COSC-BS Subcommittees

The following guidelines have been updated in February 2024.

Composition of the Subcommittees

Every subcommittee will have a chair designated by the Classification Oversight Committee of the Bárány Society (COSC-BS). The chair of a subcommittee should be a member of the Bárány Society and report to the COSC-BS. He/she will compose his/her own subcommittee group according to the following guidelines:

• Minimum 3 continents represented
• Minimum of one clinician with ENT background
• Minimum one clinician with neurology background
• Additional expertise from different backgrounds (like vestibular testing or imaging, etc.) should be sought out as needed
• Input from each member of a working group should be such that it will qualify for authorship (this should encourage small efficient working groups)

Procedures

No more than 12 months should elapse from the designation of the coordinator to presentation of first proposal to the COSC-BS. Each paper will undergo an internal review and consensus process for ICVD Publications in the Journal of Vestibular Research (JVR).

1. Subcommittee completes draft document and together with the COSC-BS, decides it is ready for input from the Bárány Society membership.
2. The draft document is placed on the JVR website, and Bárány Society members are alerted via email or other electronic means that a draft document is ready for comments. Only Bárány Society members are able to access this page.
3. Comments are provided by interested Bárány Society members via the JVR website. NOTE: These comments are only visible to the Editor of JVR and not available to the public.
4. The Editor of JVR forwards all legitimate comments to the relevant subcommittee chair.
5. At their own discretion, the subcommittee chairs respond to individual comments by replying to the member who provided the comment, revising the draft document, or both. The subcommittee chair can also decline to respond. The subcommittee chair will involve subcommittee members as they see fit.
6. After approximately 3 months, a revised document that incorporates comments received from the Bárány Society membership is prepared by the subcommittee.
7. The subcommittee chair, with the agreement of the subcommittee members and the COSC-BS, decides whether or not the document is ready for input from colleagues outside the Bárány Society. If additional input is necessary from the Bárány Society membership based on the extent of the revisions, a revised document is placed on the JVR website and another round of comments is accepted. If the subcommittee chair and members determine that the document is ready for outside comments, the subcommittee seeks input from relevant societies.
8. After revisions based on comments received from relevant outside societies, a penultimate draft is placed on the JVR website for comment from the Bárány Society membership.
9. As above, relevant comments from Bárány Society members are forwarded to the subcommittee chair by the Editor of JVR and appropriate revisions are made.
10. The subcommittee, after getting approval from the subcommittee chair, subcommittee members, and the COSC-BS, advises the Editor of JVR that the document is ready for publication.
11. JVR publishes the document as a special publication available in print and online as an open access article on both the IOS Press website and the JVR‐web.org website.

Publication and Authorship

The work of the various subcommittees will be submitted for publication to JVR after the final approval by the COSC-BS. Membership of the subcommittee does not automatically qualify for authorship. The subcommittee chair will decide whose input was sufficient to qualify for authorship; all other subcommittee members will be listed in an acknowledgement.

The chair of the subcommittee will be listed as the first author and another member, depending on the senior role played in the subcommittee, listed as last author; all other authors are listed according to alphabetical order and the list will include the addendum “on behalf of the COSC-BS.”

Dissolution of a Subcommittee

After publication of its definition, the subcommittee is dissolved. The revision and possible updating of the definition will be done according to the same procedure as described above. All members of the previous subcommittee are eligible for the revision subcommittee.

Format and Content of the Definitions

To establish the definitions all available types of evidence should be taken into account: clinical description, pathophysiology, vestibular tests, imaging, treatment results, genetics, epidemiology, etc. and should retain what is essential for the disease definition.

Each definition should include:

1. An introduction of the entity mentioning previously used terms, if appropriate.
2. A short description to define the disease.
3. Operational diagnostic criteria:
   -Criteria should be explicit to make the definition as precise as possible and to reduce room for interpretation as much as possible. Explicit means that they are unequivocal and can be ticked “yes” or “no”.  Therefore, terms open to interpretation like sometimes, often, usual, typically, etc. must be avoided. List the criteria A, B, C, D … and define for example “at least two of the following four criteria have to be met.”
   -If a disease/disorder presents as an Episodic Vestibular syndrome, define how many in what period of time are required, if appropriate.
4. For some diseases it will be necessary to define a probability for the diagnosis, e.g., definite and probable, please avoid a “possible” category as this risks being too unspecific.
5. Footnotes to explain how to apply the operational criteria.
6. Comments for more detailed explanations. Mention limitations of present knowledge and understanding, if appropriate.
7. Selected bibliography:
   -Take as examples definitions already or nearly finalized (like Menière’s Disease and Vestibular Migraine).

Volume:
Try to make the best compromise between precision and concision; the texts are not meant to be textbook chapters.

Dimensions of Disorders/Diseases:
Consider all, retain those applicable to the particular disorder/disease.

• Symptoms
  -Type of vestibular symptoms: Vertigo, dizziness, vestibulo‐visual, postural (for the clinical description the terms of vestibular symptoms as defined in the Bárány symptom classification have to be used).
  -Timing: Duration, episodic vs continuous, age of onset.
  -Triggers: Spontaneous, position change, head motion, noise, situations.
  – Accompanying symptoms: Auditory, visual, headache, neurological, autonomic (nausea, etc.), behavioral ….
• Signs: Oculo‐motor, postural findings, other neurological signs ….
• Ancillary test results: If important: e.g., caloric, rotational chair, VEMP, AEP, audiogram, imaging….
• Mechanisms: Known, hypothetical, unknown.
• Important differential diagnosis: List important differential diagnoses, give instructions on how to differentiate, consult the chair of subcommittees dealing with these differential diagnosis as appropriate.
• Time of validity: Each definition has a validity of 5 years from the time of publication.

Currently, the following vestibular disorders and topics are addressed in subcommittees:

• Vestibular Syndromes (David Newman Toker)
• Measuring Functioning, Participation, and Quality of Life (Joe Furman, Eva Grill)
• Postconcussion Vestibular Disorders (Alexander Tarnutzer)
• Combined Vestibular and Cerebellar Disorders (David Szmulewicz)
• Chronic Unilateral Vestibulopathy (to be announced)
• Unspecified Recurrent Vertigo (Julia Dlugaiczyk)
• Perilymphatic Fistula (Bryan Ward)
• Vestibular Symptoms (update) (Alexandre Bisdorff)

A series of consensus documents is finished or currently under development by the Committee for the Classification of Vestibular Disorders (ICVD) of the Bárány Society. To see a list of these documents, please click here.

As mentioned above, all finalized documents of the COSC-BS are published open access in the Journal of Vestibular Research.

For information regarding the ICVD process, contact Alexandre Bisdorff, Chair of the Classification Oversight Committee of the Bárány Society:  Alexbis@pt.lu.