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Open research questions in Vestibular and auditory disorders

47 unresolved questions extracted from the limitations and future-work sections of 484 Vestibular and auditory disorders papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • While positional testing should be applied in all patients with TVS, HINTS+ has not been validated in those patients without nystagmus or with transient (already resolved) symptoms.

    A Guide to Patients with Acute Transient Vestibular Symptoms in the Emergency Department · 2026 · DOI

  • Further studies incorporating longitudinal designs and multimodal autonomic assessments are warranted to clarify the relationship between autonomic function and VM.

    Quantitative pupillometry as a marker of autonomic dysregulation in vestibular migraine · 2026 · DOI

  • Background: Vestibular migraine (VM) has been associated with altered central sensory processing; however, objective measures of autonomic involvement remain insufficiently characterized.

    Quantitative pupillometry as a marker of autonomic dysregulation in vestibular migraine · 2026 · DOI

  • In particular, semicircular canal function, typically assessed through vestibulo-ocular reflex (VOR) recordings, has yielded inconsistent findings, with reports describing either no effect or reduced performance in microgravity.

    Swung and spun in weightlessness : Evidence of immediate canalar underdetection of rotations in parabolic flight · 2026 · DOI

  • Vitamin D deficiency has been linked to musculoskeletal pain, muscle dysfunction, and impaired postural stability; however, its role in CD remains unclear.

    Association of serum vitamin D levels with clinical severity and recovery duration in cervical dizziness · 2026 · DOI

  • However, VNG and video Fren- zel goggles alone are insufficient to differentiate peripheral DBN, particularly in cases of AC and APC-BPPV, as these forms can present similarly to central positional nystagmus.

    Vestibular deficit and recovery in rare forms of benign paroxysmal positional vertigo with downbeat nystagmus · 2026 · DOI

  • Purpose Idiopathic sudden sensorineural hearing loss (ISSNHL) is traditionally managed as a uniform clinical emergency using empirical corticosteroid protocols, yet outcomes vary widely, suggesting underlying etiologic heterogeneity.

    Pathophysiologic phenotyping of idiopathic sudden sensorineural hearing loss: toward precision management · 2026 · DOI

  • Future research should focus on well-designed, double-blind ran- domized controlled trials enrolling patients with clearly defined cen- tral vertigo, ideally confirmed by neuroimaging or vestibular testing. Ginkgo biloba extract may represent a therapeutic option for patients with central vertigo, particularly those with underlying cere- brovascular or neurodegenerative conditions in whom vestibular sup- pressants are limited by adverse effects such as sedation or cognitive impairment.

    Ginkgo biloba extract for dizziness-related symptoms in central neurological disorders: a systematic review and meta-analysis · 2026 · DOI

  • Future research should explore the barriers preventing some professionals from applying this effective methodology, despite its proven benefits and assess the impact of refresher courses on vertigo management, and evaluate the sustained benefits and economic viability of such interventions, including their potential to reduce unnecessary investigations and diagnostic delays.

    Effectiveness of training on vertigo/dizziness coding in primary care: a community-based cluster-randomized trial · 2026 · DOI

  • Several limitations should be considered when interpreting our findings. Due to the study design, we were unable to determine the proportion of patients who underwent key diagnostic maneuvers, such as the Dix-Hallpike or head impulse test -essential yet often underused in clinical practice—or whether training led to an increase in their use, which limits our ability to link training directly to procedural competence. Time trends and differences between patient groups may also represent potential sources of confounding. The COVID-19 pandemic and subsequent years likely affected diagnostic coding and the use of diagnostic tests for vertigorelated conditions; previous studies reported reductions of up to 75% in BPPV visits and 88.2% in Ménière’s disease visits in Japan due to fear of contagion. To address this, the preintervention assessment period was shifted from 2021 to 2019, but this adjustment may introduce time-trend confounding. Moreover, residual changes in care pathways and coding practices may have persisted into 2022, potentially leading to an underestimation of specific diagnoses in the post-intervention period. Despite measures to minimize contamination, such as excluding previously trained centres and restricting access to the intervention, informal professional interactions and physician mobility may have led to some contamination between intervention and control centres, potentially biasing results toward the null. Although absolute differences at the population level were small (~0.05%), they may still have meaningful implications for healthcare resource use, as modest improvements in diagnostic accuracy can reduce unnecessary tests, specialist referrals, and prolonged sick leave, not measured in this study. Vestibular migraine could not be assessed due to the absence of a specific ICD-10 code, despite its clinical importance, frequent underdiagnosis, and specific treatment options, and central vertigo diagnoses were grouped due to their very low frequency, which may have resulted in some misclassification. In addition, this classification does not capture the full etiological spectrum of vertigo, including cardiovascular, psychiatric and central causes. Given 18 ARTICLE IN PRESS ARTICLE IN PRESS that peripheral vestibular disorders are the most frequent causes of vertigo, the results should be interpreted as reflecting changes in diagnostic coding behaviour for selected peripheral conditions, rather than overall improvements in vertigo diagnostic accuracy. Accordingly, results should be interpreted with caution, placing emphasis not only on statistical significance but also on effect sizes and the consistency of associations observed across outcomes.

    Effectiveness of training on vertigo/dizziness coding in primary care: a community-based cluster-randomized trial · 2026 · DOI

  • Our findings may help clinicians align treatment selection with specific clinical objectives (e.g., symptom relief vs. functional recovery), while recognizing uncertainty in the underlying evidence. A major gap remains the lack of well-designed, headto-head trials directly comparing clearly defined acupuncture and manual-therapy protocols.

    Comparative effectiveness of acupuncture and Tuina for cervical vertigo: a systematic review and network meta-analysis of randomized controlled trials · 2026 · DOI

  • This survey was limited to all adult major trauma centres in the UK and Ireland but achieved a good response rate (87.5%). In most instances, one healthcare professional completed the survey on behalf of a team, and therefore some responses may reflect individual views or practice. This survey did not include healthcare professionals from trauma units not designated MTC status, or community rehabilitation units, both of which typically receive patients with a TBI in the sub-acute or chronic phases. Future work could extend this survey to these services to provide a more complete picture of service provision and evaluate whether clinicians experience of managing this cohort is associ- ated with referral practices. Additionally, it is acknowledged that the survey was sent to healthcare professionals working in major trauma, and as a result may only reflect service provision for moderate severe patients with TBI, as patients with mild or symp- tomatic TBI (as per the Mayo criteria (2)) do not always attend hospital or may be discharged from Accident and Emergency without being admitted to a specialist acute trauma ward. Due to the majority of respondents being physiotherapists, it was not possible to explore associations between professional background and whether routine assessment or treatment were completed.

    Inconsistencies in care: a UK and Ireland survey exploring acute vestibular service provision in adult major trauma centres · 2026 · DOI

  • Despite the clear differences observed across postures and frequency bands, several limitations should be acknowledged. First, the experimental design focused exclusively on static postures, without including dynamic balance or motor tasks that could better capture real-world postural control processes. Although careful preprocessing and artifact rejection were applied, a small amount of residual noise in the EEG signal cannot be completely excluded, especially for high-frequency bands. In addition, the sample size (n = 20) and the relatively homogeneous age range (21–28 years) limit the generalizability of the present findings. The observed EEG patterns may differ across age groups due to developmental or age-related changes in cortical connectivity and sensorimotor control. It should be noted, however, that the primary aim of this study was not to generalize the findings to the entire population, but rather to characterize cortical modulation in a group of healthy young adults with comparable anthropometric and physiological characteristics. The inclusion criteria were intentionally narrow to minimize inter-individual variability and to allow for a controlled investigation of posture-related cortical dynamics. Consequently, the present results should be interpreted as representative of individuals with similar features to those included in the study sample. Future studies could include larger and more demographically diverse populations to assess whether the reported effects are consistent across different life stages. Furthermore, while the 3-35 Hz analysis range comprehensively captured all standard EEG rhythms relevant to postural and visual modulation, it did not include ultra-slow (< 3 Hz) or high-frequency (> 35 Hz) components. A broader range such as 1-100 Hz could potentially reveal additional contributions, particularly in the orthostatic condition where muscle artifacts might be more pronounced. However, the elevated risk of non-neural contamination (EMG, eye movements) in static posture paradigms justified the decision to use an analog 35 Hz low-pass filter. Future studies using high-density montages and advanced artifact correction could explore these spectral regions to provide complementary insights. Traditional FFT-based PSD does not distinguish periodic oscillations from the aperiodic 1/f background, potentially confounding band power estimates. Parameterization approaches such as FOOOF could provide more nuanced insights into posture-related changes in aperiodic exponent/offset al.ongside periodic peaks, warranting application in future studies.

    Influence of Posture and Eye Condition on Resting-state Cortical Activity in Healthy Young Adults · 2026 · DOI

  • Future studies should aim to expand these findings by incor- porating active motor tasks and dynamic postural adjust- ments, allowing a more direct link between cortical activity and motor execution. The use of high-density EEG systems (e.g., 64 or 128 channels) would enable finer spatial resolu- tion and connectivity analyses, providing deeper insight into the interplay between cortical regions during postural con- trol. Combining EEG with other physiological or kinematic measures, such as electromyography or center-of-pressure analysis, could also help clarify how neural oscillations translate into functional movement control. Additionally, the integration of nonlinear signal processing techniques— such as entropy measures, recurrence quantification, and fractal-based analysis—could further enhance the under- standing of complex cortical dynamics. Recent work on nonlinear approaches applied to biosignals (e.g., electroder- mal activity [49]) demonstrates their potential for improv- ing automatic feature extraction and classification accuracy, and similar methods could be adapted for EEG analysis in posture-related studies. Furthermore, the integration of advanced machine learning approaches, such as convolu- tional neural networks (CNNs) or recurrent neural networks (RNNs), could open new avenues for EEG-based posture classification and prediction. These models are capable of identifying complex spatial and temporal patterns in EEG data that may remain undetected with conventional spectral methods. Applying deep learning frameworks to posture- related EEG datasets could thus enhance the understanding of cortical dynamics and support the development of intel- ligent neurofeedback and rehabilitation systems.

    Influence of Posture and Eye Condition on Resting-state Cortical Activity in Healthy Young Adults · 2026 · DOI

  • Due to the short follow-up period for evaluating the long-term impact of vestibular rehabilitation therapy, we recommend longer follow-up periods to observe the full benefits of vestibular compensation. Ethics approval and consent to participate This study was conducted in accordance with Helsinki standards for human studies and gained approval from the ethical committee at Assiut University with number (IRB 04-2023-200192). All data were coded to maintain patient confidentiality. All participants provided informed consent after receiving a detailed explanation of the study objectives and procedures.

    Symptomatic and functional outcomes of medical therapy alone versus sequential vestibular rehabilitation in patients with vestibular migraine · 2026 · DOI

  • Previous studies used acupuncture as adjunctive therapy, with small sample sizes and poorly designed control groups, which has prevented a clear determination of acupuncture's intrinsic role in treating PSVV.

    Effects and central mechanisms of acupuncture for post-stroke vascular vertigo: study protocol of a multicenter, randomized, sham-controlled trial · 2026 · DOI

  • The etiopathogenesis of MD remains incompletely understood; however, the presence of endolymphatic hydrops is recognised as a central pathophysiological mechanism with additional contributions from autoimmune, infectious, genetic and microcirculatory factors .

    Ménière’s Disease: Current Pharmacological and Surgical Approaches · 2025 · DOI

  • Previous research reports highly variable postoperative vestibular lesion rates between 18% and 85% in implanted children, with no clear consensus on underlying mechanisms.

    Saccular function evolution related to cochlear implantation in hearing impaired children · 2020 · DOI

  • In light of the accumulated lack of evidence for the effectiveness of SIT, continued use of the technique outside of research contexts does not appear to be justified.

    Research on the Efficacy of Sensory Integration Therapy: Past, Present and Future · 2008 · DOI

  • For better understanding of the contribution of the vestibular system to motor development of children, further research on the relationship of the different semi circular canals with different motor functions, the effect of rehabilitation focused on the functioning of a specific canal, and the effect of different rehabilitation programmes on different vestibular deficiencies are suggested.

    A review of the interrelationship between vestibular dysfunction, motor and learning diabilities and the rehabilitation thereof · 2007 · DOI

  • However, the cerebral dynamics of otolithic information processing and their sensitivity to body orientation remain poorly characterized.

    Cerebral vestibular-evoked potentials depend on body orientation · 2026 · DOI

  • The impact of cellular activities on large-scale brain dynamics is thought to determine brain functioning and disease, yet the causal relationships of neural mechanisms across scales remain unclear.

    The Cerebellar Engine: Multiscale Digital Brain Co-simulations Reveal How Cerebellar Spiking Architecture Shapes Cortical Coherence · 2026 · DOI

  • The vestibular system is critical for early motor development, yet the respective roles of its two subsystems, the semicircular canals and otolith organs, remain poorly defined.

    A functional hierarchy of semicircular canal and otolith contributions to early motor development · 2026 · DOI

  • Using tracer injections and electrophysiological recordings, we show that the lamprey vestibular nuclei are largely interconnected, while their inputs from other brain regions are scarce.

    Brain inputs to the vestibular nuclei in lampreys · 2026 · DOI

  • The study will provide preliminary investigation of acupuncture's neuroplasticity effects and offer guidance for the early treatment of PSVV.

    Effects and central mechanisms of acupuncture for post-stroke vascular vertigo: study protocol of a multicenter, randomized, sham-controlled trial · 2026 · DOI

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47 open questions have been extracted from the limitations and future-work passages of 484 Vestibular and auditory disorders papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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