Dr Sandarva Giri, ST4 Registrar in Audiovestibular Medicine, Lancashire Teaching Hospitals NHS Foundation Trust
Dr Sabarinath Vijaykumar, ST5 Registrar in Audiovestibular Medicine, Royal Derby Hospital.
Registration opened with participants joining from across the UK and overseas, setting the stage for a highly-engaging virtual symposium. Delegates were welcomed by Professor Soumit Dasgupta before the first session commenced.
Patricia Castro, senior audiologist and lecturer at De Montfort University, opened the symposium with an insightful overview of the neurophysiology of vestibular compensation, outlining the transition from early cerebellar and commissural inhibition to later intrinsic restoration of ipsilesional nuclei, supported by dynamic cortical, synaptic and behavioural plasticity. She highlighted the key mechanisms that underpin functional recovery—Vestibulo-ocular reflex (VOR) recalibration, velocity-storage adjustments, sensory substitution, saccadic strategies and postural reweighting—while emphasising the clinical importance of early mobilisation, timely cessation of vestibular suppressants and strong rehabilitation adherence.
Prof Margie Sharpe, a senior consultant physiotherapist from Australia, highlighted how neuroplasticity, sensory re-weighting and error-driven adaptation form the foundation of vestibular compensation across all recovery phases. She spoke about the role of the video head impulse test (vHIT), vestibular evoked myogenic potentials (VEMPs), posturography and dynamic VOR behaviours (including covert saccades and the blink strategy) in assessing and guiding personalised vestibular rehabilitation therapy(VRT). She emphasised dynamic, real-world rehabilitation using restoration, habituation, substitution, postural strategies and visual desensitisation to achieve long-term functional stability.
Angela Rego, a consultant otolaryngologist from Portugal, delivered an outstanding session on objective and subjective measures of vestibular compensation, highlighting how static and dynamic deficits evolve across compensation stages. Her talk emphasised the importance of frequency-specific assessment, showing how different tests map onto the vestibular system’s compensation bandwidth. Psychometric scales such as the Dizziness Handicap Inventory (DHI) and the Activities-Specific Balance Confidence (ABC) were shown to complement physiological tests, providing a fuller picture of patient recovery.
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Prof Rohani Omar, consultant audiovestibular physician at University College London, presented on vestibular compensation in Presbyvestibulopathy (PVP), decline in the vestibular organs, diagnosed using standardised Bárány Society criteria. She highlighted that in PVP, compensation occurs through sensory substitution, with vision and proprioception. However, age-related deterioration in these systems undermines the brain's ability to integrate sensory signals and maintain adequate compensation. Management requires multidisciplinary coordination with vestibular physiotherapy as the cornerstone. Prof Omar highlighted that age is not a barrier to successful rehabilitation outcomes. She emphasised that future research should refine diagnostic subtypes and develop novel interventions, as PVP is becoming an increasingly critical public health priority.
Prof Soumit Dasgupta, consultant audiovestibular physician at Alder Hey Children’s Hospital, delivered a comprehensive presentation on vestibular compensation in paediatrics, contrasting paediatric and adult recovery mechanisms. He explored the natural history of paediatric vestibular disorders and discussed key decompensation triggers. The presentation highlighted SHIMP (Suppression Head Impulse Test) as a significantly underrated but excellent diagnostic tool for detecting vestibular compensation. Prof Dasgupta discussed the importance of implementing age-appropriate vestibular test batteries and stressed that vestibular infant screening is both feasible and crucial for early detection in at-risk groups. The session ended with multiple case-based discussions and a strong emphasis on holistic, multidisciplinary management approaches, reminding clinicians that successful vestibular rehabilitation involves treating the whole child, not just responding to test results.
The virtual event concluded with an engaging Q&A session, during which delegates raised clinical questions that were directly answered by the speaker. Overall, it was a highly informative session that provided clear concepts of vestibular compensation, red flags and critical considerations clinicians must address in practice.
Upcoming Event: BAAP Annual Conference, 19 - 20 March 2026.
