Acute Vestibular Neuritis and Ramsay-Hunt Syndrome / 대한평형의학회지

Acute vestibular neuritis is the disorder characterized by acute, spontaneous vertigo with the unilateral vestibular loss. Reactivation of herpes simplex virus is considered as its cause. Its management consists of symptomatic therapy in the acute phase and following rehabilitation exercise to improve central compensation. The differential diagnosis should include central vestibular disorders mimicking peripheral vertigo. Ramsay-Hunt syndrome, which defined as a herpes zoster oticus with facial paresis, is also a disorder frequently accompanied with vestibular deficit. Combination therapy of acyclovir and corticosteroid is recommended for the treatment. In this review, diagnosis and management of the two disorders are described.

Differential diagnosis of peripheral vertigo / 영남의대학술지

Dizziness can be classified mainly into 4 types: vertigo, disequilibrium, presyncope, and lightheadedness. Among these types, vertigo is a sensation of movement or motion due to various causes. The main causes of peripheral vertigo are benign paroxysmal positional vertigo (BPPV), acute vestibular neuritis (AVN), and Meniere's disease. BPPV is one of the most common causes of peripheral vertigo. It is characterized by brief episodes of mild to intense vertigo, which are triggered by specific changes in the position of the head. BPPV is diagnosed from the characteristic symptoms and by observing the nystagmus such as in the Dix-Hallpike test. BPPV is treated with several canalith repositioning procedures. AVN is the second most common cause of peripheral vertigo. Its key symptom is the acute onset of sustained rotatory vertigo without hearing loss. It is treated with symptomatic therapy with antihistamines, anticholinergic agents, antidopaminergic agents, and gamma-aminobutyric acid-enhancing agents that are used for symptoms of acute vertigo. Meniere's disease is characterized by episodic vertigo, fluctuating hearing loss, and tinnitus. It is traditionally relieved with life-style modification, a low-salt diet, and prescription of diuretics. However, diagnosis and treatment of the peripheral vertigo can be difficult without knowledge of BPPV, AVN, and Meniere's disease. This article provides information on the differential diagnosis of peripheral vertigo in BPPV, AVN, and Meniere's disease.

Contralateral Suppression of Transient Evoked Otoacoustic Emission in Vestibular Neuritis / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The etiology of vestibular neuritis is unknown. Many investigators have suggested that this condition spares the inferior vestibular nerve system. However, others have reported that the lesion sometimes affects the inferior vestibular nerve system based on vestibular evoked myogenic potential. The function of the inferior vestibular nerve was studied in acute vestibular neuritis by monitoring medial olivocochlear bundle (MOCB) function. Under normal conditions, contralateral acoustic stimulation has inhibitory effects on ipsilateral otoacoustic emissions through the MOCB. MATERIALS AND METHODS: Twenty patients that presented with dizziness and spontaneous nystagmus, and were confirmed to have acute vestibular neuritis by rotatory chair and caloric testing were enrolled in this study. We evaluated the evoked otoacoustic emissions with and without contralateral acoustic stimulation in both ears in all patients. The percent loss of normal inhibitory action on otoacoustic emissions was determined in the normal and affected ears. RESULTS: All patients showed inhibitory effects in response to contralateral acoustic stimulation on evoked otoacoustic emissions in normal ears. Fifteen patients (75%) had an absence of contralateral suppression of otoacoustic emissions on the affected side. CONCLUSION: The findings of this study suggest the presence of dysfunction of the MOCB in patients with acute vestibular neuritis.

Subjective Visual Vertical during Eccentric Rotation in Acute Vestibular Neuritis Patients

BACKGROUND AND OBJECTIVE: By assessing unilateral utricular function at the acute unilateral vestinuloneuritis (Acute UVN), we sought to determine the ability of the subjective visual vertical (SVV) during eccentric rotation (dynamic SVV) in localizing the site of the lesion in unilateral vestibular neuritis (UVN). METHODS: The static SVV and dynamic SVV of fifteen patients diagnosed with acute UVN were enrolled within 10 days of onset (average 7 days). First, the static SVV was measured in a dark booth without rotation. The dynamic SVV was measured during rotation with an eccentric displacement of the head to 3.5 cm from the vertical rotation axis during a constant velocity of 300 degrees/s. RESULTS: In the acute stage of UVN, the static SVV showed an increase in deviation to the side of the lesion compared to those of normal subjects. Also, we found 73% of abnormal findings in Acute UVN patients by assessing static conventional SVV. The dynamic SVV had a statistically significant increase in deviation to the side of the lesion compared to those of normal subjects and 93% patients showed beyond normal range. CONCLUSIONS: The dynamic SVV would be an effective method in the diagnosis and localization of acute unilateral vestibularneuritis.

Acute Vestibular Neuritis in Children

The acute vestibular neuritis is rarely seen in children and it is hard to find the related reports. In this paper, we report three cases of acute vestibular neuritis less than 15 years old that we experienced during last 10 years. The three cases are 14 and 11-year old boys and a 12-year-old-girl. They complained vertigo without hearing loss. Only one of three cases had previous common cold history and they showed all negative reactions in virus blood tests. After medical treatment and early rehabilitation, vertigo was completely controlled within 3 weeks and there was no recurrent symptoms so far. This recovery in children seems to be faster and more complete than in adults.

Clinical Aspect of Acute Vestibular Neuritis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The etiology and pathophysiology of acute vestibular neuritis are largely unknown and its diagnostic criteria and clinical course also have not been established definitely. This study was performed to provide a basis for creating the classification system and diagnostic criteria of vestibular neuritis. MATERIALS AND METHODS:We studied sixty-seven patients who showed no subjective auditory symptoms, and who showed spontaneous nystagmus for more than 24 hours under ENG (Electronystagmography) after the onset of vertigo. We evaluated the frequency of nystagmus and the site of lesion, and looked for the presence of any combined infectious diseases. Eye tracking test with ENG and auditory test were performed. Bithermal caloric test was performed after disappearance of sponteneous nystagmus and canal paresis was calculated. RESULTS: We found 52 cases (78%) of unilateral single attack, 10 cases (15%) of unilateral recurrent attack, 4 cases (6%) of opposite recurrent attack and one case (1%) of bilateral simultaneous attack. For the presence of combined infectious diseases, we found 24 casees (36%) with URI, one case (2%) with mumps and three cases (5%) with Ramsay-Hunt syndrome. Ipsilateral sensorineural hearing loss at 8000 Hz was found in 10 cases (24%). Neurologic abnormality was found in 14 cases (21%), but not found in 53 cases (79%). The canal paresis on bithermal caloric response was more than 50% for 30 cases (68%), 26%-50% for 4 cases (9%), and in the normal range for 10 cases (23%). CONCLUSION: There are some cases of the acute vestibular neuritis that showed atypical clinical features (recurrent attack, bilateral attack), which is inconsistent with the Coates criteria. Appropriate classification system and diagnostic criteria for acute vestibular neuritis, including recurrent attack and bilateral attack, are required.