Description: Hormonal fluctuations significantly impact vestibular function across different life stages in women. This session explores how vestibular function is affected during menarche, pregnancy, and menopause, highlighting diagnostic insights using vHIT SHIMP, saccadometry, and ocular counter-roll (OCR). We will discuss how estrogen and progesterone influence vestibular pathways, leading to dizziness and balance dysfunctions. Attendees will gain practical knowledge on identifying vestibular disorders linked to hormonal changes and optimizing diagnostic accuracy using advanced vestibular assessments.

Outcome Objectives: By the end of this session, attendees will be able to:

- Analyze the effects of hormonal fluctuations on vestibular function during menarche, pregnancy, and menopause.
- Compare vHIT SHIMP, saccadometry, and OCR findings across these three hormonal stages.
- Interpret vestibular test results to differentiate between peripheral and central dysfunctions in hormonally influenced dizziness.
- Implement clinical strategies for assessing vestibular disorders in women experiencing hormonal transitions.

Structure of the Session (30 min):

- Introduction (5 min): Overview of hormonal influences on the vestibular system.
- Menarche & Vestibular Function (7 min): Early hormonal changes and their impact on balance.
- Pregnancy & Vestibular Adaptations (7 min): Hemodynamic and vestibular changes in gestation.
- Menopause & Vestibular Decline (7 min): Estrogen depletion and balance dysfunction.

Conclusion (4 min): Summary and final considerations.

Background & References:

MacDougall HG, McGarvie LA, Halmagyi GM, Rogers SJ, Manzari L, Burgess AM, Curthoys IS, Weber KP. A new saccadic indicator of peripheral vestibular function based on the video head impulse test. Neurology. 2016 Jul 26;87(4):410-8. doi: 10.1212/WNL.0000000000002827

Demian D, Petrak M, Zielinski G, Massingale S, Alexander A, Fuemmeler L, Lin CC. Clinical Saccadometry: Establishing Evaluative Standards Using a Simplified Video Oculography Protocol in the Adult Population. J Am Acad Audiol. 2023 Feb;34(1-02):19-27. doi: 10.1055/s-0043-1772582.

Castillo-Bustamante M, Del Cid Chua C, Vázquez M, Bello Dotel L, Baez Recalde M. Hormonas sexuales y alteraciones neurotológicas en Mujeres [Estrogen and neurotological diders in womenSexual hormones and neurotological disorders in women]. Rev Fac Cien Med Univ Nac Cordoba. 2020 Dec 19;77(4):351-355. Spanish. doi: 10.31053/1853.0605.v77.n4.29349

Castillo-Bustamante M, Çelebisoy N, Echavarria LG, Franco I, Valencia S, Gonzalez S, García A. Balance in Transition: Unraveling the Link Between Menopause and Vertigo. Cureus. 2024 Apr 29;16(4):e59277. doi: 10.7759/cureus.59277 Feng MY, Gu HH, Tian Q, Yang HL, Zhuang JH. Molecular Mediators of Estrogen Reduction-induced Otolith Shedding. Curr Med Sci. 2021 Aug;41(4):667-672. doi: 10.1007/s11596-021-2421-3

Vestibular migraine (VM) is one of the most common causes of recurrent vertigo, yet it remains underdiagnosed and often challenging to manage in clinical practice. In this keynote lecture, two experts will provide a comprehensive overview of VM based on current diagnostic and therapeutic approaches. The first part will focus on the clinical features and diagnostic criteria of VM. The second part will discuss evidence-based treatment strategies, including both acute management and preventive therapy. This session will offer practical insights for clinicians managing patients with balance disorders and highlight key updates in the field of vestibular medicine.

Functional impairment of the vestibular end organ resulting from impulse noise exposure

Ototoxicity includes both cochleotoxicity and vestibulotoxicity. Whilst the former is well recognised, there is a distinct lack of awareness for the latter. Drug induced toxicity of the vestibular system generates significant morbidity and indeed is cryptogenic and remains undiagnosed. It is imperative that pharmacological agents that can damage the cochlea are recognised as agents that can also damage the vestibular system and hence evaluated from the vestibular point of view for prevention and treatment purposes. This lecture discusses in detail the different vestibulotoxic agents, their mechanism of action, their effect and the management of vestibulotoxicity. Alder Hey Hospitals affiliated to the University of Liverpool, UK has developed a vestibulotoxicity monitoring protocol for this purpose and one of the very few global centres to incorporate this as routine to monitor ototoxicity

Skull vibration Induced Nystagmus (an updating point)

Description

In this short talk, I will focus on the diagnostic dilemma posed by patients who continue to experience dizziness despite successful canalith repositioning maneuvers for BPPV. Using selected patient cases and vestibular testing data, I will explore how residual dizziness can overlap with or mask underlying conditions such as vestibular migraine, Ménière’s disease, or persistent postural-perceptual dizziness (PPPD). My goal is to help clinicians differentiate between benign post-treatment symptoms and signs of a broader vestibular pathology that requires additional management.

Outcome Objectives

After this presentation, attendees will be able to:

- Recognize clinical red flags that suggest residual dizziness is not due to BPPV alone
- Compare features of RD with vestibular migraine, Ménière’s disease, and PPPD
- Apply practical strategies to avoid unnecessary repeated repositioning maneuvers

Title: What’s New in Pediatric Swallowing Assessment: Innovations and Future Directions

Description & Background: Pediatric dysphagia is a complex, multifactorial condition with significant implications on nutrition, growth, respiratory health, and quality of life. Assessment of swallowing in children requires a nuanced approach due to age-related anatomical and physiological differences, comorbid conditions, and limitations in cooperation or communication, particularly among infants and children with developmental delays.

In recent years, pediatric swallowing assessment has undergone notable advancements. Beyond conventional videofluoroscopic swallow studies (VFSS), newer techniques such as fiberoptic endoscopic evaluation of swallowing (FEES), high-resolution pharyngeal manometry, pharyngeal impedance monitoring, and advanced salivary diagnostics are emerging as powerful tools. Additionally, incorporating artificial intelligence (AI) in interpreting imaging and developing wearable technologies and portable assessments signal a move towards personalised and non-invasive diagnostics.

This presentation will synthesize the latest evidence, showcase practical applications from a multidisciplinary pediatric swallowing and aerodigestive clinic, and propose frameworks for integrating novel tools into routine practice. Emphasis will be placed on the importance of an interdisciplinary approach involving otolaryngologists, speech-language pathologists, gastroenterologists, radiologists, and nutritionists in developing individualized care pathways for children with swallowing difficulties.

Drawing from real-world clinical experience, the talk will explore gaps, especially in the pediatric normative data for newer technologies, and emphasise the need for international collaboration to develop standardised protocols and cross-disciplinary training models.

Outcome Objectives: By the end of this session, participants will be able to:

1. Describe the latest diagnostic innovations in pediatric swallowing assessment, including instrumental and non-instrumental methods.
2. Recognize the clinical value of a multidisciplinary, integrated approach to evaluating dysphagia in children.
3. Apply new knowledge in tailoring swallowing assessments for medically complex pediatric populations.
4. Identify emerging research directions, including the role of salivary biomarkers, AI-based analytics, and cross-disciplinary protocols in enhancing assessment accuracy and patient outcomes.
5. Develop ideas for collaborative international research and practice models to standardise and optimize pediatric swallowing evaluation globally.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a valuable, minimally invasive tool for assessing oropharyngeal dysphagia. This presentation will provide an overview of FEES methodology, indications, and interpretation strategies in both acute and chronic care settings. Emphasis will be placed on its role in multidisciplinary dysphagia management, including collaboration between otolaryngologists, speech-language pathologists, and rehabilitation teams.

The session will include case-based examples to illustrate typical findings, safety considerations, and decision-making in diet modification and therapeutic planning. Attendees will gain practical insights into integrating FEES into routine clinical workflows and enhancing patient outcomes through accurate and timely swallowing assessment.

Outcome Objectives

By the end of this session, participants will be able to:

- Recognize swallowing dysfunction patterns in a range of systemic diseases.
- Analyze pathophysiological mechanisms linking systemic conditions to dysphagia.
- Interpret VFSS and FEES findings in systemic disease-related swallowing disorders.
- Compare therapeutic strategies for managing dysphagia in complex internal medicine patients.
- Implement interdisciplinary assessment approaches in their clinical practice.

Structure of the Session

- Brief overview of systemic diseases commonly associated with dysphagia
- Pathophysiological insights for each condition
- Case presentations with VFSS and FEES video analysis
- Interactive discussion on evaluation and management strategies
- Audience Q&A and takeaway clinical pearls

Background

Swallowing involves a complex neuromuscular coordination that can be disrupted by systemic diseases affecting the gastrointestinal, endocrine, connective tissue, or central nervous systems. Inflammatory bowel diseases can lead to pharyngeal dysmotility via systemic inflammation or medication effects. Fibromyalgia and amyloidosis may impair swallowing through myopathy or protein deposition in muscular and neural tissues. Hypothyroidism and Behçet’s disease can lead to structural or sensory abnormalities. Neurological diseases, whether central or peripheral, are well-known causes of oropharyngeal dysphagia. Despite their varied etiologies, these conditions often present with overlapping symptoms and require detailed instrumental evaluation for accurate diagnosis. VFSS and FEES are essential tools for identifying aspiration risk, residue, and impaired protective reflexes in this population.