Subclinical Vestibular Involvement in Chronic Suppurative Otitis Media: Perforation Size and Mediolateral Postural Sway

PURPOSE: This study aimed to assess postural stability and vestibulo-ocular reflex (VOR) function in patients with chronic suppurative otitis media (CSOM) and to elucidate how vestibular involvement varies according to otoscopic findings and demographic characteristics. METHOD: = 33.26 years). All patients had tympanic membrane perforation in at least one ear, for which localization and perforation size were documented. Pure-tone audiometry and immittance measurements were performed. Vestibular assessment consisted of subjective symptom evaluation using the Dizziness Handicap Inventory, semicircular canal-specific VOR gain measurements using the video head impulse test (vHIT), and functional balance analysis using computerized dynamic posturography (CDP). RESULTS: No significant differences were found between groups in vHIT gains for any semicircular canal. While anteroposterior CDP parameters showed no group differences, mediolateral vestibular (VEST), preference (PREF), and Global scores were significantly reduced in the CSOM group. Both disease duration and perforation severity significantly affected mediolateral CDP outcomes, with higher severity and durations longer than 5 years associated with lower VEST, PREF, and Global scores. Somatosensory score, visual score, perforation location, laterality, and anteroposterior sway measures showed no significant differences. CONCLUSIONS: CSOM is associated with subclinical yet measurable impairments in vestibular function and postural stability, characterized by preserved high-frequency semicircular canal function on vHIT but significant mediolateral instability on posturography, even in the absence of self-reported dizziness. These findings indicate early vestibular-mediated balance deficits beyond conductive hearing loss and underscore the importance of routine vestibular assessment for timely identification and targeted rehabilitation.