The International Classification of Vestibular Disorders: Achievements, challenges, and future directions

Diego Kaski¹, Alexander A Tarnutzer^{2

3}, Yuri Agrawal⁴, John Carey⁵, Yoon-Hee Cha⁶, Scott Dz Eggers⁷, Joseph Furman⁸, Hyun Ah Kim⁹, Ji-Soo Kim¹⁰, Thomas Lempert¹¹, Jose A López-Escámez^{12

13

14}, Mans Magnusson^{15

16}, David E Newman-Toker^{17

18}, Barry M Seemungal¹⁹, Jeffrey P Staab²⁰, Michael Strupp²¹, Raymond van de Berg²², Michael von Brevern²³, Bryan K Ward²⁴, Alexandre Bisdorff²⁵

Affiliations

¹ SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK.
² Neurology, Cantonal Hospital of Baden, Baden, Switzerland.
³ Faculty of Medicine, University of Zurich, Zurich, Switzerland.
⁴ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, USA.
⁵ Department of Otorhinolaryngology, Johns Hopkins University, School of Medicine, Baltimore, USA.
⁶ Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
⁷ Department of Neurology, Mayo Clinic, Rochester, MN, USA.
⁸ Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
⁹ Department of Neurology, Keimyung University Dongsan Hospital, Daegu, South Korea.
¹⁰ Department of Neurology, Seoul National University College of Medicine, Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹¹ Department of Neurology, Schlosspark-Klinik, Berlin, Germany.
¹² Meniere Disease Neuroscience Research Program, Faculty of Medicine and Health, School of Medical Sciences, The Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
¹³ Division of Otolaryngology, Department of Surgery, Instituto de Investigación Biosanitaria, ibs.GRANADA, Universidad de Granada, Granada, Spain.
¹⁴ Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain.
¹⁵ Department of Otorhinolaryngology and Clinical Sciences, Lund University & Skane University Hospital, Lund, Sweden.
¹⁶ Rigshospitalet and Danish Technological University, Copenhagen, Denmark.
¹⁷ Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
¹⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁹ Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK.
²⁰ Departments of Psychiatry and Psychology and Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
²¹ Department of Neurology and German Center for Vertigo and Balance Disorders, LMU Hospital, LMU Munich, Munich, Germany.
²² Department of Otorhinolaryngology and Head and Neck Surgery, Division of Vestibular Disorders, Maastricht University Medical Center, Maastricht, Netherlands.
²³ Private Practice of Neurology and Department of Neurology, Charité, Berlin, Germany.
²⁴ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
²⁵ Clinique du Vertige, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg.

PMID: 39973600
PMCID: PMC12231871
DOI: 10.1177/09574271251313803

Review

The International Classification of Vestibular Disorders: Achievements, challenges, and future directions

Diego Kaski et al. J Vestib Res. 2025 May.

. 2025 May;35(3):105-112.

doi: 10.1177/09574271251313803. Epub 2025 Jan 8.

Authors

Affiliations

¹ SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK.
² Neurology, Cantonal Hospital of Baden, Baden, Switzerland.
³ Faculty of Medicine, University of Zurich, Zurich, Switzerland.
⁴ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, USA.
⁵ Department of Otorhinolaryngology, Johns Hopkins University, School of Medicine, Baltimore, USA.
⁶ Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
⁷ Department of Neurology, Mayo Clinic, Rochester, MN, USA.
⁸ Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
⁹ Department of Neurology, Keimyung University Dongsan Hospital, Daegu, South Korea.
¹⁰ Department of Neurology, Seoul National University College of Medicine, Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹¹ Department of Neurology, Schlosspark-Klinik, Berlin, Germany.
¹² Meniere Disease Neuroscience Research Program, Faculty of Medicine and Health, School of Medical Sciences, The Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
¹³ Division of Otolaryngology, Department of Surgery, Instituto de Investigación Biosanitaria, ibs.GRANADA, Universidad de Granada, Granada, Spain.
¹⁴ Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain.
¹⁵ Department of Otorhinolaryngology and Clinical Sciences, Lund University & Skane University Hospital, Lund, Sweden.
¹⁶ Rigshospitalet and Danish Technological University, Copenhagen, Denmark.
¹⁷ Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
¹⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁹ Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK.
²⁰ Departments of Psychiatry and Psychology and Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
²¹ Department of Neurology and German Center for Vertigo and Balance Disorders, LMU Hospital, LMU Munich, Munich, Germany.
²² Department of Otorhinolaryngology and Head and Neck Surgery, Division of Vestibular Disorders, Maastricht University Medical Center, Maastricht, Netherlands.
²³ Private Practice of Neurology and Department of Neurology, Charité, Berlin, Germany.
²⁴ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
²⁵ Clinique du Vertige, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg.

PMID: 39973600
PMCID: PMC12231871
DOI: 10.1177/09574271251313803

Abstract

In 2007, the Bárány Society embarked on a project to establish definitions of vestibular syndromes and disorders based on best available evidence, referred to as the International Classification of Vestibular Disorders (ICVD). Since then, numerous publications providing consensus-driven diagnostic criteria for vestibular symptoms, syndromes, and disorders have been published. Here, we reflect on the rationale for developing the ICVD as well as its subsequent achievements, challenges, and outlook. In this summary of the work of the ICVD to date, the authors will focus on practical aspects to help improve the utility and applicability of these diagnostic criteria moving forward.

Keywords: Bárány Society; International Classification of Vestibular Disorders; dizziness; unsteadiness; vertigo.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Four-layer framework of the International Classification of Vestibular Disorders. *BPPV:* benign paroxysmal positional vertigo; *OTR:* ocular tilt reaction; *TIA*: transient ischemic attack; *VOR:* vestibular ocular reflex.

See this image and copyright information in PMC

References

1. Bisdorff A, Bosser G, Gueguen R, et al. The epidemiology of vertigo, dizziness, and unsteadiness and its links to co-morbidities. Front Neurol 2013; 4: 29. - PMC - PubMed
1. Bosner S, Schwarm S, Grevenrath P, et al. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care - a systematic review. BMC Fam Pract 2018; 19: 33. - PMC - PubMed
1. Newman-Toker DE, Hsieh YH, Camargo CA, Jr., et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 2008; 83: 765–775. - PMC - PubMed
1. Newman-Toker DE, Cannon LM, Stofferahn ME, et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007; 82: 1329–1340. - PubMed
1. Drossman DA, Hasler WL. Rome IV-functional GI disorders: disorders of gut-brain interaction. Gastroenterology 2016; 150: 1257–1261. - PubMed

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The International Classification of Vestibular Disorders: Achievements, challenges, and future directions

Affiliations

The International Classification of Vestibular Disorders: Achievements, challenges, and future directions

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources