bims-madeba 2026-11-01 papers

Issue of 2026–11–01
three papers selected by
Jun Maruta, Mount Sinai Health System

Front Psychol. 2026 ;17 1867836

Reframing the lived experience of persistent dizziness: insights from active inference.

Marc A Broberg, Mick Thacker, Karl J Friston, Jorge E Esteves.

We present an active inference account of persistent dizziness predicated on models of enactivism and ecological psychology; including first-hand accounts of the patient's lived experience. Mechanistically, we consider persistent dizziness to reflect an initial failure of sensory attenuation of vestibular and other sensory prediction errors. This failure becomes self-maintaining if the patient infers-or learns-that unattenuated prediction errors cannot be resolved through action. The ensuing formulation provides an integrative account of the pathophysiology of dizziness and how it underwrites-and is maintained by-affective inference and an altered sense of agency that shapes the experience of the person with dizziness. We foreground the holistic person-centered approach on offer from a clinical perspective, and consider complementary levels of therapeutic intervention under this theoretical framework.

Keywords: PPPD; ViolEx model; active inference; enactivism / ecological psychology; free energy principle (FEP); lived experience; persistent dizziness; phenomenology

DOI: https://doi.org/10.3389/fpsyg.2026.1867836

Audiol Res. 2026 Oct 09. pii: 156. [Epub ahead of print]16(5):

Vertigo and Nystagmus: The Role of the Velocity Storage Integrator in Skull Vibration Induced Nystagmus (SVIN).

Ian S Curthoys.

This paper reviews the vestibular neural mechanisms that generate vertigo and nystagmus. Angular acceleration activates a group of neurons in the brainstem that cause the person to have the sensation of turning. But long after the end of the acceleration, these neurons continue to fire; they perseverate, causing afternystagmus, and I contend that this gives the false sensation that the person is continuing to turn when they are actually stationary. That false sensation, that illusion, is called vertigo, and the neural basis for it is the continued firing of this cluster of neurons in the brainstem which signal turning-firing long after the turn has stopped. Any other process that generates activity of this group of neurons-disease, dysfunction, other sensory input-will also result in that false sensation of turning-vertigo. The group of neurons is called the velocity storage integrator (VSI). The operation of this VSI network is directly linked to neural systems controlling nausea and postural stability, and it is a key part of a neural circuit generating the subjective sensation of vertigo. The VSI receives input from vestibular, optokinetic, and proprioceptive systems, and it projects to many neural systems to generate nystagmus, sensation, nausea, and postural responses.

Keywords: nystagmus; otolith; semicircular canal; vertigo

DOI: https://doi.org/10.3390/audiolres16050156

J Audiol Otol. 2026 Oct;30(4): 236-246

Dizziness in Clinical Practice: Insights From a Multidisciplinary Patient Cohort.

Alida Naudé, Amisha Kanji.

Background and Objectives: This study aimed to characterize the clinical presentation, comorbidity profiles, and diagnostic outcomes of patients referred for dizziness assessment at a tertiary-level multidisciplinary clinic.
Subjects and Methods: We conducted a retrospective observational study involving 254 patients. Data were extracted from structured intake forms and included demographics, symptom type and frequency, comorbidities, Dizziness Handicap Inventory (DHI) scores, prior healthcare utilization, and final diagnoses. Statistical analyses included descriptive statistics, analysis of variance, chi-square tests, and Spearman's correlations to explore the relationships between DHI scores and clinical variables.
Results: Most patients reported daily symptoms and multiple aggravating factors, including head movements and stress. Anxiety (44.5%) and memory complaints (47.2%) were common comorbidities. The mean DHI score was 34.2 (standard deviation=16.8), reflecting a mild-to-moderate perceived handicap. Peripheral vestibular disorders were the most common diagnostic category (42.9%), followed by non-peripheral causes (37.8%). Significant differences in DHI scores were observed across diagnostic categories (p<0.001), with higher scores observed in PPPD, combined vestibular disorders, and non-peripheral diagnostic groups. However, DHI scores were not significantly associated with symptom frequency, comorbidities, or healthcare utilization history.
Conclusions: Dizziness presentation is heterogeneous and frequently involves prolonged diagnostic delays, overlapping symptomatology, and psychosocial comorbidities. This study's findings support the need for earlier access to vestibular assessments and integrated multidisciplinary management to reduce disability and improve outcomes for patients with chronic dizziness.

Keywords: Comorbidity; Dizziness; Vestibular disorders

DOI: https://doi.org/10.7874/jao.2025.00402