Search Results (316)

Background: Vertigo and dizziness have been observed in patients with atrial fibrillation (AF), yet their role as possible early manifestations of AF remains insufficiently understood. Methods: A systematic review of five relevant studies, comprising a total of 2102 patients, was conducted to evaluate the relationship between vestibular symptoms and AF. Results: Dizziness and vertigo were frequently reported, particularly in acute presentations, although they were rarely considered primary symptoms. Evidence suggests a potential correlation between vestibular manifestations and AF, with vertigo possibly acting as an autonomic or inflammatory trigger in selected cases. Conclusions: The findings highlight the clinical relevance of including vertigo and dizziness in the routine assessment of patients with AF. Proper recognition of these symptoms may reduce underdiagnosis, improve treatment adherence, and prevent complications associated with misattribution of vertigo to non-cardiac causes. Full article

Background/Objectives: Previous research has demonstrated that the perception of self-motion, as signaled by cervical proprioception, is significantly altered during neck muscle fatigue, while no similar effects are observed when self-motion is signaled by the vestibular system. Given that in typical natural movements, both proprioceptive and vestibular signals are activated simultaneously, this study sought to investigate whether the misperception of motion persists during neck muscle fatigue when both proprioceptive and vestibular stimulation are present. Methods: The study evaluated the gain of the perceptual responses to symmetric yaw sinusoidal head rotations on a stationary trunk during visual target localization tasks across different rotational frequencies. In addition, the final localization error of the visual target was assessed following asymmetric sinusoidal head rotations with differing half-cycle velocities. Results: The findings indicated that even with combined proprioceptive and vestibular stimulation, self-motion perceptual responses under neck muscle fatigue showed a pronounced reduction in the gain at low-frequency stimuli and a notable increase in localization error following asymmetric rotations. Notably, spatial localization error was observed to persist after asymmetric stimulation conditioning in the light. Additionally, even moderate levels of muscle fatigue were found to result in increased self-motion misperception. Conclusions: This study suggests that neck muscle fatigue can disrupt spatial orientation, even when the vestibular system is activated, so that slow movements are inaccurately perceived. This highlights the potential risks associated with neck muscle fatigue in daily activities that demand precise spatial perception. Full article

Background/Objectives: Skull vibration-induced nystagmus (SVIN) is a rapid bedside test that reveals vestibular asymmetry. Its clinical utility in Ménière’s disease (MD) remains controversial, particularly regarding its association with radiological endolymphatic hydrops (EH). This study aimed to evaluate the relationship between SVIN, audiovestibular parameters, and EH severity in patients with unilateral definite MD. Methods: This prospective observational study was conducted at a tertiary academic referral center and included patients with unilateral MD who underwent SVIN testing (SVT), audiovestibular evaluation (PTA, cVEMP, oVEMP, vHIT, and caloric testing), and 3T MRI with gadolinium-enhanced 3D-FLAIR sequences to quantify EH. Results: In total, 84 patients were included in the study. SVIN was present in 57.14% of patients (n = 48), with ipsilesional nystagmus being the most frequent subtype (64.58%). Patients with SVIN had significantly higher vestibular EH (p = 0.017) and vestibular endolymphatic ratio (REL) in the affected ear (p = 0.019). Disease duration (p = 0.026) and shorter time since last vertigo spell (p = 0.018) were also associated with SVIN presence. REL correlated moderately with disease duration (r = 0.390, p < 0.001), PTA (r = 0.576, p < 0.001), and number of vertigo spells (r = 0.236, p = 0.031), but not with time since last crisis (r = −0.127, p = 0.252). ROC analysis yielded an AUC of 0.735 for REL in predicting SVIN. Conclusions: SVIN correlates with the severity of vestibular EH. This finding indicates a stimulus-locked response of a vestibular asymmetry rather than a purely structural alteration. Full article

Background: Despite the widespread use of antibiotics, acute mastoiditis (AM) and related complications resulting from acute purulent otitis media continue to occur, predominantly in children. Although numerous studies have focused on the pathogenesis, aetiological agents, and treatment of AM, comprehensive investigations of the long-term outcomes of AM and the physiological consequences of surgical intervention in the temporal bone are lacking. Methods: Thirty patients who had undergone mastoidectomy for acute mastoiditis at a median age of 2.12 years were invited for evaluation at least five years postoperatively. The assessment included the Chronic Otitis Media Questionnaire 12, clinical examination with otomicroscopy, extended high-frequency pure-tone audiometry, distortion product otoacoustic emissions, middle ear impedance testing, and a newly developed protocol for noninvasive mastoid function measurement. Results were compared with a control group of 30 ears and with a group of 30 ears treated solely with tympanostomy for acute otitis media at risk of mastoiditis. Results: Although mean Chronic Otitis Media Questionnaire 12 scores were below 1 point, patients who had undergone mastoidectomy reported slightly greater difficulties with hearing in both quiet and noisy environments, along with an increased perception of tinnitus and unpleasant sensations around the ear. Otomicroscopy revealed minor structural changes in the test groups, which were absent from the control group. Pure-tone audiometry demonstrated approximately 10 dB higher thresholds at high and extended high frequencies, with similar findings observed in the distortion product otoacoustic emissions. Middle ear impedance testing indicated elevated stapedius reflex thresholds in the mastoidectomy group, while other parameters showed no statistically significant differences. Mastoid function testing demonstrated preserved pressure-buffering capacity but reduced thermal insulation of the vestibular organ under extreme thermal stimulation—an occurrence rarely encountered in daily life. Conclusions: In the long term, most patients recovering from acute mastoiditis exhibit only minor functional and structural sequelae, and the impact of mastoidectomy appears negligible compared with less invasive surgical interventions. Full article

Existing research has preliminarily achieved stable walking in humanoid robots; however, natural human-like leg motion and adaptive capabilities in dynamic environments remain unattained. This paper proposes a bionic central pattern generator (CPG) gait generation method based on Kimura neurons. The method maps the CPG output to the spatial motion patterns of the robot’s center of mass (CoM) and foot trajectory, modulated by 22 undetermined parameters. To address the vague physical interpretation of CPG parameters, the strong neuronal coupling, and the difficulty of decoupling, this research systematically optimized the CPG parameters by defining an objective function that integrates dynamic balance performance with step constraints, thereby enhancing the naturalness and coordination of gait generation. To further enhance the walking stability of the robot under varying road curvatures, a vestibular reflex mechanism was designed based on the Tegotae theory, enabling real-time posture adjustment during slope walking. To validate the proposed approach, a virtual simulation platform and a physical humanoid robot system were constructed to comparatively evaluate motion performance on flat terrain and slopes with different gradients. The results show that the energy consumption characteristics of robot-coordinated gait are highly consistent with the energy-saving mechanism of human natural motion. In addition, the established reflection mechanism significantly improves the motion stability of the robot in slope transition, and its excellent stability margin and environmental adaptability are verified by simulation and experiment. Full article

Purpose: This systematic review aims to analyze the literature on the application of AI in predicting patient outcomes and treatment-related toxicity in those undergoing SBRT or SRS across heterogeneous tumor sites. Materials and methods: Our review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, EMBASE and Scopus were systematically searched for English-language human studies evaluating AI for outcome and toxicity prediction in patients undergoing SBRT or SRS for solid tumors. Search terms included (“Stereotactic Body Radiotherapy” OR “SBRT” OR “Stereotactic Radiosurgery” OR “SRS” OR “Stereotactic Ablative Radiotherapy” OR “SABR”) AND (“Artificial Intelligence” OR “AI” OR “Machine Learning” OR “Deep Learning” OR “Radiomics”) AND (“Response Prediction” OR “Response to Treatment” OR “Outcome Prediction”) AND (“Toxicity” OR “Side Effects” OR “Treatment Toxicities” OR “Adverse Events”). Results: The search yielded 29 eligible retrospective studies, published between 2020 and 2025. Eight studies addressed early-stage primary lung cancer, highlighting the potential of AI-based models in predicting radiation-induced pneumonitis, fibrosis and local control. Five studies investigated AI models for predicting hepatobiliary toxicity following SBRT for liver tumors. Sixteen studies involved SRS-treated patients with brain metastases or benign intracranial neoplasms (e.g., arteriovenous malformations, vestibular schwannomas, meningiomas), exploring AI algorithms for predicting treatment response and radiation-induced changes. In the results, AI might have been exploited to both reaffirm already known clinical predictors and to identify novel imaging, dosimetric or biological biomarkers. Examples include predicting radiation pneumonitis in lung cancer, residual liver function in hepatic tumors and local recurrence in brain metastases, thus supporting tailored treatment decisions. Conclusions: Combining AI with SBRT could greatly enhance personalized cancer care by predicting patient-specific outcomes and toxicity. AI models analyze complex datasets, including imaging and clinical data, to identify patterns that traditional methods may miss, thus enabling more accurate risk stratification and reducing variability in treatment planning. With further research and clinical validation, this integration could make radiotherapy safer, more effective and contribute to advancement in precision oncology. Full article

Background/Objectives: To evaluate the predictive role of anti-compensatory saccades in diagnosing mild acute unilateral vestibular loss. Methods: Consecutive patients with vertigo who underwent a bedside vestibular evaluation and video head impulse testing of the horizontal semicircular canal at the San Bernardino Outpatient Clinic in Salò, Italy, between 1 January and 30 June 2024 were examined (Group 1). Two control groups were considered: patients with severe unilateral acute vestibular loss (Group 2) and healthy subjects (Group 3). The video head impulse testing patterns of anti-compensatory saccades (amplitude, scattered pattern, and latency) using the suppression head impulse paradigm were analyzed to evaluate their predictive role in identifying horizontal canal dysfunction, even when borderline gain values of the canal’s vestibulo-ocular reflex were present. Results: Group 1 included 74 patients, Group 2 included 20 patients, and Group 3 included 20 healthy, voluntary subjects. The anti-compensatory saccades revealed significant differences in the amplitudes and scattered patterns between the two ears, exclusively in Groups 1 and 2. Conclusions: The anti-compensatory saccades alterations using the suppression head impulse paradigm can predict mild acute unilateral vestibular loss, even when the horizontal semicircular canal’s vestibulo-ocular reflex gain values are mild (lower borderline). Conversely, a borderline asymmetry of the horizontal semicircular canal’s vestibulo-ocular reflex using the classic head impulse paradigm should not be considered a marker of mild acute unilateral vestibular loss when the saccadic pattern is symmetrical using the suppression head impulse paradigm. Further meticulous differential diagnostic investigations are necessary in such cases to effectively diagnose horizontal semicircular canal dysfunction. Full article

Background/Objectives: Pediatric episodic vestibular syndrome (EVS) is increasingly recognized, with recurrent vertigo of childhood (RVC) and vestibular migraine of childhood (VMC) being the most prevalent disorders. In 2021, the Bárány Society and the International Headache Society proposed new diagnostic criteria for RVC, VMC, and probable VMC (pVMC), replacing the older term benign paroxysmal vertigo (BPV). This study aimed to evaluate the clinical applicability of these new criteria. Methods: We conducted a cross-sectional study at a pediatric neurotology clinic within a tertiary hospital, including patients under 18 years with episodic vestibular symptoms evaluated between 2018 and 2025. All patients underwent a standardized neuro-otological assessment. Diagnoses were assigned using both the 2018 ICHD-3 and the 2021 Bárány criteria. Patients who did not fulfill any of the three new diagnostic categories, nor met criteria for any other specific vestibular disorder, were grouped into an undetermined category referred to as episodic vestibular syndrome without hearing loss (EVSw/oHL). Demographic and clinical variables were compared across diagnostic groups using non-parametric and chi-squared tests. Results: Among the 202 children evaluated, 109 met the inclusion criteria and were classified as RVC (n = 55), VMC (n = 23), pVMC (n = 13), or EVSw/oHL (n = 18). All patients previously diagnosed with BPV met the new criteria for RVC. Application of the Bárány criteria significantly reduced the proportion of unclassified EVS cases (from 35.78% to 16.51%). Significant clinical differences were observed among the groups in terms of episode duration, presence of vomiting, migraine and headache, and family history of migraine. Conclusions: The new Bárány criteria provide a more inclusive and clinically meaningful framework for classifying pediatric EVS. They improve diagnostic clarity, reduce the proportion of unclassifiable cases, and support earlier and more tailored management strategies. Full article

Background and Clinical Significance: Intralabyrinthine schwannoma (ILS) is a rare benign tumor of the inner ear, often presenting with nonspecific symptoms such as hearing loss, tinnitus and vertigo. Vestibular function in ILS patients remains underexplored. This study aims to evaluate vestibulo-ocular reflex (VOR) function and inner ear magnetic resonance imaging (MRI) signal changes in ILS, and to provide insights into potential mechanisms underlying vestibular dysfunction. Case Presentation: We report four cases of MRI confirmed ILS, including two intravestibular and two intravestibulocochlear schwannomas. All patients exhibited unilateral canal paresis on caloric testing, and two of three showed abnormal video head impulse test (vHIT) with decreased VOR gain and corrective saccades. Decreased signal intensity was observed in the semicircular canals in three cases, in the vestibule in one case, and in the cochlea in one case. A systematic literature review including 10 studies (n = 171) showed a 73.3% rate of abnormal caloric responses. Five studies conducted vHIT, reporting reduced mean VOR gain and corrective saccades, though quantitative analysis was limited. Cervical and ocular vestibular evoked myogenic potential abnormalities were found in 68.4% and 65.7% of reported cases, respectively. Conclusions: Impaired VOR function in patients with ILS may result not only from anatomical disruption but also from underlying biochemical or metabolic alterations within the inner ear. Full article

Background/Objectives: Vestibular migraine is a frequently underdiagnosed cause of dizziness in adult females, often overlapping clinically with other vestibular and neurological conditions. Despite its recognition in diagnostic criteria, limited data exist on its prevalence and functional impact in women presenting with dizziness in clinical settings. This study assesses the frequency and diagnostic rate of vestibular migraine among females aged 20–50 years presenting with dizziness and evaluates its impact on quality of life and work productivity. Methods: A cross-sectional study was conducted, which included 196 female patients reporting dizziness who were evaluated. Vestibular migraine was diagnosed using ICHD-3 criteria. Functional impact was assessed using the Dizziness Handicap Inventory (DHI) and Work Productivity and Activity Impairment (WPAI) questionnaire. Group comparisons and regression analyses were conducted using SPSS version 24. Results: Vestibular migraine was diagnosed in 84 participants, yielding a prevalence rate of 42.86% (95% CI: 36.13–49.86%). Compared to non-migraine participants, those with vestibular migraine had longer dizziness duration (37.62 ± 11.34 vs. 24.58 ± 10.49 min, p = 0.032), higher DHI (58.34 ± 15.62 vs. 32.76 ± 14.83, p < 0.001) and WPAI scores (42.19 ± 13.45 vs. 23.47 ± 12.90, p < 0.001), and more missed workdays. Regression analysis identified vestibular migraine, poor sleep, anxiety/depression, and BMI as significant predictors of work impairment. Conclusions: Vestibular migraine is a prevalent and functionally disabling condition among women with dizziness, underscoring the importance of systematic diagnosis and multidisciplinary management. Full article

Background: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic vestibular disorder characterized by dizziness, instability, and visual hypersensitivity. Vestibular Physical Therapy (VPT) is commonly used, but its efficacy remains uncertain due to limited and heterogeneous evidence. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of VPT in reducing dizziness and improving balance in individuals with PPPD. Methods: A systematic search of MEDLINE and PEDro was conducted in January 2025. Studies were selected following PRISMA guidelines and included if they assessed VPT interventions in patients diagnosed with PPPD. Risk of bias was assessed using the PEDro scale and the modified Newcastle–Ottawa Scale. The meta-analysis focused on pre- and post-intervention changes in Dizziness Handicap Inventory (DHI) scores using a random-effects model. Results: Six studies met the inclusion criteria. VPT significantly reduced DHI scores (pooled Hedges’ g = 1.60; 95% CI: 0.75–2.45), indicating a moderate to large improvement. Additional outcomes included improvements in postural control (e.g., mini-BESTest and posturography) and psychological well-being (anxiety and depression questionnaires). However, high heterogeneity (I² = 92%) was present across studies. Conclusions: VPT may improve dizziness and balance in PPPD, though evidence is limited. Further high-quality trials with standardized protocols are needed. Full article

(1) Aim: To compare transverse dimensions measured on AI-generated intra-oral models and conventional digital intra-oral models. (2) Methods: A group of 38 patients treated with clear aligners was selected retrospectively from those whose records featured both AI-generated and conventional digital intra-oral models taken at the same timepoint. Transverse dimensions (inter-canine, inter-premolar, and inter-molar distances) on both upper and lower arches were evaluated and compared. Intra-class correlation index and paired t-test were applied to test the repeatability of measurements and statistically significant differences, respectively. Statistical significance was set at 0.05. (3) Results: Intra-class correlation index showed good repeatability. Paired t-test showed differences in measurements of the distances between the thicket area of gingiva on the palatal side of the upper first molar (p = 0.002), the gingival margin of the lower first molar (p = 0.014), and the mesio-vestibular cusps of the lower first molars (p = 0.019). (4) Conclusions: Transverse measurements were similar on AI-generated and conventional intra-oral .stl renderings. Statistical differences were found on posterior areas of both upper and lower dental arches, but are unlikely to be clinically significant. Full article

Background/Objectives: The aetiology of Bell’s palsy remains unclear and is typically diagnosed by exclusion. This study investigated the potential role of neurotropic viruses and explored the relationship between facial nerve impairment and vestibular dysfunction to improve the understanding of the condition. Methods: Antibodies against herpes simplex virus (HSV) and varicella-zoster virus (VZV) were assessed using ELISA. Vestibular function was evaluated through computerised videonystagmography, rotatory chair, and clinical vestibulospinal assessments. Facial nerve lesion localisation was determined by stapedial reflex testing. Fisher’s exact test was used for statistical analysis. Results: Of 51 patients with Bell’s palsy, 62.7% exhibited vestibular dysfunction, and 70.6% were IgG-positive for at least one neurotropic virus. Vestibular impairment was significantly more common in seropositive patients. Statistically significant associations were observed between vestibular dysfunction and viral IgG seropositivity (p < 0.0001), the severity of vestibular dysfunction and facial paresis (p = 0.0126), and the side of vestibular impairment and the side of facial palsy (p < 0.0001), with 90.6% of cases showing ipsilateral involvement. Conclusions: These findings support the hypothesis that neurotropic viruses may act as a common pathological factor in both Bell’s palsy and associated vestibular dysfunction. Full article

Background/Objectives: Schwannoma is a rare tumor, typical in young adults, originating from the myelin sheath that surrounds Schwann cells. It can occur in any part of the Peripheral Nervous System (PNS). It develops in the head and neck region in 25–48% of cases, and the eighth pair of cranial nerves (vestibulocochlear nerves) are the most hit (vestibular schwannoma). Oral cavity involvement is exceedingly rare, accounting for about 1–2% of all cases. The most affected oral site is the tongue, especially its anterior third, while localization on the lip is one of the least common sites for the development of this lesion. Case Presentation: A lower lip schwannoma on a 17-year-old boy, present for about 7 years, was documented. Material and Methods: PubMed and Google Scholar were used as research engines; English scientific works published in the last 20 years (2005–2024) regarding oral cavity involvement, using the keywords “Schwannoma”, “Oral Schwannoma”, “Pediatric Oral Schwannoma”, and “Schwannoma of the lip”, were considered. Results: In total, 805 and 16,890 items were found on PubMed and Google Scholar search engines, respectively. After title, abstract, full text evaluation, and elimination of duplicates, 26 articles were included in the review process. Discussion: Clinically, oral schwannoma presents as an asymptomatic hard–elastic fluctuating mass, often misdiagnosed on the lip as a traumatic or inflammatory lesion (e.g., mucocele). Biopsy is mandatory, and histological examination reveals positivity to the neuronal marker S-100. Conclusions: Complete excision also prevents recurrence. Malignant transformation is extremely rare. Full article

Objective: Mandibular expansion remains controversial due to concerns about long-term stability and effectiveness. While maxillary expansion protocols are well established, investigations into mandibular expansion remain limited. This study evaluates the efficacy of the Clara Expander appliance for mandibular expansion in early mixed dentition, assessing skeletal and dental changes using cone-beam computed tomography (CBCT). Materials and Methods: This prospective longitudinal study was conducted in Valencia, Spain, with a population of healthy children aged 6–10 years presenting negative osseodental mandibular discrepancies. CBCT scans were performed before and after treatment to evaluate mandibular dimensional changes, with statistical analyses conducted and a significance threshold of p < 0.05. A total of seven subjects were included in this case series, allowing for a descriptive analysis of treatment outcomes within this specific clinical context. Results: CBCT analysis confirmed significant mandibular expansion following the Clara Expander protocol. Post-treatment findings showed statistically significant increases in dental parameters, including Tooth 6 (furcation, MD = −2.25; p = 0.015), Tooth E (furcation, cementoenamel junction, vestibular, lingual, all p < 0.001), Tooth D (all variables significant), and Tooth C (furcation, MD = −4.18; p = 0.002; cementoenamel junction, MD = −3.56; p = 0.015). Conclusions: The Clara Expander appliance effectively promotes skeletal and dental mandibular expansion, with minimal adverse effects. Its user-friendly, non-invasive design enhances patient compliance and outcomes, contributing valuable data to the field of mandibular expansion and informing future research and clinical applications. Full article