{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:20:41Z","timestamp":1787649641040,"version":"build-2736575974"},"reference-count":22,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Audiol. Res.","Audiology Research"],"abstract":"<jats:p>Background\/Objectives: Skull vibration-induced nystagmus (SVIN) is a robust sign of vestibular asymmetry, yet its relationship with tests of impulsive canal function, short-latency otolithic reflexes, and sustained visuo-vestibular processing remains incompletely defined. To describe four clinical\u2013physiological cases in which SVIN was dominant or disproportionate relative to the canal, otolithic-reflex, and sustained-domain profiles, and to propose a temporal-domain interpretation of this physiological non-congruence. Methods: Four patients with persistent disequilibrium, episodic vertigo, or selective vestibular-reflex dissociation underwent multidomain neuro-otological assessment, including bedside examination, video head impulse test\/head impulse paradigm (vHIT\/HIMP), suppression head impulse paradigm (SHIMP) when available, cervical and ocular vestibular-evoked myogenic potentials (cVEMPs and oVEMPs), rotatory or caloric testing when available, and optokinetic or other visuo-vestibular paradigms. SVIN was elicited by 100-Hz mastoid vibration and characterized by direction, dimensionality, stimulation-site dependence, reproducibility, and slow-phase velocity when available. Results: SVIN remained clinically informative across patients with preserved, minimally abnormal, or selectively dissociated canal and otolithic-reflex findings. The recurring feature was not normality of all conventional tests, but physiological non-congruence between the vibration-induced ocular response and the canal, otolithic-reflex, or sustained-domain profile. One patient showed normal six-canal vHIT and symmetric VEMPs despite an exceptionally large fixed-direction SVIN; another showed selective cVEMP absence with preserved oVEMPs and normal vHIT. Atypical multidimensional SVIN coexisted with marked optokinetic directional asymmetry in the adolescent case. Conclusions: SVIN is not a surrogate for vHIT, VEMPs, caloric, rotatory, or velocity-storage-related testing. It should be interpreted as a distinct phase-locked probe of vibration-sensitive vestibular imbalance. Irregular afferents provide the supported physiological framework, whereas dimorphic afferents represent a plausible, hypothesis-generating bridge population capable of contributing to otherwise unexplained clinicophysiological dissociations.<\/jats:p>","DOI":"10.3390\/audiolres16050123","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:00:48Z","timestamp":1787644848000},"page":"123","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Skull Vibration-Induced Nystagmus Reveals Hidden Vestibular Asymmetry Dissociated from vHIT, VEMPs and Velocity-Storage-Related Responses: A Clinical\u2013Physiological Case Series and Temporal-Domain Hypothesis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7126-2719","authenticated-orcid":false,"given":"Leonardo","family":"Manzari","sequence":"first","affiliation":[{"name":"MSA ENT Academy Center, 03043 Cassino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Dumas, G., Curthoys, I.S., Lion, A., Perrin, P., and Schmerber, S. 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