Fellowship In Vestibular Medicine

Preamble

Vestibular disorders represent one of the most common yet challenging medical conditions affecting millions of people worldwide. The global prevalence of vertigo and dizziness disorders ranges from 15–35% in the general population, with vertigo alone affecting approximately 5–10% of adults annually. Studies indicate that up to 35% of people aged 40 years and above experience some form of vestibular dysfunction during their lifetime. Balance disorders show an even higher prevalence, particularly in the elderly population where it affects up to 85% of individuals above 65 years of age. These conditions significantly impact quality of life, leading to increased fall risk, reduced mobility, psychological distress, and substantial healthcare costs. In India and other developing countries, the burden of vestibular disorders is compounded by late diagnosis, lack of specialized services, and limited awareness among healthcare professionals.

Common conditions like Benign Paroxysmal Positional Vertigo (BPPV), vestibular migraine, vestibular neuritis and Meniere’s disease are frequently misdiagnosed or managed sub-optimally, leading to chronicity, psychiatric comorbidities, and poor quality of life. The complexity of vestibular disorders stems from the intricate nature of the balance system, which involves peripheral vestibular organs, central nervous system pathways, visual input, and proprioceptive mechanisms. Diagnosis and management of these disorders requires specialized knowledge and skills spanning both otolaryngology and neurology domains.

Despite the high prevalence and significant disability associated with these disorders, there is a dearth of structured training programs in vestibular medicine. Traditional medical education provides limited exposure to vestibular medicine, resulting in misdiagnosis of these cases. This leads to unnecessary investigations, inappropriate treatments, prolonged patient suffering, and increased healthcare expenditure. The management of vertigo and balance disorders constitutes the cornerstone of both neurotology and otology practice, requiring practitioners to be equipped with solid knowledge spanning not just otolaryngology but also neurology, ophthalmology, and rehabilitation medicine. The rapidly evolving field of vestibular medicine demands expertise in advanced diagnostic techniques including Craniooculography (COG), Videonystagmography (VNG), Video Head Impulse Testing (vHIT), Functional Head Impulse Testing (fHIT), Vestibular Evoked Myogenic Potentials (VEMP), Stabilometry, and Craniocorpography. Furthermore, the therapeutic landscape has expanded to include sophisticated surgical interventions, targeted pharmacotherapy, and evidence-based vestibular rehabilitation protocols.

Given the multisystem nature of vestibular disorders, which intersect with neurology, otolaryngology, audiology, physiotherapy, and rehabilitation medicine, a multidisciplinary and skill-intensive approach is critical. This Fellowship in Vestibular Medicine addresses the critical need for specialized training to develop competent professionals with the knowledge, skills, and professional attitudes required to provide comprehensive, evidence-based care for patients with vertigo and balance disorders—from diagnosis to advanced medical, surgical, and rehabilitative interventions.

This curriculum is designed for advanced fellows seeking comprehensive expertise in vestibular medicine, with a strong emphasis on neuro-otology, neurology and neuro-ophthalmology. It aligns with the latest international guidelines and incorporates interdisciplinary training, advanced diagnostics, clinical management, and research skills.

Eligibility for Admission

• Essential Qualifications: MS/DNB in Otorhinolaryngology (ENT) from an institution recognized by NMC
• Desirable Qualifications:
  • Minimum 2 years of post-qualification clinical experience
  • Basic training or certification in vestibular science
  • Research publications in otolaryngology or related fields
• Selection Criteria:
  • Written examination (50%)
  • Interview/Viva voce (30%)
  • Academic record and research experience (20%)

Aim of the Program/Course

To train medical professionals to be proficient in the comprehensive management of vertigo and balance disorders using advanced diagnostics, medical and surgical therapies, and rehabilitation.

Objectives/Outcomes of the Program

• Explain the anatomy, neurophysiology, and pathophysiology of the vestibular system and its connections.
• Acquire in-depth knowledge of clinical presentation, diagnostic criteria, differential diagnosis, and management guidelines of common and complex vestibular disorders.
• Describe principles, indications, and interpretations of advanced vestibular diagnostics (COG, VNG, vHIT, fHIT, Stabilometry, CCG, VEMP).
• Appraise evidence-based pharmacological, surgical, and rehabilitative interventions.
• Understand vestibular interface with psychiatric, visual, musculoskeletal, and cognitive systems.

• Conduct a focused vestibular history and perform a comprehensive clinical examination.
• Execute and interpret advanced vestibular diagnostic procedures.
• Manage acute vestibular emergencies.
• Formulate differential diagnoses and individualized management plans.
• Perform repositioning maneuvers for BPPV.
• Plan and implement vestibular rehabilitation strategies.
• Assist and perform selected surgical procedures:
  • Endolymphatic sac decompression
  • Labyrinthectomy
  • Vestibular neurectomy
  • Intratympanic therapies
  • Surgery for superior canal dehiscence
• Maintain accurate digital and written records in a logbook/portfolio.

• Communicate clearly and empathetically with patients and caregivers.
• Work effectively in a multidisciplinary team.
• Exhibit professionalism, ethics, and cultural sensitivity.
• Educate patients about disorders and treatments.
• Engage in lifelong learning, research, and teaching.

• Demonstrate advanced vestibular anatomy, physiology, and pathophysiology knowledge.
• Diagnose and treat vertigo and imbalance with neurological and neuro-ophthalmic manifestations.
• Perform and interpret vestibular/neuro-ophthalmic tests (COG, VNG, fHIT, vHIT, Stabilometry, CCG, VEMP, ECoG, imaging).
• Perform vestibular procedures such as caloric tests and repositioning maneuvers.
• Customize vestibular rehabilitation plans.
• Assist/perform vestibular surgeries (labyrinthectomy, sac decompression, neurectomy).
• Formulate multidisciplinary evidence-based management plans.
• Collaborate effectively with neurology, otology, ophthalmology, audiology, rehabilitation.
• Contribute to research and publish findings.
• Demonstrate professionalism, ethics, leadership, and educate peers/trainees.

Program Structure

Attendance

Minimum of 80% attendance in theory and 90% in clinical postings is mandatory to appear for the university examination.

Syllabus / Course Contents

Teaching - Learning Methods

• Lectures and case-based discussions
• Seminars and journal clubs
• Hands-on workshops and clinical training
• Surgical observation and assistance
• Simulation-based training
• Logbook maintenance and reflective writing
• Externship postings at Centers for Excellence

Scheme of Examination

• 2 Theory tests (50 marks each)
• 2 Clinical exams (50 marks each)
• Assessment of seminars & journal clubs

Theory: One paper (100 marks, 3 hrs)
- 2 Long essays (2 × 20 = 40 marks)
- 5 Short notes (5 × 12 = 60 marks)

Practical/Clinical: 100 marks
- Case presentation (50)
- OSCE (20)
- Viva voce (10)
- Research viva (10)
- Portfolio (10)

Eligibility to Appear

• 80% theory & 90% clinical attendance
• One research project completed
• One paper/poster presentation
• Satisfactory assessments & logbook completion

Criteria for Pass

Minimum 50% in theory and 50% in practical, separately. All logbook entries must be completed and signed.

Declaration of Class

• 50–59%: Pass Class
• 60–69%: Second Class
• 70–74%: First Class
• ≥75%: First Class with Distinction

Recommended Books

• Baloh RW, Halmagyi GM. Disorders of the Vestibular System. Oxford, 1996
• Leigh RJ, Zee DS. The Neurology of Eye Movements, 5th Ed. Oxford, 2015
• Shepard NT, Telian SA. Practical Management of the Balance Disorder Patient. 1996
• Jacobson GP, Shepard NT. Balance Function Assessment and Management, 2nd Ed. 2014
• Goebel JA. Practical Management of the Dizzy Patient, 2nd Ed. 2008
• Swartz JD, Loevner LA. Imaging of the Temporal Bone, 5th Ed. 2009
• Yousem DM, Grossman RI. Neuroradiology: The Requisites, 3rd Ed. 2010
• Furman J, Cass S, Whitney S. Vestibular Disorders: A Case Study Approach, 3rd Ed. 2010

Journals

• Journal of Vestibular Research
• Otology & Neurotology
• Audiology and Neurotology
• Indian Journal of Otolaryngology and Head & Neck Surgery