The nystagmus Ménière memory model (NMMM) a dynamic central memory theory integrating peripheral vestibular fluctuations and vestibular recalibration

The direction-changing behavior of spontaneous nystagmus during Ménière's disease attacks remains difficult to reconcile with static, lesion-based models . Nystagmus may evolve from an initial phase beating toward the affected ear to a later phase beating away, while vestibular tests often show dissociation: caloric weakness and abnormal SHIMP responses can coexist with preserved HIMP-vHIT gains. We propose the Nystagmus Ménière Memory Model (NMMM), a dynamic framework in which rapidly fluctuating peripheral vestibular output interacts with a centrally stored vestibular set-point established through compensation. Because this central set-point updates more slowly than peripheral vestibular fluctuations, transient mismatch can occur, resulting in nystagmus reversals and time-dependent test discordance. The model does not rely on a pressure-based hypothesis of endolymphatic hydrops. Instead, it integrates contemporary evidence supporting volume regulation changes, epithelial remodeling, and especially ionic/metabolic dysregulation as plausible mechanisms for reversible cochleo-vestibular dysfunction . We incorporate functional differences between vestibular afferent dynamics: regular afferents provide low-frequency rate coding (typically < 5 Hz), whereas irregular afferents support temporal coding optimized for high-frequency transients (typically >5 Hz). Importantly, this is a functional weighting framework and does not imply strict one-to-one mappings between hair-cell type, afferent class, and clinical tests. NMMM offers a time-resolved interpretation of attack-phase nystagmus and vestibular test dissociation and generates testable predictions for longitudinal prospective studies.