**3. Economic aspects**

The CI nor the vHIT could replace each other. On the average, the time needed to perform a horizontal vHIT is 6 ± 1 min (mean ± standard deviation), 3-D vHIT 10 ± 2 min and a caloric irrigation 22 ± 2 min. The examination and documentation of the results by the clinician including removing error traces and setting markers right were estimated at 5–10 min for each test. Rotatory tests, which are more time consuming (10–20 min), might be important in only limited number of disease, for example, BV or central vestibular disease, which is not reviewed in detail here.

In certain disease and depending on the question, not all tests have to be applied, to save time. The saved time could be used to diagnose additional patients. From an economic point of view, just to identify a unilateral vestibular failure and with the mixture of diagnosis in a specialized vertigo/dizziness clinic, I recommend using the vHIT-first approach. In case of an unremarkable vHIT, you additionally should use the CI. There is one exception, if you clinically suspect an MD, you should use the CI first (for details see [20]). From these data, I suggest a disease-dependent approach to save diagnostic time and decrease stress of the patient.

#### **4. Summary**

The PC was most affected (89%), less the HC (85%) and least the AC (39%). Preserved AC function was associated with aminoglycoside toxicity, MD and BVL of unknown origin. No such sparing of specific SCCs was found for inner ear infections, cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) and sensorineural hearing

Stroke with an acute vestibular syndrome is found in about 16% of inferior cerebellar stroke. The main question is how to dissociate stroke from a peripheral vestibular lesion, which accounts for about 25% [83]. This is very important for stroke treatment as there is only a short time frame (4.5 h after symptom onset in Germany) to apply revascularization therapy with

To differentiate the peripheral disease from stroke, the horizontal vHIT is used, together with central signs, for example, the gaze evoked nystagmus and the tonic skew deviation, a vertical divergence of the eyes. This test battery is also known as the HINTS test. In general, the vHIT is normal in stroke. There are some rare exceptions with lesions of the brainstem (e.g. vestibular nuclei) or cerebellum, mostly in the territory of the anterior inferior cerebellar artery (AICA). It is important that the auditory artery is a branch of the AICA which supplies the labyrinth and cochlea. For further discussion on this topic, I recommend the current

The CI nor the vHIT could replace each other. On the average, the time needed to perform a horizontal vHIT is 6 ± 1 min (mean ± standard deviation), 3-D vHIT 10 ± 2 min and a caloric irrigation 22 ± 2 min. The examination and documentation of the results by the clinician including removing error traces and setting markers right were estimated at 5–10 min for each test. Rotatory tests, which are more time consuming (10–20 min), might be important in only limited number of disease, for example, BV or central vestibular disease, which is not reviewed

In certain disease and depending on the question, not all tests have to be applied, to save time. The saved time could be used to diagnose additional patients. From an economic point of view, just to identify a unilateral vestibular failure and with the mixture of diagnosis in a specialized vertigo/dizziness clinic, I recommend using the vHIT-first approach. In case of an unremarkable vHIT, you additionally should use the CI. There is one exception, if you clinically suspect an MD, you should use the CI first (for details see [20]). From these data, I suggest a disease-dependent approach to save diagnostic time and decrease stress of the

loss [81]. CANVAS is a late-onset ataxia with a neuropathy and a BV [82].

*2.3.7. Inferior cerebellar stroke*

126 Up to Date on Meniere's Disease

literature [83–86].

in detail here.

patient.

**3. Economic aspects**

the systemic intravenous thrombolysis.

From the reviewed data presented here, it is recommended to use a vestibular-testing battery depending on the question asked. The bithermal CI does not replace the vHIT and vice versa, both techniques are needed. In future, the more detailed vestibular test profiles will help to diagnose disease with a higher sensitivity and specificity, to predict outcome and to identify new disease with new therapeutic options.
