Vestibular Alterations in Patients with Systemic Sclerosis: A Narrative Review

Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease characterized by immune dysregulation, microvascular damage, and progressive fibrosis affecting multiple organs. While cardiopulmonary, renal, and gastrointestinal manifestations have been extensively investigated, involvement of the vestibular system remains insufficiently explored and is likely underrecognized in clinical practice. Vestibular symptoms such as dizziness, vertigo, imbalance, and postural instability may significantly affect quality of life and functional independence in patients with SSc. The pathophysiology of vestibular involvement in SSc is presumed to be multifactorial, involving microangiopathy of the inner ear, immune-mediated damage to vestibular end organs, fibrotic changes affecting inner ear homeostasis, and, in some cases, central nervous system involvement. This narrative review provides a comprehensive and critical synthesis of the current literature on vestibular alterations in systemic sclerosis. We discuss underlying mechanisms, clinical manifestations, diagnostic strategies, associations with common vestibular disorders, and the role of vestibular rehabilitation. By consolidating existing evidence and identifying knowledge gaps, this review aims to promote a more systematic and multidisciplinary approach to the evaluation and management of vestibular dysfunction in SSc.