High-Frequency Vibration as a Vestibular Stimulus: From Jerk-Rich Physiology to Clinical Applications.

BACKGROUND: High-frequency bone-conducted vibration (BCV) and skull vibration-induced nystagmus (SVIN) are widely used to probe vestibular function, yet their physical nature and physiological targets remain incompletely defined. In particular, the relationship between vibration physics and jerk, the time derivative of acceleration, and their relevance to vestibular activation has not been systematically explored. OBJECTIVE: To develop an engineering-informed framework for high-frequency vestibular stimulation, linking jerk-rich transient stimuli to otolithic biomechanics and vestibular signal processing, and translating this framework into practical guidance for interpreting BCV-evoked vestibular-evoked myogenic potentials (VEMPs) and SVIN. METHODS: This narrative review integrates: (1) mechanical analysis of sinusoidal motion, quantifying how displacement, velocity, acceleration and jerk scale with frequency; (2) contemporary vestibular physiology on Type I and Type II hair cells, calyx synapses and irregular versus regular afferents; and (3) experimental and clinical data on BCV, high-frequency sound, oVEMPs, cVEMPs and SVIN in health and vestibular disease. RESULTS: For a sinusoid of fixed displacement amplitude, velocity scales with angular frequency (ω), acceleration with ω² and jerk with ω³. At 60-100 Hz, jerk becomes a prominent macroscopic descriptor of the stimulus, not a directly encoded neural variable, reflecting rapid temporal transients and the dynamic filtering of otolithic macular mechanics. In parallel, Type I hair cells, calyx endings and irregular afferents form a transient, high-bandwidth vestibular pathway characterized by high gain, phase leads at higher frequencies and strong phase locking to high-frequency BCV and sound. The Type I-calyx complex supports multiple transmission modes, including ultra-fast resistive coupling, capable of transmitting rapid receptor-potential changes generated by mechanical transients at the sensory epithelium. Animal and human data indicate that BCV and high-frequency sound preferentially activate irregular otolithic and canal afferents. Accordingly, BCV-evoked oVEMPs, cVEMPs and SVIN provide complementary readouts of this rapid-transient vestibular pathway. In unilateral vestibular loss, Ménière's disease and third-window syndromes, this framework helps explain why vibratory responses may remain abnormal, or even exaggerated, despite partially normal caloric or vHIT findings. CONCLUSIONS: High-frequency BCV should not be interpreted simply as "very high-frequency rotation", but as a rapid transient mechanical stimulus shaped by otolithic biomechanics and high-bandwidth afferent pathways. BCV-evoked oVEMPs and cVEMPs reflect rapid transient otolithic activation recorded in extraocular and neck muscles, while SVIN reflects the time-integrated imbalance of rapid transient vestibular signals across canal-otolith pathways. Incorporating this dual-channel, biomechanics-informed perspective may improve test selection, pattern recognition and disease-specific interpretation in vestibular clinics.