An update on neuro-otology and neuro-ophthalmology - focusing on new developments in the last three years.

Vertigo, dizziness, and imbalance are among the most frequent presenting symptoms in primary care and in the emergency department (ED). The clinical diagnosis is based on a structured patient history and bedside examination of the vestibular system and the ocular motor system, looking especially for central ocular motor signs. Recent guidelines, such as the GRACE-3 guideline on acute vertigo and dizziness, the increasing availability of bedside diagnostic algorithms, and the use of quantitative vestibular and ocular motor testing in both the ED-setting and in the outpatient center have facilitated and standardized the approach to the dizzy patient. Here we review recent developments in neuro-otology and neuro-ophthalmology, covering the period after the latest neuro-otology update was published in this journal in 2023. Both new-onset acute, episodic and chronic vestibular conditions are discussed separately, highlighting advancements in disease characterization, diagnostic criteria, and treatment strategies. While major progress has been made in terms of the pathophysiology, etiology, genetics, and diagnostic criteria of peripheral, central, and functional vestibular diseases as well as ocular motor disorders, this knowledge has to be transferred into clinical practice. Systematic teaching of doctors to increase knowledge and to improve skills in applying the different tests in clinical practice on a high level are identified challenges. In terms of treatment, there is still a very great need for state-of-the art clinical trials applying approved therapies.