Skip to main content

ORIGINAL RESEARCH article

Front. Neurol.
Sec. Neuro-Otology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1540443
This article is part of the Research Topic Challenges and Current Research Status of Vertigo/Vestibular Diseases Volume III View all 13 articles

World-wide survey on the treatment of peripheral vestibular disorders

Provisionally accepted
Michael Strupp Michael Strupp 1,2*Nils Lucca Kern Nils Lucca Kern 1,2Göran Laurell Göran Laurell 3Louisa Lehner Louisa Lehner 1,2Eva Grill Eva Grill 1,4Ralf Strobl Ralf Strobl 1,4
  • 1 German Vertigo and Balance Center, LMU Munich University Hospital, Munich, Bavaria, Germany
  • 2 Department of Neurology, LMU University Hospital, Munich, Germany
  • 3 Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Uppsala, Sweden
  • 4 Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Bavaria, Germany

The final, formatted version of the article will be published soon.

    Objective. The aim of this world-wide survey was to evaluate the currently applied treatment options of the six most frequent peripheral vestibular disorders: benign paroxysmal positional vertigo (BPPV), acute unilateral vestibulopathy (AUVP)/vestibular neuritis, Menière’s disease (MD), bilateral vestibulopathy (BVP), vestibular paroxysmia (VP) and superior canal dehiscence syndrome (SCDS). Background. For the therapy of vestibular disorders, there are four treatment options: vestibular physical therapy (canalith repositioning maneuvers or balance training), pharmacotherapy, surgery, and psychotherapy. Since there are very few state-of-the-art RCTs, the treatment of vestibular disorders is so far not standardized and various methods are applied with heterogeneous efficacy. Design/Methods. A web-based standardized survey questionnaire on the treatment of the six most frequent peripheral vestibular disorders was used to collect data. Results. 234 replies from five continents, 47 countries, 162 cities and 188 centers were received: (% from all 234 replies; multiple answers possible): BPPV: posterior canal BPPV: 71% Epley, 40% Semont, and 12% others. Horizontal canal BPPV canalolithiasis: 58% Lempert (roll-over) maneuver, 33% Gufoni, 7% prolonged rest, and 9% others. Horizontal canal BPPV cupulolithiasis: 35% Gufoni, 27% Lempert (roll-over) maneuver, 9% Zuma, and 7% head shaking: AUVP: 79% pharmacotherapy, namely 47% glucocorticoids, 39% antiemetics, and 24% betahistine; 67% vestibular physical therapy. MD: 85% pharmacotherapy, namely 65% betahistine, 21% diuretics, 20% steroids, 16% antiemetics, 14% gentamicin; 37% surgery. VP: 65% pharmacotherapy, namely 57% anticonvulsants; 7% surgery. BVP: 77% vestibular physical therapy. SCDS: 50% Surgery, namely 19% canal plugging, 12% capping, and 8% resurfacing. Conclusions. In this world-wide survey with 234 replies from 188 centers widely heterogeneous applied treatment options were reported for the six most frequent peripheral vestibular disorders. This study shows in particular that certain drugs are often used despite low or very low evidence. Namely in AUVP, MD and VP well-designed controlled trials with clinically meaningful endpoints are needed.

    Keywords: Peripheral vestibular disorders, BPPV, acute unilateral vestibulopathy, Menière's disease, bilateral vestibulopathy, Vestibular paroxysmia, SCDS, 67% vestibular physical therapy. MD: 85% pharmacotherapy, namely 65% betahistine, 21% diuretics, 20% steroids, 16% antiemetics, 14% gentamicin

    Received: 05 Dec 2024; Accepted: 15 Jan 2025.

    Copyright: © 2025 Strupp, Kern, Laurell, Lehner, Grill and Strobl. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Michael Strupp, German Vertigo and Balance Center, LMU Munich University Hospital, Munich, 81377, Bavaria, Germany

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.