Multiple sclerosis is a common demyelinating disease of the central nervous system (CNS) that often presents with vestibular symptoms, including vertigo, nystagmus, and oculomotor disturbances. These manifestations occur in 4–67% of patients and can mimic peripheral vestibular disorders, making diagnosis challenging. Lesions affecting central vestibular and cerebellar pathways account for three main clinical presentations: acute vestibular syndrome, positional vertigo, and chronic imbalance. Distinguishing central from peripheral causes is crucial for accurate diagnosis. Videonystagmography and the video head impulse test enhance diagnostic precision. This chapter reviews the neurotological features of multiple sclerosis (MS) and underscores the role of vestibular testing in clinical evaluation and patient management.