Across institutions and specialties, the paraclinical assessment of dizzy patients remains inconsistent. This symposium will examine the use of vestibular function tests—such as vHIT, VEMPs, caloric irrigation—alongside audiometry and neuroimaging, highlighting their respective roles in ENT-driven diagnostic workflows. Presenters will address how clinical relevance, accessibility, cost-effectiveness, and emerging evidence can guide rational testing strategies and optimize resource use. Differences in practice between countries and interdisciplinary settings will also be discussed, with the goal of identifying pathways toward more standardized and efficient dizziness diagnostics.

Diagnostic Challenges panel discussion general

This proposal presents a series of real-life clinical cases that illustrate common diagnostic errors and challenges encountered in neurotology. Despite major advances in vestibular testing and imaging, clinicians still face significant difficulties in accurately differentiating between peripheral and central causes of vertigo, as well as functional and psychogenic components. The cases selected reflect typical pitfalls seen in everyday clinical practice, such as misdiagnosis of vestibular migraine as Menière’s disease, misinterpretation of pseudospontaneous nystagmus in cupulolithiasis-type BPPV, and diagnostic complexity in multicanal BPPV with overlapping otolithic debris. Additionally, we explore a case of delayed compensation in vestibular neuritis despite early and correct treatment, suggesting the possibility of hidden pathophysiological factors.

Through this structured case-based approach, we aim to emphasize the importance of systematic clinical reasoning, detailed positional testing, and reassessment in patients who do not follow the expected recovery pattern. These cases serve not only as learning tools, but also as a starting point for discussing broader diagnostic strategies in neurotology, encouraging clinicians to adopt a flexible and integrative perspective