicine doctor; epidemiology, the Australian latitude gradient, and the three mechanisms of vertigo2Pathophysiology & DemyelinationHow demyelination of the MLF, vestibular nuclei and cerebellum produces the oculomotor and vestibular signs3Clinical Features & INOInternuclear ophthalmoplegia and the central oculomotor signs that separate MS from peripheral vertigo4Diagnosis & the McDonald CriteriaDissemination in space and time, MRI of brain and spine, CSF, and excluding NMOSD and MOGAD5Differential DiagnosisCentral versus peripheral vertigo, posterior circulation stroke, NMOSD, MOGAD and coincident BPPV6Management & RehabilitationRelapse steroids, disease-modifying therapy, symptomatic treatment of nystagmus, and vestibular rehabilitation
🎧 Clinician Audio (6)
1Introduction, History & EpidemiologyWhy MS matters to the vestibular medicine doctor; epidemiology, the Australian latitude gradient, and the three mechanisms of vertigo2Pathophysiology & DemyelinationHow demyelination of the MLF, vestibular nuclei and cerebellum produces the oculomotor and vestibular signs3Clinical Features & INOInternuclear ophthalmoplegia and the central oculomotor signs that separate MS from peripheral vertigo4Diagnosis & the McDonald CriteriaDissemination in space and time, MRI of brain and spine, CSF, and excluding NMOSD and MOGAD5Differential DiagnosisCentral versus peripheral vertigo, posterior circulation stroke, NMOSD, MOGAD and coincident BPPV6Management & RehabilitationRelapse steroids, disease-modifying therapy, symptomatic treatment of nystagmus, and vestibular rehabilitation
Cervical Arterial Dissection
Vertebral and carotid dissection presenting with vertigo and neck pain.
▶ Clinician Videos (6)
1Introduction & EpidemiologyWhy dissection is the stroke not to miss in the young
2Pathophysiology & the Vulnerable WallIntramural haematoma, false lumen and the arteriopathy
3Clinical Features & the Dizzy PatientPain, partial Horner and the isolated-vertigo mimic
4Bedside Recognition & ImagingHINTS, red flags and the crescent sign
5Differential Diagnosis & ManagementCADISS, TREAT-CAD, thrombolysis and stenting
6Prognosis & ControversiesRecanalisation, recurrence and the manipulation debate
🎧 Clinician Audio (6)
1Introduction & EpidemiologyWhy dissection is the stroke not to miss in the young
2Pathophysiology & the Vulnerable WallIntramural haematoma, false lumen and the arteriopathy
3Clinical Features & the Dizzy PatientPain, partial Horner and the isolated-vertigo mimic
4Bedside Recognition & ImagingHINTS, red flags and the crescent sign
5Differential Diagnosis & ManagementCADISS, TREAT-CAD, thrombolysis and stenting
6Prognosis & ControversiesRecanalisation, recurrence and the manipulation debate
Vestibular Processing Disorders
PPPD · Visually Induced Dizziness · Mal de Débarquement · Post-Concussion Dizziness · Anxiety-Related Dizziness · Motion Sickness Susceptibility
Real, disabling, frequently missed — the processing disorders.
PPPD (Persistent Postural-Perceptual Dizziness)
Chronic dizziness worsened by upright posture, movement, and complex visual environments.
▶ Clinician Videos (6)
1Introduction & EpidemiologyPPPD as the commonest chronic vestibular diagnosis
2Pathophysiology — Failed Recalibration & Visual DependenceWhy the protective control mode fails to switch off
3Clinical Features — The Postural, Motion & Visual TriadUpright posture, self-motion and complex visual load
4Diagnosis — Bárány Criteria & the BedsideThe five criteria and a positive diagnosis
5Management — Education, Rehabilitation, CBT & PharmacologyThe four pillars delivered together
6Prognosis, Refractory Disease & ControversiesOutcomes, relapse and the refractory minority
🎧 Clinician Audio (6)
1Introduction & EpidemiologyPPPD as the commonest chronic vestibular diagnosis
2Pathophysiology — Failed Recalibration & Visual DependenceWhy the protective control mode fails to switch off
3Clinical Features — The Postural, Motion & Visual TriadUpright posture, self-motion and complex visual load
4Diagnosis — Bárány Criteria & the BedsideThe five criteria and a positive diagnosis
5Management — Education, Rehabilitation, CBT & PharmacologyThe four pillars delivered together
6Prognosis, Refractory Disease & ControversiesOutcomes, relapse and the refractory minority
Visually Induced Dizziness
Dizziness triggered by complex or moving visual patterns, screens, and busy environments.
▶ Clinician Videos (6)
1Introduction, Definitions & EpidemiologyVID terminology, prevalence and risk factors
2Pathophysiology — Visual-Vestibular Weighting & Sensory MismatchReweighting, the conflict model and cortical motion processing
3Clinical Features & the Trigger HierarchyThe nine VVAS triggers and the cost of avoidance
4Diagnosis, the VVAS & Objective MeasuresStructured history, the 9-item VVAS and posturography
5Management — Optokinetic Rehabilitation, CBT & PharmacologyGraded exposure, psychology and the limited role of medication
6Prognosis, Special Populations & ControversiesRecovery, special groups and the open debates
🎧 Clinician Audio (6)
1Introduction, Definitions & EpidemiologyVID terminology, prevalence and risk factors
2Pathophysiology — Visual-Vestibular Weighting & Sensory MismatchReweighting, the conflict model and cortical motion processing
3Clinical Features & the Trigger HierarchyThe nine VVAS triggers and the cost of avoidance
4Diagnosis, the VVAS & Objective MeasuresStructured history, the 9-item VVAS and posturography
5Management — Optokinetic Rehabilitation, CBT & PharmacologyGraded exposure, psychology and the limited role of medication
6Prognosis, Special Populations & ControversiesRecovery, special groups and the open debates
Mal de Débarquement Syndrome
Persistent sensation of rocking or swaying, often following travel by sea, air, or land.
▶ Clinician Videos (6)
1Introduction & EpidemiologyWhat MdDS is, its central basis, history, and who it affects2Pathophysiology — Velocity Storage MaladaptationHow velocity storage adapts to motion and then fails to reset3Clinical Features, Subtypes & Associated FeaturesThe rocking, paradoxical motion-relief, and MT vs SO subtypes4Diagnosis — The 2020 Bárány CriteriaCriteria A–E and the probable spontaneous-onset category5Investigations & Differential DiagnosisTiered work-up; the motion-relief discriminator vs PPPD6Management — VOR Readaptation, Pharmacology & PrognosisDai protocol, medication, neuromodulation, prognosis & recurrence
🎧 Clinician Audio (6)
1Introduction & EpidemiologyWhat MdDS is, its central basis, history, and who it affects2Pathophysiology — Velocity Storage MaladaptationHow velocity storage adapts to motion and then fails to reset3Clinical Features, Subtypes & Associated FeaturesThe rocking, paradoxical motion-relief, and MT vs SO subtypes4Diagnosis — The 2020 Bárány CriteriaCriteria A–E and the probable spontaneous-onset category5Investigations & Differential DiagnosisTiered work-up; the motion-relief discriminator vs PPPD6Management — VOR Readaptation, Pharmacology & PrognosisDai protocol, medication, neuromodulation, prognosis & recurrence
Post-Concussion Dizziness
Multi-mechanism dizziness after head injury.
▶ Clinician Videos (6)
1Introduction & EpidemiologyA multi-mechanism syndrome and who it affects
2Neurometabolic Cascade & PathophysiologyFrom mechanical force to the clinical vulnerability window
3The Five SubtypesPeripheral, central, autonomic, PPPD and vestibular migraine
4Diagnosis — Red Flags & VFT BatteryImaging triggers, the positional screen and VOMS
5Management — Subtype-Directed TreatmentRepositioning, graded exercise, VRT and pharmacology
6Prognosis, Refractory Disease & MedicolegalRecovery, the refractory work-up and reporting
🎧 Clinician Audio (6)
1Introduction & EpidemiologyA multi-mechanism syndrome and who it affects
2Neurometabolic Cascade & PathophysiologyFrom mechanical force to the clinical vulnerability window
3The Five SubtypesPeripheral, central, autonomic, PPPD and vestibular migraine
4Diagnosis — Red Flags & VFT BatteryImaging triggers, the positional screen and VOMS
5Management — Subtype-Directed TreatmentRepositioning, graded exercise, VRT and pharmacology
6Prognosis, Refractory Disease & MedicolegalRecovery, the refractory work-up and reporting
Anxiety-Related Dizziness
Dizziness driven by anxiety disorders, panic attacks, or hyperventilation syndrome.
▶ Clinician Videos (6)
1Introduction & the Vestibular-Anxiety ProblemWhy it's common, under-recognised, and a positive diagnosis2Neuroanatomy & the Vestibular-Anxiety CircuitThe parabrachial–amygdala–locus coeruleus circuit and three models3Clinical Phenotypes & HyperventilationPanic, GAD, hyperventilation syndrome and space–motion discomfort4Diagnosis & What to Exclude FirstDSM-5, HADS, DHI, Nijmegen, the work-up and the red flags5Pharmacotherapy & Stepped CareSSRIs at half dose, titration, SNRIs and benzodiazepine limits6Non-Drug Therapy, Prognosis & ControversiesVRT, CBT, mindfulness, outcomes and open questions
🎧 Clinician Audio (6)
1Introduction & the Vestibular-Anxiety ProblemWhy it's common, under-recognised, and a positive diagnosis2Neuroanatomy & the Vestibular-Anxiety CircuitThe parabrachial–amygdala–locus coeruleus circuit and three models3Clinical Phenotypes & HyperventilationPanic, GAD, hyperventilation syndrome and space–motion discomfort4Diagnosis & What to Exclude FirstDSM-5, HADS, DHI, Nijmegen, the work-up and the red flags5Pharmacotherapy & Stepped CareSSRIs at half dose, titration, SNRIs and benzodiazepine limits6Non-Drug Therapy, Prognosis & ControversiesVRT, CBT, mindfulness, outcomes and open questions
Motion Sickness Susceptibility
A universal vestibular trait — critical in migraine and rehab.
▶ Clinician Videos (6)
1Introduction & EpidemiologyMSS as a heritable, measurable trait — prevalence, sex and age patterns
2Sensory Conflict & Velocity StorageThe neural-mismatch model, velocity storage, and the brainstem emetic cascade
3Neurochemistry & GeneticsFive receptor systems, heritability, GWAS loci, and reversible modifiers
4Clinical Assessment & Vestibular DisordersMSSQ-Short, VIMSSQ-Short, and the five disorder patterns
5Management — Non-Pharmacological & PharmacologicalHabituation, VRT, scopolamine, antihistamines, and dopaminergic adjuncts
6Cybersickness, Special Populations & Future DirectionsVIMS, the VR-rehabilitation paradox, pregnancy, elderly, and research frontiers
🎧 Clinician Audio (6)
1Introduction & EpidemiologyMSS as a heritable, measurable trait — prevalence, sex and age patterns
2Sensory Conflict & Velocity StorageThe neural-mismatch model, velocity storage, and the brainstem emetic cascade
3Neurochemistry & GeneticsFive receptor systems, heritability, GWAS loci, and reversible modifiers
4Clinical Assessment & Vestibular DisordersMSSQ-Short, VIMSSQ-Short, and the five disorder patterns
5Management — Non-Pharmacological & PharmacologicalHabituation, VRT, scopolamine, antihistamines, and dopaminergic adjuncts
6Cybersickness, Special Populations & Future DirectionsVIMS, the VR-rehabilitation paradox, pregnancy, elderly, and research frontiers
Systemic & Multisensory Balance Disorders
POTS · Orthostatic Hypotension · Presbystasis · Cervicogenic Dizziness · Peripheral Neuropathy & Sensory Ataxia · Frequent Falls
Systemic and multisensory causes of dizziness and imbalance.
POTS (Postural Orthostatic Tachycardia Syndrome)
Excessive heart rate increase upon standing causing dizziness, lightheadedness, and fatigue.
▶ Clinician Videos (6)
1Introduction & EpidemiologyDefining POTS, the heart-rate criterion, prevalence and the post-COVID rise2Pathophysiology & the Four SubtypesVenous pooling, compensatory tachycardia, and the four overlapping subtypes3Clinical Features & PresentationOrthostatic symptoms and the systemic associations that unlock the diagnosis4Diagnosis — Criteria & Autonomic TestingActive stand and tilt testing, thresholds, exclusions and the subtype work-up5Management — Lifestyle, Exercise & PharmacotherapyStepped care: fluid, salt, compression, reconditioning and subtype-directed drugs6Differential Diagnosis, Prognosis & Special PopulationsSeparating the mimics, the realistic outlook, and special populations
🎧 Clinician Audio (6)
1Introduction & EpidemiologyDefining POTS, the heart-rate criterion, prevalence and the post-COVID rise2Pathophysiology & the Four SubtypesVenous pooling, compensatory tachycardia, and the four overlapping subtypes3Clinical Features & PresentationOrthostatic symptoms and the systemic associations that unlock the diagnosis4Diagnosis — Criteria & Autonomic TestingActive stand and tilt testing, thresholds, exclusions and the subtype work-up5Management — Lifestyle, Exercise & PharmacotherapyStepped care: fluid, salt, compression, reconditioning and subtype-directed drugs6Differential Diagnosis, Prognosis & Special PopulationsSeparating the mimics, the realistic outlook, and special populations
Orthostatic Hypotension
A drop in blood pressure upon standing, causing dizziness, lightheadedness, and risk of falls.
▶ Clinician Videos (6)
1Introduction, Epidemiology & the Five SyndromesDefinition, epidemiology, and the five orthostatic syndromes2Pathophysiology & the Autonomic Reflex ArcThe baroreflex arc and its two modes of failure3Clinical Assessment — Active Stand, NASA Lean & TiltThe bedside tests, tilt-table, and autonomic profiling4Differential Diagnosis & Neurogenic OHThe mimics, then neurogenic causes by anatomical level5Management — Non-Pharmacological & PharmacologicalStepped care: reversible causes, physical measures, then drugs6Special Populations, Referral & PrognosisOlder adults, supine hypertension, referral and prognosis
🎧 Clinician Audio (6)
1Introduction, Epidemiology & the Five SyndromesDefinition, epidemiology, and the five orthostatic syndromes2Pathophysiology & the Autonomic Reflex ArcThe baroreflex arc and its two modes of failure3Clinical Assessment — Active Stand, NASA Lean & TiltThe bedside tests, tilt-table, and autonomic profiling4Differential Diagnosis & Neurogenic OHThe mimics, then neurogenic causes by anatomical level5Management — Non-Pharmacological & PharmacologicalStepped care: reversible causes, physical measures, then drugs6Special Populations, Referral & PrognosisOlder adults, supine hypertension, referral and prognosis
Age-Related Balance Decline (Presbystasis)
Progressive balance deterioration with ageing, involving multiple sensory and motor systems.
▶ Clinician Videos (6)
1Introduction & EpidemiologyWhy age-related balance decline is under-recognised, its epidemiology and the falls burden2Pathophysiology — Multisensory TriadVestibular, visual and proprioceptive ageing and the loss of redundancy3Clinical Features & Presbyvestibulopathy CriteriaThe chronic symptom pattern, the Bárány criteria and the vHIT gain band4Investigations & Differential DiagnosisConfirming bilateral hypofunction, treating BPPV first, and the broad differential5Falls Risk & Multidomain ManagementFalls-risk screening and the six-domain management model6Vestibular Rehabilitation & PrognosisThe phased rehabilitation programme, prognosis and future directions
🎧 Clinician Audio (6)
1Introduction & EpidemiologyWhy age-related balance decline is under-recognised, its epidemiology and the falls burden2Pathophysiology — Multisensory TriadVestibular, visual and proprioceptive ageing and the loss of redundancy3Clinical Features & Presbyvestibulopathy CriteriaThe chronic symptom pattern, the Bárány criteria and the vHIT gain band4Investigations & Differential DiagnosisConfirming bilateral hypofunction, treating BPPV first, and the broad differential5Falls Risk & Multidomain ManagementFalls-risk screening and the six-domain management model6Vestibular Rehabilitation & PrognosisThe phased rehabilitation programme, prognosis and future directions
Cervicogenic Dizziness
Cervical proprioceptive dysfunction causing dizziness and unsteadiness.
▶ Clinician Videos (6)
1Introduction, Definition & EpidemiologyWhat cervicogenic dizziness is, why neck pain and dizziness coincide, and how common it is.2Pathophysiology — Cervical Afferents & Sensory ReweightingUpper-cervical proprioceptors, sensory mismatch, and maladaptive central reweighting.3Clinical Features & the Neck–Dizziness ComplexUnsteadiness rather than spinning, coupling with neck pain, and whiplash presentations.4Diagnosis, Bedside Tests & the Role of ExclusionStepwise diagnosis by exclusion, the smooth-pursuit neck-torsion and joint-position-error tests, and red flags.5Assessment Battery & Differential DiagnosisThe cervical sensorimotor battery and the differential, including vestibular migraine.6Management, Stepped Care & PrognosisManual therapy, sensorimotor rehabilitation, the stepped-care pathway, and prognosis.
🎧 Clinician Audio (6)
1Introduction, Definition & EpidemiologyWhat cervicogenic dizziness is, why neck pain and dizziness coincide, and how common it is.2Pathophysiology — Cervical Afferents & Sensory ReweightingUpper-cervical proprioceptors, sensory mismatch, and maladaptive central reweighting.3Clinical Features & the Neck–Dizziness ComplexUnsteadiness rather than spinning, coupling with neck pain, and whiplash presentations.4Diagnosis, Bedside Tests & the Role of ExclusionStepwise diagnosis by exclusion, the smooth-pursuit neck-torsion and joint-position-error tests, and red flags.5Assessment Battery & Differential DiagnosisThe cervical sensorimotor battery and the differential, including vestibular migraine.6Management, Stepped Care & PrognosisManual therapy, sensorimotor rehabilitation, the stepped-care pathway, and prognosis.
Peripheral Neuropathy & Sensory Ataxia
Nerve damage affecting proprioception and balance, common in diabetes and other systemic conditions.
▶ Clinician Videos (6)
1Introduction, Epidemiology & the Dorsal Column PathwayHow common sensory ataxia is, why it matters in balance practice, and the dorsal column pathway.2Clinical Features & Bedside AssessmentCardinal features, the Romberg test and its variants, and confirming the ataxia is proprioceptive.3Investigations — NCS, Blood Panel & Skin BiopsyNerve conduction studies, the blood panel, onconeural antibodies, skin biopsy and imaging.4Differential Diagnosis — Sensory, Cerebellar & VestibularSeparating sensory ataxia from cerebellar, vestibular, spinal and functional mimics, including CANVAS.5Aetiology & Systemic CausesThe metabolic, immune, paraneoplastic, hereditary and toxic causes and the features that flag each.6Management, Rehabilitation, Prognosis & Future DirectionsAetiology-directed treatment, balance rehabilitation, falls prevention and prognosis.
🎧 Clinician Audio (6)
1Introduction, Epidemiology & the Dorsal Column PathwayHow common sensory ataxia is, why it matters in balance practice, and the dorsal column pathway.2Clinical Features & Bedside AssessmentCardinal features, the Romberg test and its variants, and confirming the ataxia is proprioceptive.3Investigations — NCS, Blood Panel & Skin BiopsyNerve conduction studies, the blood panel, onconeural antibodies, skin biopsy and imaging.4Differential Diagnosis — Sensory, Cerebellar & VestibularSeparating sensory ataxia from cerebellar, vestibular, spinal and functional mimics, including CANVAS.5Aetiology & Systemic CausesThe metabolic, immune, paraneoplastic, hereditary and toxic causes and the features that flag each.6Management, Rehabilitation, Prognosis & Future DirectionsAetiology-directed treatment, balance rehabilitation, falls prevention and prognosis.
Frequent Falls in the Elderly
Multifactorial falls risk in older adults involving vestibular, visual, proprioceptive, and cardiovascular factors.
▶ Clinician Videos (6)
1Epidemiology and the Burden of FallsWhy falls are the highest-burden presentation in balance medicine2The Multifactorial Model of FallsConvergent system failure across sensory and systemic domains3Clinical Features, Red Flags & Structured AssessmentHistory, red flags, TUG, Berg and the gait exam4Investigations & Differential DiagnosisTargeted work-up and the dominant driver5Vestibular & Sensory Causes of FallsBPPV, bilateral vestibulopathy and presbyastasis6Multidomain Management & PreventionExercise, deprescribing and the prevention framework
🎧 Clinician Audio (6)
1Epidemiology and the Burden of FallsThe scale, cost and classification of falls2The Multifactorial Model of FallsWhy older adults fall3Clinical Features, Red Flags & Structured AssessmentReading the fall and the structured work-up4Investigations & Differential DiagnosisTargeting investigation and the dominant driver5Vestibular & Sensory Causes of FallsThe contributors generalists miss6Multidomain Management & PreventionSimultaneous intervention across domains
Interesting Cases and Miscellaneous Diseases in Vestibular Clinics
▼Content coming soon — added progressively.
The rarer diagnoses and fascinating presentations of vestibular clinics.
1. Acute Post-Viral Cerebellar Ataxia (PVCA) Coming soon
Post-viral immune cerebellar syndrome, most common in children.
2. Waardenburg Syndrome Coming soon
Neurocristopathy — hearing loss, vestibular dysfunction and pigmentary changes.
3. Wilson's Disease Coming soon
Copper metabolism disorder with hepatic and neurological features.
4. Carotid Sinus Hypersensitivity Coming soon
Exaggerated baroreceptor response causing syncope or presyncope.
5. Superior Oblique Myokymia Coming soon
Trochlear nerve misfiring — shimmering monocular oscillopsia.
6. Palatal Myoclonus Coming soon
Rhythmic palatal movements from Guillain-Mollaret triangle lesions.
7. Stapedius Myoclonus Coming soon
Rhythmic stapedius contractions causing objective tinnitus.
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Emergency Clinicians
High-acuity protocols — acute vestibular syndrome, stroke mimics, HINTS in the ED, and rapid disposition decision-making.
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1. The HINTS Exam — A Stroke Triage Tool
The three-step bedside exam that outperforms early MRI.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
1Why HINTS Beats Early MRI for StrokesOrigin, evidence base (Kattah 2009), and the AVS framework that makes HINTS the most powerful bedside stroke-triage tool
2Diagnosing Strokes with the HINTS Eye ExamPrecise bedside technique for all three HINTS components — head impulse, nystagmus assessment, and test of skew
3HINTS Plus — Interpretation, Pitfalls & Safe DispositionINFARCT mnemonic, the AICA-territory pitfall, HINTS Plus, and safe ED disposition decisions
2. Acute Vestibular Syndrome — Stroke vs Neuritis
Stroke versus neuritis in acute continuous vertigo.
▶ Clinician Videos (3)
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The High-Stakes 24-Hour Rule
Clinical definition, diagnostic criteria, AVS subtypes, and stroke epidemiology
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Vestibular Neuritis vs Posterior Fossa Stroke
Pathophysiology, AICA/PICA territories, and the clinical mimicry that defies history
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HINTS, Red Flags, and the AVS Management Pathway
HINTS examination, stroke red flags, imaging decisions, and ED management
🎧 Clinician Audio (3)
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The 24-Hour Rule, Epidemiology, and Diagnostic Framework
Clinical definition, AVS subtypes, stroke prevalence, and why CT fails in the first 24 hours
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Vestibular Neuritis vs Posterior Fossa Stroke
Pathophysiology, AICA/PICA/cerebellar territories, and the clinical mimicry
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HINTS, Red Flags, Imaging, and Management
HINTS examination, stroke red flags, imaging decisions, and ED management pathway
3. BPPV in the Emergency Department
Rapid bedside diagnosis and treatment in the ED.
▶ Clinician Videos (3)
🎧 Clinician Audio (3)
1Recognising BPPV in the EDEpidemiology, pathophysiology, and why BPPV is frequently misdiagnosed
2Bedside Diagnosis — Dix-Hallpike and Supine RollNystagmus patterns, canal identification, and central red flags
3Treatment and DispositionCanalith repositioning, antiemetics, discharge advice, and specialist referral
4. Posterior Circulation Stroke — Vascular Anatomy for ED
AICA, PICA and basilar anatomy for dizziness presentations.
▶ Clinician Videos (3)
1Vertebrobasilar Anatomy — The Vessels That MatterVertebrals, basilar, PICA, AICA, SCA and PCA — the vessels and territories ED clinicians must know
2Territory-to-Syndrome MappingWallenberg, AICA audiovestibular, locked-in and top-of-basilar — predicting the artery from the signs
3Red Flags, Imaging & Time-Critical ManagementVertigo-plus syndromes, CT vs CTA vs MRI-DWI, thrombolysis and thrombectomy windows
🎧 Clinician Audio (3)
1Vertebrobasilar Anatomy — The Vessels That MatterA walk through posterior-circulation anatomy and territories for the emergency clinician
2Territory-to-Syndrome MappingPattern-recognition deep dive: matching vertebrobasilar territories to the classical brainstem syndromes
3Red Flags, Imaging & Time-Critical ManagementHow to recognise posterior stroke, choose the right imaging, and act within the reperfusion window
5. Episodic Vestibular Syndrome — ED Triage
Triage framework for recurrent vertigo episodes.
▶ Clinician Videos (3)
1Episodic Vertigo in the ED — A Differential FrameworkDefining episodic vestibular syndrome, the differential, and the commonest cause: vestibular migraine
2Ménière's, VB-TIA & Vestibular Paroxysmia — Recognising the PatternsHydrops and Tumarkin, ABCD² risk stratification, and the carbamazepine-responsive paroxysmia
3Cardiac Mimics & ED Algorithm — Getting Disposition RightCardiac and orthostatic causes, red flags, and the structured ED management algorithm
🎧 Clinician Audio (3)
1Framing Episodic Vertigo — Benign vs DangerousDifferential, vestibular migraine, Ménière's disease
2Catching the Dangerous Minority — VB-TIA, Cardiac & ParoxysmiaABCD² risk stratification, cardiac and orthostatic causes, vestibular paroxysmia
3ED Management Algorithm — Risk Stratification & DispositionStructured assessment, red flags, discharge vs admission, follow-up pathways
6. Nystagmus Interpretation for Emergency Clinicians
Practical nystagmus interpretation for emergency clinicians.
▶ Clinician Videos (3)
1Peripheral Nystagmus — Recognising the Benign PatternUnidirectional horizontal-torsional, Alexander's Law, fixation suppression
2Central Nystagmus — Spotting the Red FlagsDirection-changing, pure vertical, pure torsional, failed fixation suppression
3Bedside Workflow for the Dizzy ED PatientObservation, gaze testing, HINTS, positional manoeuvres — sequential triage
🎧 Clinician Audio (3)
1Peripheral Nystagmus — Recognising the Benign PatternUnidirectional horizontal-torsional, Alexander's Law, fixation suppression
2Central Nystagmus — Spotting the Red FlagsDirection-changing, pure vertical, pure torsional, failed fixation suppression
3Bedside Workflow for the Dizzy ED PatientObservation, gaze testing, HINTS, positional manoeuvres — sequential triage
7. Vestibular Emergencies — What Not to Miss
Cerebellar haemorrhage, dissection and other must-not-miss diagnoses.
▶ Clinician Videos (3)
1Vascular Killers — Cerebellar Stroke, VAD, and Basilar OcclusionPosterior-circulation red flags, HINTS+, and time-critical imaging decisions
2Metabolic & Toxic Traps — Wernicke's and CO PoisoningUnder-recognised metabolic emergencies that mimic vestibular disease
3Infection, Trauma & the ED PathwayBacterial labyrinthitis, meningitis, temporal bone fracture — and the full disposition rule
🎧 Clinician Audio (3)
1Vascular Killers — Cerebellar Stroke, VAD, and Basilar OcclusionPosterior-circulation red flags, HINTS+, and time-critical imaging decisions
2Metabolic & Toxic Traps — Wernicke's and CO PoisoningUnder-recognised metabolic emergencies that mimic vestibular disease
3Infection, Trauma & the ED PathwayBacterial labyrinthitis, meningitis, temporal bone fracture — and the full disposition rule
8. Syncope vs Vertigo — Sorting It Out in ED
Separating vertigo from presyncope and cardiac causes.
▶ Clinician Videos (3)
1Defining the Difference — Syncope vs VertigoBedside definitions, overlap zones, and the witness-history questions that separate them
2Sorting the Causes — Reflex, Orthostatic, CardiacThree mechanism buckets, cardiac red flags, and the Canadian Syncope Risk Score
3ED Workup, Disposition & Vestibular OverlapFive data points, overlap syndromes (CSH, POTS, vestibular syncope), and safe disposition
🎧 Clinician Audio (3)
1Defining the Difference — Syncope vs VertigoBedside definitions, overlap zones, and the witness-history questions that separate them
2Sorting the Causes — Reflex, Orthostatic, CardiacThree mechanism buckets, cardiac red flags, and the Canadian Syncope Risk Score
3ED Workup, Disposition & Vestibular OverlapFive data points, overlap syndromes (CSH, POTS, vestibular syncope), and safe disposition
9. Head Impulse Test — Technique and Pitfalls
Correct technique, common errors and interpretation.
▶ Clinician Videos (3)
1VOR Physiology & the Bedside HITThree-neuron arc, what the head impulse actually tests, and why small-fast-unpredictable matters
2Performing HIT & Reading SaccadesStep-by-step technique, overt vs covert saccades, and interpreting peripheral vs central patterns
3Pitfalls & the Dangerous Negative HITFalse positives, false negatives, vHIT, and why a normal HIT in AVS is a red flag
🎧 Clinician Audio (3)
1The Origin & Physiology of HITHalmagyi & Curthoys 1988, the VOR three-neuron arc, and the physiological basis of the corrective saccade
2Technique & Interpretation at the BedsideThe six-step HIT recipe, identifying overt and covert saccades, and integrating HIT into HINTS
3Pitfalls, vHIT & the Dangerous NegativeCommon examination errors, when to escalate to vHIT, and the stroke triage implications of a normal HIT in AVS
10. Disposition Decisions — Safe Discharge After Dizziness
Evidence-based criteria for safe discharge after dizziness.
▶ Clinician Videos (3)
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Risk Stratification & Red FlagsTiTrATE framework, HINTS with gait, and the red flags that override the discharge pathway
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Safe Discharge & DocumentationThe five convergent criteria for safe discharge and the documentation that protects the clinician
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Referrals & MedicolegalOutpatient referral pathways with urgency thresholds and structural mitigation of missed posterior fossa stroke
🎧 Clinician Audio (3)
1Risk Stratification & Red FlagsTiTrATE, HINTS with gait, and the red flags that override the discharge pathway
2Safe Discharge & DocumentationThe five convergent criteria and the documentation that protects patient and clinician
3Referrals & Medicolegal ConsiderationsOutpatient pathways with urgency thresholds and structural mitigation of medicolegal risk
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Vestibular Physiotherapists
Rehabilitation frameworks, balance and gait training, VFT-informed exercise protocols, and assessment tools.
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VRT Principles & Evidence Base
Foundational principles of vestibular rehabilitation: neuroplasticity mechanisms, evidence base, and exercise prescription frameworks.
▶ Clinician Videos (4)
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Why VRT Works: Neuroplasticity & AdaptationCentral compensation and the neuroplastic mechanisms that underpin vestibular rehabilitation
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Patient Selection & AssessmentSelecting candidates for VRT, baseline assessment, and red flags that defer rehabilitation
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Exercise Prescription PrinciplesFrequency, intensity, type, and progression — building an evidence-based VRT programme
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Outcome Measurement & ProgressionValidated outcome measures, dose-response, and criteria for progressing or discharging
🎧 Clinician Audio (4)
1Why VRT Works: Neuroplasticity & AdaptationCentral compensation and the neuroplastic mechanisms that underpin vestibular rehabilitation
2Patient Selection & AssessmentSelecting candidates for VRT, baseline assessment, and red flags that defer rehabilitation
3Exercise Prescription PrinciplesFrequency, intensity, type, and progression — building an evidence-based VRT programme
4Outcome Measurement & ProgressionValidated outcome measures, dose-response, and criteria for progressing or discharging
Gaze Stabilisation Training
VOR adaptation training — exercise prescription, dose-response, and progression for gaze instability.
▶ Clinician Videos (4)
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The VOR & Why Adaptation Works
Retinal slip as the error signal driving cerebellar plasticity
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Patient Selection & Indications
Confirming gaze-stability deficit before prescribing GST
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Exercise Library
x1, x2, near-far switching, busy-background and walking layers
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Outcome Measurement & Progression
DVA, fHIT, DHI, ABC at 4-6 weeks; plateau and onward referral
🎧 Clinician Audio (4)
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The VOR & Why Adaptation Works
Retinal slip as the error signal driving cerebellar plasticity
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Patient Selection & Indications
Confirming gaze-stability deficit before prescribing GST
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Exercise Library
x1, x2, near-far switching, busy-background and walking layers
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Outcome Measurement & Progression
DVA, fHIT, DHI, ABC at 4-6 weeks; plateau and onward referral
BPPV — All Variants (Physio focus)
Recognising and treating posterior, horizontal, and anterior canal BPPV with the appropriate repositioning manoeuvre.
▶ Clinician Videos (4)
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Canal Anatomy & Variant Recognition
Posterior 85%, horizontal 10%, anterior 1–2%; canalithiasis vs cupulolithiasis
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Diagnostic Manoeuvres
Dix-Hallpike, supine roll, ear-down testing — confirming the canal
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Repositioning Manoeuvres
Epley, Semont, BBQ roll, Gufoni, Yacovino by canal variant
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Post-Manoeuvre Care, Recurrence & Referral
Aftercare, recurrence rates, plateau triggers, onward referral
🎧 Clinician Audio (4)
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Canal Anatomy & Variant Recognition
Posterior 85%, horizontal 10%, anterior 1–2%; canalithiasis vs cupulolithiasis
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Diagnostic Manoeuvres
Dix-Hallpike, supine roll, ear-down testing — confirming the canal
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Repositioning Manoeuvres
Epley, Semont, BBQ roll, Gufoni, Yacovino by canal variant
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Post-Manoeuvre Care, Recurrence & Referral
Aftercare, recurrence rates, plateau triggers, onward referral
Balance & Gait Rehabilitation
Sensory-integration assessment, progressive balance training, and gait re-education for vestibular patients.
▶ Clinician Videos (4)
1Balance Systems & Sensory IntegrationVestibular, visual and somatosensory weighting and the central reweighting that drives rehab2Assessment BatteryMini-BESTest, FGA, ABC scale and TUG — thresholds and MCIDs that defend rehab decisions3Progressive Exercise PrescriptionStatic, reactive and dynamic balance exercises — dosing, progression, deficit-matching4Falls Prevention & Real-World CarryoverOtago, STEADI, vitamin D, OT review and the six-week wrap that proves it worked
🎧 Clinician Audio (4)
1Balance Systems & Sensory IntegrationVestibular, visual and somatosensory weighting and the central reweighting that drives rehab2Assessment BatteryMini-BESTest, FGA, ABC scale and TUG — thresholds and MCIDs that defend rehab decisions3Progressive Exercise PrescriptionStatic, reactive and dynamic balance exercises — dosing, progression, deficit-matching4Falls Prevention & Real-World CarryoverOtago, STEADI, vitamin D, OT review and the six-week wrap that proves it worked
Bilateral Vestibulopathy Rehab
Substitution-based rehabilitation strategies for patients with bilateral vestibular hypofunction.
▶ Clinician Videos (4)
1Diagnosis & Functional ImpactBárány Society 2017 criteria, aetiology buckets, and the assessment battery for bilateral loss2Substitution StrategyWhy adaptation fails — cervico-ocular reflex, saccadic substitution, visual preprogramming and proprioceptive reweighting3Exercise ProgramsDosing template for cervico-ocular, saccadic, balance and dim-condition training; progression rules4Long-term Compensation & QoLOscillopsia management, falls prevention bundle, prognosis and indefinite maintenance programme
🎧 Clinician Audio (4)
1Diagnosis & Functional ImpactBárány Society 2017 criteria, aetiology buckets, and the assessment battery for bilateral loss2Substitution StrategyWhy adaptation fails — cervico-ocular reflex, saccadic substitution, visual preprogramming and proprioceptive reweighting3Exercise ProgramsDosing template for cervico-ocular, saccadic, balance and dim-condition training; progression rules4Long-term Compensation & QoLOscillopsia management, falls prevention bundle, prognosis and indefinite maintenance programme
Cervicogenic Dizziness
Diagnostic criteria, cervical assessment, and combined manual-therapy plus exercise approach.
▶ Clinician Videos (4)
1Diagnostic Criteria & DifferentialWrisley criteria; ruling out vestibular and central causes before labelling cervicogenic2Cervical AssessmentJPE test, smooth pursuit neck torsion, ROM and segmental palpation battery3Manual Therapy & Vestibular ComboCombined manual therapy and vestibular exercises driving the 8 to 12 week response4Outcome Tracking & Refer OnwardNDI, JPE, FGA tracking; onward referral for migraine, trauma, radiculopathy or plateau
🎧 Clinician Audio (4)
1Diagnostic Criteria & DifferentialWrisley criteria; ruling out vestibular and central causes before labelling cervicogenic2Cervical AssessmentJPE test, smooth pursuit neck torsion, ROM and segmental palpation battery3Manual Therapy & Vestibular ComboCombined manual therapy and vestibular exercises driving the 8 to 12 week response4Outcome Tracking & Refer OnwardNDI, JPE, FGA tracking; onward referral for migraine, trauma, radiculopathy or plateau
Concussion / mTBI Vestibular Rehab
Vestibular rehabilitation for post-concussive dizziness — VOMS, sub-symptom dosing, and return-to-activity progression.
▶ Clinician Videos (4)
1Concussion Pathway & Five TrajectoriesVestibular, ocular, cervical, cognitive, mood — dominant trajectory directs the lead therapy2Oculomotor Dysfunction & the VOMS BatteryMaster 2016 prevalence, full 7-domain VOMS protocol, Mucha 2014 sensitivity and specificity3Buffalo Treadmill & Sub-Symptom Threshold ExerciseFull BCTT protocol, Leddy 2019 RCT data, 80–85 percent threshold dosing4Return-to-Activity Ladder, Paediatric Care & ReferralBerlin and Amsterdam 6-stage ladder, SCAT6 gates, paediatric and persistent care
🎧 Clinician Audio (4)
1Concussion Pathway & Five TrajectoriesVestibular, ocular, cervical, cognitive, mood — dominant trajectory directs the lead therapy2Oculomotor Dysfunction & the VOMS BatteryMaster 2016 prevalence, full 7-domain VOMS protocol, Mucha 2014 sensitivity and specificity3Buffalo Treadmill & Sub-Symptom Threshold ExerciseFull BCTT protocol, Leddy 2019 RCT data, 80–85 percent threshold dosing4Return-to-Activity Ladder, Paediatric Care & ReferralBerlin and Amsterdam 6-stage ladder, SCAT6 gates, paediatric and persistent care
Functional Dizziness — Physio Approach
Physio approach to functional dizziness and PPPD-spectrum presentations — graded exposure and habituation.
▶ Clinician Videos (4)
1Functional vs Structural Dizziness — Mechanism ModelsFoundational mechanism model that frames the rest of the series2Behavioural Assessment & CBT IntegrationAssessment and engagement workflow used in the clinic3Graded Exposure & Habituation ProtocolsStructured rehabilitation programme step by step4Outcome Measurement & Long-Term MaintenanceOutcome measurement, plateau triage and long-term maintenance
🎧 Clinician Audio (4)
1Functional vs Structural Dizziness — Mechanism ModelsFoundational mechanism model that frames the rest of the series2Behavioural Assessment & CBT IntegrationAssessment and engagement workflow used in the clinic3Graded Exposure & Habituation ProtocolsStructured rehabilitation programme step by step4Outcome Measurement & Long-Term MaintenanceOutcome measurement, plateau triage and long-term maintenance
Outcome Measures in VRT
Patient-reported and performance-based outcome tools, MCIDs, and re-test frequency for VRT.
▶ Clinician Videos (4)
1Why Measure? Domains, Frameworks, MCID ConceptsWhy outcome measurement matters, the ICF-mapped framework, and the MCID concept that drives meaningful change2Patient-Reported Tools (DHI, ABC, VVAS, NPQ)Scoring, interpreting and acting on the four core questionnaires — subscale patterns drive treatment focus3Performance-Based Tools (FGA, Mini-BESTest, Romberg, DVA)The objective battery that pairs with the questionnaires — dynamic gait, balance subsystems, sensory weighting, gaze4Interpreting Change & Driving ProgressionMCID interpretation rules, plateau triage, progression decisions and discharge criteria
🎧 Clinician Audio (4)
1Why Measure? Domains, Frameworks, MCID ConceptsWhy outcome measurement matters, the ICF-mapped framework, and the MCID concept that drives meaningful change2Patient-Reported Tools (DHI, ABC, VVAS, NPQ)Scoring, interpreting and acting on the four core questionnaires — subscale patterns drive treatment focus3Performance-Based Tools (FGA, Mini-BESTest, Romberg, DVA)The objective battery that pairs with the questionnaires — dynamic gait, balance subsystems, sensory weighting, gaze4Interpreting Change & Driving ProgressionMCID interpretation rules, plateau triage, progression decisions and discharge criteria
PPPD — Rehab Component
PPPD-specific rehabilitation programme — VRT plus CBT-informed structure for chronic functional dizziness.
▶ Clinician Videos (4)
1PPPD Diagnostic Criteria & Mechanism (Bárány Society 2017)Bárány 2017 diagnostic criteria and the 3P mechanism model2CBT-Informed Assessment & EngagementPatient-reported tools, predictive-coding script, and engagement strategy3VRT + CBT Programme Structure & DosageIntegrated graded exposure, visual desensitisation, and CBT dosage4Pharmacotherapy Adjuncts & Long-term OutcomesSSRI/SNRI coordination, combination care, and outcome data
🎧 Clinician Audio (4)
1PPPD Diagnostic Criteria & Mechanism (Bárány Society 2017)Bárány 2017 diagnostic criteria and the 3P mechanism model2CBT-Informed Assessment & EngagementPatient-reported tools, predictive-coding script, and engagement strategy3VRT + CBT Programme Structure & DosageIntegrated graded exposure, visual desensitisation, and CBT dosage4Pharmacotherapy Adjuncts & Long-term OutcomesSSRI/SNRI coordination, combination care, and outcome data
VFT Interpretation (Physio lens)
Reading vHIT, caloric, and VEMP reports to guide exercise selection and rehabilitation planning.
▶ Clinician Videos (4)
1vHIT — Reading Gain, Saccades, and AsymmetryRead vHIT canal by canal: gain, refixation saccades, and the affected-plane prescription that follows.2Caloric Testing and Rotational ChairJongkees canal paresis and rotation phase — pairing the low and mid-frequency probes with vHIT.3VEMP — cVEMP and oVEMP (Otolith Integrity)Saccule and utricle assessment, SVV, and the otolith-targeted rehab additions canal work misses.4Integrating VFT Into the Rehabilitation PlanThree-vertex map and five rehab phenotypes — turning a six-page VFT report into a one-page plan.
🎧 Clinician Audio (4)
1vHIT — Reading Gain, Saccades, and AsymmetryRead vHIT canal by canal: gain, refixation saccades, and the affected-plane prescription that follows.2Caloric Testing and Rotational ChairJongkees canal paresis and rotation phase — pairing the low and mid-frequency probes with vHIT.3VEMP — cVEMP and oVEMP (Otolith Integrity)Saccule and utricle assessment, SVV, and the otolith-targeted rehab additions canal work misses.4Integrating VFT Into the Rehabilitation PlanThree-vertex map and five rehab phenotypes — turning a six-page VFT report into a one-page plan.
Vestibular Migraine — Rehab
Trigger management, cautious dosing, and co-management of vestibular migraine in the rehab setting.
▶ Clinician Videos (4)
1VM Diagnostic Criteria and Common TriggersBárány Society and IHS criteria, and the six trigger categories that shape lifestyle prescription.2Trigger Management and Lifestyle PillarsSleep, hydration, diet and aerobic exercise — the foundation of VM rehabilitation.3Cautious Dosing and Habituation LimitsWhy standard VRT fails in VM and the 25–30% dose principle for safe progression.4Long-term Outcomes and Co-management12-week trajectory, plateau handling, and joint review with the vestibular medicine doctor.
🎧 Clinician Audio (4)
1VM Diagnostic Criteria and Common TriggersBárány Society and IHS criteria, and the six trigger categories that shape lifestyle prescription.2Trigger Management and Lifestyle PillarsSleep, hydration, diet and aerobic exercise — the foundation of VM rehabilitation.3Cautious Dosing and Habituation LimitsWhy standard VRT fails in VM and the 25–30% dose principle for safe progression.4Long-term Outcomes and Co-management12-week trajectory, plateau handling, and joint review with the vestibular medicine doctor.
Vestibular Medicine in Children — under revision
The resources in this section have been withdrawn while the series is revised. They will be republished as each review is completed.
The resources in this section have been withdrawn while the series is revised. They will be republished as each review is completed.