{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T18:12:25Z","timestamp":1779387145171,"version":"3.53.1"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Audiology Research"],"abstract":"<jats:p>Background\/Objectives: In a recent article we outlined how the vestibular efferent system connects the stereo\/kinociliary complex at the apex of the macular vestibular hair cells of the inner ear and coordinates movement so that planned body movements are precisely timed to coordinate with the expected otoconial movement that the body movement induces. Methods: Our present article proposes an extension of this concept with details about how a sailor develops \u201csea legs.\u201d The rocking motion of a boat in rough seas requires sailors to sway in order to remain vertical. This causes fluctuation in the gravity-referenced otoconial signal. Results: As a sailor develops sea legs, it is necessary that the routine vestibular efferent system activity (based on gravity-referenced orientation on land) is disrupted as the otoconia move with this rocking process in order to re-coordinate with the new otoconial movement. As a result, the cerebral cortex must reconfigure vestibular efferent activity so that the stereo\/kinociliary complex moves in conjunction with the otoconial movement. This process is carried out via the striated organelle (STO) and is one that takes several days. Those who are unfortunate and have severe motion sickness, become extremely unwell with nausea, vomiting, severe unsteadiness, and anorexia during this time. Conclusions: The present article describes how \u201csea legs\u201d develop and discusses why an unpleasant symptom set can accompany it. We will also outline how a new medication, a calcitonin gene-related peptide (CGRP) inhibitor, which is presently used for the treatment of vestibular dysfunction, has been shown to suppress vestibular efferent activity and may be an effective therapy for these overly symptomatic individuals.<\/jats:p>","DOI":"10.3390\/audiolres16030072","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:46:18Z","timestamp":1779381978000},"page":"72","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Seasickness, Sea Legs, and Gravity: Suppression of Motion Sickness, Development of Sea Legs, The Role of the Striated Organelle in the Vestibular Efferent System"],"prefix":"10.3390","volume":"16","author":[{"given":"Neil S.","family":"Longridge","sequence":"first","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4499-3476","authenticated-orcid":false,"given":"Arthur I.","family":"Mallinson","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"518","DOI":"10.3390\/audiolres14030044","article-title":"A new perspective to interpret how the vestibular efferent system correlates the complexity of routine balance maintenance with management of emergency fall prevention strategies","volume":"14","author":"Longridge","year":"2024","journal-title":"Audiol. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1136\/bmj.1.3656.171","article-title":"General observations on sea-sickness and the labyrinthine theory","volume":"1","author":"Maitland","year":"1931","journal-title":"Br. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/bmj.1.3656.176","article-title":"Note on seasickness","volume":"1","author":"Flack","year":"1931","journal-title":"Br. Med. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"369","DOI":"10.3233\/VES-1999-9506","article-title":"Disruption of postural readaptation by inertial stimuli following space flight","volume":"9","author":"Black","year":"1999","journal-title":"J. Vestib. Res."},{"key":"ref_5","first-page":"17","article-title":"The perception of gravity and of angular acceleration in invertebrates","volume":"Volume VI\/1","author":"Kornhuber","year":"1974","journal-title":"Handbook of Sensory Physiology"},{"key":"ref_6","unstructured":"Barany, R. (1916). Some New Methods for Functional Testing of the Vestibular Apparatus and the Cerebellum, Elsevier. Nobel Prize Lecture."},{"key":"ref_7","first-page":"1","article-title":"Electronystagmography","volume":"189","author":"Jongkees","year":"1964","journal-title":"Acta Otolaryngol. Suppl."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1002\/lary.23258","article-title":"the interpretation of clinical tests of peripheral vestibular function","volume":"122","author":"Curthoys","year":"2012","journal-title":"Laryngoscope"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/S0733-8619(18)30359-1","article-title":"Dynamic posturography in the diagnosis and management of dizziness and balance disorders","volume":"8","author":"Nashner","year":"1990","journal-title":"Neurol. Clin."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1007\/BF00237749","article-title":"M.I.T.\/Canadian vestibular experiments on the Spacelab-1 mission. 4. Space motion sickness: Symptoms, stimuli and predictability","volume":"64","author":"Oman","year":"1986","journal-title":"Exp. Brain Res."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wolfson, R.J. (1966). Ultrastructure of the vestibular sense organ. The Vestibular System and Its Diseases, University of Pennsylvania Press.","DOI":"10.9783\/9781512808698"},{"key":"ref_12","first-page":"405","article-title":"Anatomy of the otolith organs","volume":"20","author":"Lindeman","year":"1973","journal-title":"Adv. Otorhinolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"515","DOI":"10.3109\/00016486709128785","article-title":"Body position and the intensity of caloric nystagmus","volume":"63","author":"Coats","year":"1967","journal-title":"Acta Oto-Laryngol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s00221-024-06992-8","article-title":"Integrating vestibular and visual cues for verticality perception","volume":"243","author":"Schoenmaekers","year":"2025","journal-title":"Exp. Brain Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0022215100070018","article-title":"Regional differences in structure of the vestibular sensory regions","volume":"83","author":"Lindeman","year":"1969","journal-title":"J. Laryngol. Otol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.brainres.2006.02.083","article-title":"Assembly of the otoconia complex to the macular sensory epithelium of the vestibule","volume":"1091","author":"Lundberg","year":"2006","journal-title":"Brain Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1177\/000348946407300315","article-title":"Averaged evoked myogenic and cortical potentials to sound in man","volume":"73","author":"Cody","year":"1964","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1212\/WNL.42.8.1635","article-title":"Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation","volume":"42","author":"Colebatch","year":"1992","journal-title":"Neurology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/j.clinph.2005.03.019","article-title":"Vestibular-evoked extraocular potentials produced by stimulation with bone conducted sound","volume":"116","author":"Rosengren","year":"2005","journal-title":"Clin. Neurophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3167\/proj.2024.180204","article-title":"Man and Camera Become One: Steadicam, Embodiment, and Visual Conventions","volume":"18","year":"2024","journal-title":"Projections"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1152\/jn.1980.43.4.986","article-title":"Efferent vestibular system in the squirrel monkey: Anatomical location and influence on afferent activity","volume":"43","author":"Goldberg","year":"1980","journal-title":"J. Neurophysiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1152\/jn.91112.2008","article-title":"Efferent-mediated responses in vestibular nerve afferents of the alert macaque","volume":"101","author":"Sadeghi","year":"2009","journal-title":"J. Neurophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1152\/jn.00053.2019","article-title":"A review of efferent cholinergic synaptic transmission in the vestibular periphery and its functional implications","volume":"123","author":"Poppi","year":"2020","journal-title":"J. Neurophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S0022-5320(63)80040-4","article-title":"Electron microscopic observations on the human membranous labyrinth with particular reference to M\u00e9ni\u00e8re\u2019s Disease","volume":"49","author":"Friedmann","year":"1963","journal-title":"J. Ultrastruct. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4473","DOI":"10.1073\/pnas.1101003109","article-title":"Striated organelle, a cytoskeletal structure positioned to modulate hair-cell transduction","volume":"109","author":"Vranceanu","year":"2012","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1038\/207171a0","article-title":"Broad-banded striated bodies in the sensory epithelium of the human macula and in neurinoma","volume":"207","author":"Friedmann","year":"1965","journal-title":"Nature"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1288\/00005537-196408000-00007","article-title":"An evaluation of the ultrastructural findings in the utricle in menieres disease","volume":"74","author":"Hilding","year":"1964","journal-title":"Laryngoscope"},{"key":"ref_28","unstructured":"Mallinson, A.I. (2011). Visual Vestibular Mismatch: A Poorly Understood Presentation of Balance System Disease. [Ph.D. Thesis, Maastricht University]."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hoskin, J.L., and Fife, T.D. (2022). New Anti-CGRP Medications in the Treatment of Vestibular Migraine. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.799002"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0165-3806(98)00030-3","article-title":"Calcitonin gene-related peptide immunoreactivity in the rat efferent vestibular system during development","volume":"108","author":"Dememes","year":"1998","journal-title":"Dev. Brain Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1152\/jn.00226.2024","article-title":"Systemic calcitonin gene-related peptide modifies auditory and vestibular end organ electrical potentials, and increases sensory hypersensitivities","volume":"134","author":"Rahman","year":"2025","journal-title":"J. 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