Otoneuroscience and space vestibulo-neuroscience in the new century.

From a clinically oriented point of view, efforts of otoneuroscience should be directed toward an improvement of the management of dizzy and vertiginous patients. At present, the main obstacles in this field are: (1) the lack of specific therapies for many of the clinical diagnoses. This reduces the necessity of clinical vestibular diagnosis to a pragmatic exclusion of the few diseases with therapeutic consequences; (2) the lack of feedback to confirm or disprove clinical diagnoses; (3) poor knowledge of the pathophysiology of many of the otoneurological diseases; experiments in animal models may be helpful in this respect; (4) most progress in medicine originates from the results of numerous, poorly controlled 'unscientific' trial and error experiments obtained during treatment of patients; training clinicians in more scientific, critical thinking would help to increase the profits that can be realized from this important source of information; and (5) to date, information obtained during zero-gravity experiments in space have not yet led to important consequences in treatment of patients under 1-g conditions, but are important for a possible evolutionary step of mammals adapting to a new environment.