Transformación Epistemológica y Manejo de Precisión en Neuro-Otología: Una Revisión Sistemática de la Literatura (2020-2025)

Objective: To analyze the transformation of diagnostic and therapeutic paradigms in the management of vertigo and vestibular disorders, evaluating recent evidence on emergency clinical algorithms, pharmacological safety in vulnerable populations, and the emergence of precision medicine in inner ear pathologies. Method: A systematic literature review was conducted following PRISMA methodology. Biomedical databases (PubMed, Cochrane Library, Embase) and clinical trial registries were consulted to identify studies published between January 2020 and February 2025. Meta-analyses, randomized controlled trials, and clinical practice guidelines (Bárány Society, ACORL, IETS) were included. Results: Current evidence dismisses diagnosis based on symptom quality ("vertigo" vs. "dizziness") in favor of the TiTrATE model (Timing, Triggers, And Targeted Examination). HINTS+ and STANDING physical examination protocols demonstrate superior sensitivity to diffusion-weighted magnetic resonance imaging (DWI) in the first 48 hours of acute vestibular syndrome (AVS). In pharmacology, the 2024 Beers Criteria severely restrict the use of vestibular antihistamines in geriatrics, while droperidol re-emerges as a safe antiemetic standard at low doses. In Menière's Disease, the identification of immunological phenotypes and rare genetic variants paves the way for targeted therapies such as Ebselen (SPI-1005). Regarding vestibular neuritis, recent meta-analyses (2024-2025) confirm the inefficacy of corticosteroids for long-term functional recovery. Conclusions: Neuro-otology is transitioning towards a stage of diagnostic precision where instrumented oculomotor semiology and molecular biomarkers displace indiscriminate imaging and empirical vestibular suppression. Urgent updating of hospital protocols is required to integrate these findings and minimize iatrogenesis in at-risk populations.