Introduction: With recent advancements in vestibular assessments, new ancillary tests can assist clinicians to better understand underlying cause of a balance problem. The recently established specialized vestibular clinic in Sultan Ahmad Shah Medical Centre @IIUM is equipped with these tests. This study aimed to determine the prevalence of the different diagnoses of balance disorders in a specialized vestibular clinic in Kuantan, Malaysia. Materials and Methods: This is a retrospective review of 121 walk-in patients over an 18-month period at a specialized Vestibular Clinic in Sultan Ahmad Shah Medical Centre @IIUM. The variables analysed in this review include the age, gender, ethnicity, diagnoses, and total number of visits before diagnoses were achieved. Results: Meticulous history taking, focused otorhinolaryngological examination and detailed vestibular assessment through the specialized vestibular clinic helped us in reaching a conclusive diagnosis. The most common cause of balance disorders in our review was Benign Paroxysmal Positional Vertigo (BPPV), constituting 41.3% of the cases. Among the canals, the posterior canal is the most affected  (70%) and is usually treated with Epley manoeuvre. Other common diagnoses   include Vestibular Migraine, Meniere’s Disease and Vestibular Neuritis. Conclusion: Vestibular clinics play a vital role in helping to pinpoint the accurate diagnosis of patients with balance disorders.

IntroductionVertigo, or the perception of a spinning sensation, is a common symptom experienced by patients who are referred to Otorhinolaryngology clinics. Betahistine is a medication that has been widely used to treat vertigo and its accompanying symptoms. However, the effects of this medication on the vestibulo-ocular reflex (VOR) are still unknown. Initially, it was assumed that betahistine should be discontinued prior to any vestibular tests, particularly the video head impulse test (vHIT). MethodThirty young healthy adults were randomly divided into two equal groups for this randomized double-blind clinical study (betahistine 24 mg and placebo). Baseline pure-tone audiometry (PTA), tympanometry, and VOR measurements were taken, followed by experimental measurements at one hour, four hours, eight hours, and 24 hours after consumption. The video head impulse test (vHIT) was used to determine the VOR. ResultBetahistine had no statistically significant effect on vestibulo-ocular reflex gain (F(4,140) = 0.601, p = 0.662). The gain variability across repetitive head impulses remained constant over time. ConclusionsBetahistine has no effect on the vestibulo-ocular reflex. As a result, this medication can be taken prior to the vHIT procedure.

Spontaneous herniation of the temporomandibular joint along a bony defect in the external auditory canal is an uncommon condition that may lead to otologic symptoms. A 43-year-old gentleman presented with otalgia and an external auditory canal soft tissue lesion, which flattens upon opening of the jaw. Computed tomography scan of the temporal region confirmed the presence of a soft tissue lesion that herniated through an external auditory canal wall defect. This condition should be included in the differential diagnoses of an external auditory canal mass, despite infrequently encountered. It is important to inspect the external auditory canal during movement of the jaw when a soft tissue lesion is noted, so as not to miss this diagnosis.