Recent advances in diagnostic and therapeutic strategies for management of dizzy patients in Japan

The present review summarized the recent advances in diagnostic and therapeutic strategies for management of dizzy patients in Japan. Standardization of diagnosis, examination, and treatment of vestibular disorders and nationwide epidemiological surveys of vestibular disorders are high-priority projects of Japan Society for Equilibrium Research (JSER). JSER published clinical practice guidelines for Ménière’s disease, delayed endolymphatic hydrops, benign paroxysmal positional vertigo, vestibular neuritis, vestibular test battery, and vestibular rehabilitation. JSER published a video library of vestibular testing and nystagmus and abnormal eye movements. JSER performed nationwide surveys of Ménière’s disease, delayed endolymphatic hydrops, and bilateral vestibulopathy. Visualization of endolymphatic hydrops in gadolinium-enhanced magnetic resonance imaging (MRI) was developed in Japan. MRI of endolymphatic hydrops becomes an indispensable tool to diagnose Ménière’s disease. The new surgical procedure of endolymphatic sac surgery with steroid instillation and middle ear pressure therapy with a Japanese device become new therapeutic strategies for intractable Ménière’s disease in Japan. Neural and pharmacological mechanisms of static vestibular compensation were revealed in Japan. Diazepam accelerates the initial process of static vestibular compensation and short-term administration with diazepam is recommended for the treatment of acute vertigo in patients with unilateral vestibulopathy. Betahistine accelerates the late process of static vestibular compensation and long-term administration with betahistine is recommended for the treatment of subacute vertigo in patients with unilateral vestibulopathy. Vestibular rehabilitation is effective in developing dynamic vestibular compensation and beneficial for improving chronic dizziness in patients with unilateral vestibulopathy. Vestibular rehabilitation with a Japanese vestibular substitution device is a promising strategy for chronic dizziness in patients with unilateral vestibulopathy.