In the past year significant advances have been made in our understanding of the neurochemistry and neuropharmacology of the peripheral and central vestibular systems. The recognition of the central importance of
excitatory amino acids and their receptors at the level of the hair cells, vestibular nerve and vestibular nucleus has progressed further, and the role of
nitric oxide in relation to activation of the
N-methyl-D-aspartate receptor subtype is becoming increasingly clear. Increasing evidence suggests that excessive
N-methyl-D-aspartate receptor activation and
nitric oxide production after exposure to
aminoglycoside antibiotics is a critical part of hair cell death, and new pharmacological strategies for preventing
aminoglycoside ototoxicity are emerging as a result. Conversely, the use of
aminoglycosides to lesion the peripheral vestibular system in the treatment of
Meniere's disease has been studied intensively. In the vestibular nucleus, new studies suggest the importance of
opioid,
nociceptin and
glucocorticoid receptors in the control of vestibular reflex function. Finally, the mechanisms of action and optimal use of
antihistamines in the treatment of vestibular disorders has also received a great deal of attention.