To analyze the distribution patterns of multidimensional vestibular dysfunction across different Hoehn-Yahr (H-Y) stages in patients with Parkinson’s disease (PD), and to explore its associations with motor symptoms, balance function, and peripheral inflammatory cytokines. Methods: A total of 78 patients with idiopathic PD admitted to the Department of Neurology, the First Hospital of Hebei Medical University, from June 2022 to June 2024 were retrospectively enrolled. According to the H-Y stage, the patients were divided into an early-stage group (H-Y stages 1.0-2.5, n=45) and a middle-to-advanced-stage group (H-Y stages 3.0-4.0, n=33). General clinical data, disease duration, levodopa equivalent daily dose (LED), Unified Parkinson’s Disease Rating Scale part III (UPDRS-III) score, Tinetti gait score, Activities-specific Balance Confidence Scale (ABC) score, and Berg Balance Scale score were collected. Vestibular function tests included caloric testing, smooth pursuit, saccade testing, optokinetic nystagmus, gaze-evoked nystagmus, cervical vestibular-evoked myogenic potential (cVEMP), and ocular vestibular-evoked myogenic potential (oVEMP). Peripheral blood inflammatory cytokines were also measured. Results: In the 78 patients with PD, cVEMP abnormalities were observed in 40 patients (51.3%), oVEMP abnormalities in 40 patients (51.3%), and any VEMP abnormality in 53 patients (67.9%). Compared with the early-stage group, the middle-to-advanced-stage group had a longer disease duration, higher LED and UPDRS-III scores, and lower Tinetti gait, ABC, and Berg Balance Scale scores (all P<0.05). The rates of cVEMP, oVEMP, and optokinetic nystagmus abnormalities were higher in the middle-to-advanced-stage group than in the early-stage group (all P<0.05). Spearman correlation analysis showed that H-Y stage was positively correlated with disease duration, LED, UPDRS-III score, cVEMP abnormality, oVEMP abnormality, any VEMP abnormality, and optokinetic nystagmus abnormality, and negatively correlated with Tinetti gait, ABC, and Berg Balance Scale scores. Patients with cVEMP abnormalities had lower ABC scores and higher interleukin-5 (IL-5) levels, whereas patients with oVEMP abnormalities had more advanced H-Y stages and higher IL-5 levels. Conclusion: The abnormalities of cVEMP, oVEMP, and optokinetic nystagmus in PD patients may exhibit features correlated with Hoehn-Yahr (H-Y) staging, suggesting that dysfunction in the otolith-brainstem reflex pathway and visual-vestibular oculomotor integration is more pronounced in patients at higher disease stages. cVEMP abnormalities may be associated with reduced balance confidence, whereas oVEMP abnormalities are more likely to reflect the involvement of the vestibulo-ocular pathway associated with greater disease severity. The association between IL-5 and VEMP abnormalities remains an exploratory finding and requires further validation.