The Masterclass
On 6 March 2026, Cape Hearing Implants (CHi) in collaboration with The South African Society of Otorhinolaryngology had the honour of hosting the 2026 Cape Town Masterclass on Peripheral, Central, and Functional Vestibular and Ocular Motor Disorders. The event, held at the prestigious Netcare Christiaan Barnard Memorial Hospital, was headlined by world-renowned neurologist and vestibular medicine expert Professor Michael Strupp from Munich, Germany. This masterclass brought together a remarkable audience of multidisciplinary professionals, including otorhinolaryngologists, neurologists, audiologists, ophthalmologists, and physiotherapists, highlighting the intricate overlaps that exist in the management of these complex disorders.
The Audience
The diverse audience underscores the collaborative nature of vestibular disorder management. By bringing together specialists from various disciplines, the event facilitated discussions on how these conditions are interrelated—with insights from each field enriching the overall understanding. The updating of knowledge among otorhinolaryngologists focused on ear-related issues, neurologists specialising in brain disorders, audiologists concerned with hearing, ophthalmologists focused on eye disorders and vision, and physiotherapists dedicated to rehabilitation exemplified the multidisciplinary approach required for optimal patient outcomes in vestibular and ocular motor disorders.
Treatment options
Professor Strupp emphasised a holistic treatment strategy for vestibular and oculomotor disorders, which begins with comprehensive patient education. Understanding a patient’s condition is crucial, including guidance on diet and lifestyle modifications, as well as medical treatments. The multi-faceted treatment options discussed during the masterclass encompass physiotherapy, surgical interventions, and psychological support. This comprehensive approach ensures that each patient receives individualised care tailored to their specific needs.
The important “CAP” principal of all treatments
Integral to successful treatment, as highlighted by Professor Strupp, is adhering to the “CAP” principle: Compliance, Adherence, and Persistence. Since improvement can often be slow and gradual, patients must remain committed to their treatment plans. This principle serves as a cornerstone for effective management and underscores the importance of patient engagement throughout their therapeutic journey.
Benign Paroxysmal Positional Vertigo (BPPV): not so “Benign”
One of the more provocative topics discussed was the recent redefinition of Benign Paroxysmal Positional Vertigo (BPPV). Originally labelled “benign” by Dix and Hallpike, because of its typically normal caloric test results, Professor Strupp noted that this term might not accurately reflect the significant impact BPPV has on patients’ lives. Many individuals live in fear of triggering their symptoms, restricting their ability to lie flat or even sleep comfortably. Consequently, the suggestion to drop the term “benign” and restructure its description to include “peripheral” provides a clearer understanding of the disorder’s seriousness and site of lesion.
De-learning
Professor Strupp offered compelling insights on the necessity of “de-learning” in medicine. As new evidence emerges, it becomes essential for medical professionals to abandon outdated practices that may no longer be valid and even be harmfull. He illustrated this by pointing out that diuretics for instance, often used for Meniere’s Disease, may cause harm rather than benefit, especially when combined with salt restriction, which can lead to sodium loss. By fostering a mindset of continuous learning and the willingness to discard disproven beliefs, healthcare professionals can significantly enhance patient outcomes.
A gene for bilateral vestibulopathy
A groundbreaking finding by Professor Strupp and his team is the identification of genetic cause of bilateral vestibulopathy. This often underdiagnosed condition underscores the need for awareness of genetic links that may influence treatment strategies. Emphasising this evolutionary perspective can allow healthcare teams to modify therapeutic approaches, potentially diminishing the reliance on conventional physical therapy and shifting towards lifelong management strategies tailored to the patient’s genetic profile.
Disease to the power of X
Another pivotal principle introduced by Professor Strupp involved the concept of “disease to the power of X.” This implies that patients may present with multiple vestibular disorders concurrently, necessitating a comprehensive assessment to ensure all dimensions of their health are addressed. Overlooking coexisting conditions can significantly hinder patient recovery.
An application (App) for dizzy patients
Innovations in technology are becoming increasingly significant in diagnosing and managing vestibular disorders. One noteworthy application discussed during the masterclass is the Eye Stabiliser App, designed to help patients record episodes of nystagmus. The app captures eye movement, providing clinicians with vital data without the patient needing to rely on their ability to remain still. This advancement exemplifies how technology can enhance diagnostic accuracy and patient engagement in their own health journey.
Conclusion
In conclusion, the 2026 Cape Town Masterclass was a monumental success in advancing the understanding and management of vestibular and ocular motor disorders. Professor Michael Strupp’s expertise and insights catalysed significant discourse among multidisciplinary professionals, setting the stage for further collaborative efforts in this field. We look forward to welcoming Professor Strupp back on 1 October 2026 in Somerset West for another invigorating Vestibular Workshop, attached to the ENT Congress 2026 “ Striving towards excellence in ENT” where we can continue our exploration of these complex conditions and refine our approaches to patient care.
