A comparative study of detection methods for assessing superior and inferior vestibular nerve damages in patients with vestibular neuritis / 临床耳鼻咽喉头颈外科杂志

Objective:This study aims to compare the examination results of the vestibular evoked myogenic potential（VEMP） and video head impulse testing（vHIT） in patients with vestibular neuritis（VN）, thus exploring the methods to distinguish superior and inferior vestibular nerve damages in VN patients, and their feasibility. Methods:A total of 25 patients with unilateral VN treated in the Otology Department of the First Hospital of Qinhuangdao from May 2018 to July 2021 were recruited. They were respectively tested for ocular VEMP（oVEMP）, cervical VEMP（cVEMP） and vHIT, and the examination results were analyzed. Results:Examination results of oVEMP showed that 96%（24/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patient had no waveform introduced of both ears. The overall abnormal rate examined by oVEMP was 100%（26/26）. Examination results of cVEMP showed that 36%（9/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patients had no waveform introduced of both ears. The overall abnormal rate examined by cVEMP was 40%（10/25）, and 60%（15/25） patients had normal waveforms of both ears. Examination results of vHIT showed that 100%（25/25） patients had semicircular canal gain decline of one side, 92%（23/25） had anterior Semicircular canal decline of one side, and 36%（9/25） had posterior semicircular canal decline of one side. VEMP and vHIT results were compared. Examination results of VEMP showed that 60%（15/25） VN patients had superior vestibular nerve damage, and 40%（10/25） had both superior and inferior vestibular nerve damages. Examination results of vHIT showed that 64%（16/25） VN patients had superior vestibular nerve damage, and 36%（9/25） had both superior and inferior vestibular nerve damages. There was no significant difference in the ratio of VN patients with superior and inferior vestibular nerve damages examined by VEMP or vHIT（χ²=0.085, P>0.05）. The matching ratio of VEMP and vHIT results was 80%（20/25）, and the non-matching ratio was 20%（5/25）. Conclusion:Consistent results obtained from both VEMP and vHIT can preliminarily identify the type of vestibular nerve damage. If their results are not consistent, it is recommended not to identify the scope of the vestibular nerve damage.

Application of vestibular function examination in the analysis of damaged site in patients with acute vestibular neuritis / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the site of vestibular nerve damaged in patients with acute vestibular neuritis. Methods:Fifty-seven patients with acute vestibular neuritis were recruited, and each patient underwent caloric irrigation test, video head impulse test（vHIT） and vestibular evoked myogenic potentials（VEMPs）. The results were further analyzed. Results:Analysis of abnormal rates of different vestibular function tests: the abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and posterior semicircular canal vHIT were 92.98%, 92.98%, 92.98%, and 52.63%, respectively. The abnormal rate of cervical vestibular evoked myogenic potentials（cVEMP） and ocular vestibular evoked myogenic potentials（oVEMP） were 52.63% and 89.47%. The abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP were significantly higher than posterior semicircular canal vHIT and cVEMP（P<0.01）. Combination analysis of different vestibular function tests: there are twenty-six patients（45.61%, superior and inferior vestibular nerve） with abnormal caloric irrigation test, video head impulse test, and VEMPs. There are twenty-five patients（43.86%, superior vestibular nerve） with abnormal caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP. There are 4 patients（7.02%, inferior vestibular nerve） with abnormal posterior semicircular canal vHIT and cVEMP. There are two patients（3.51%, ampullary vestibular nerve） with abnormal caloric irrigation test, horizontal semicircular canal vHIT, and anterior semicircular canal vHIT. The rate of superior and inferior vestibular neuritis and superior vestibular neuritis were significantly higher than inferior vestibular neuritis and ampullary vestibular neuritis（P<0.01）. Conclusion:Acute vestibular neuritis subtypes can be divided into four categories: superior and inferior vestibular neuritis, superior vestibular neuritis, inferior vestibular neuritis, and ampullary vestibular neuritis. Video head impulse test can accurately assess the site of vestibular nerve damage in patients with acute vestibular neuritis. In addition, vHIT combined with VEMPs can provide objective evidence for the diagnosis of ampullary vestibular neuritis.

Diagnostic evolution of vestibular neuritis after long-term monitoring / Evolução diagnóstica da neurite vestibular após monitoração de longo prazo

Abstract Introduction The diagnosis of vestibular neuritis is based on clinical and laboratory findings after exclusion of other disease. There are occasional discrepancies between clinical impressions and laboratory results. It could be the first vertigo episode caused by other recurrent vestibular disease, other than vestibular neuritis. Objective This study aimed to analyze the clinical features and identify the diagnostic evolution of patients with clinically suspected vestibular neuritis. Methods A total of 201 patients clinically diagnosed with vestibular neuritis were included in this study. Clinical data on the symptoms and signs of vertigo along with the results of vestibular function test were analyzed retrospectively. Patients were categorized in terms of the results of caloric testing (CP - canal paresis) group; canal paresis ≥25%; (MCP -minimal canal paresis) group; canal paresis <25%). Clinical features were compared between the two groups and the final diagnosis was reviewed after long-term follow up of both groups. Results Out of 201 patients, 57 showed minimal canal paresis (CP < 25%) and 144 showed definite canal paresis (CP ≥ 25%). A total of 48 patients (23.8%) experienced another vertigo episode and were re-diagnosed. Recurring vestibular symptoms were seen more frequently in patients with minimal canal paresis (p = 0.027). Repeated symptoms were observed on the same affected side more frequently in the CP group. The proportion of final diagnosis were not different between two groups. Conclusions Patients with minimal CP are more likely to have recurrent vertigo than patients with definite CP. There was no significant difference in the distribution of the final diagnoses between two groups when the vertigo recurs.

Resumo Introdução O diagnóstico de neurite vestibular é baseado em achados clínicos e laboratoriais após exclusão de outra doença. Existem discrepâncias ocasionais entre a impressão clínica e os resultados laboratoriais. Pode ser o primeiro episódio de vertigem causado por outra doença vestibular recorrente, além da neurite vestibular. Objetivo Analisar as características clínicas e identificar a evolução diagnóstica de pacientes com suspeita clínica de neurite vestibular. Método Foram incluídos neste estudo 201 pacientes com diagnóstico clínico de neurite vestibular. Os dados clínicos sobre os sintomas e sinais de vertigem e os resultados dos testes de função vestibular foram analisados retrospectivamente. Os pacientes foram categorizados de acordo com os resultados das provas calóricos (Grupo PC: paresia do canal ≥ 25%; Grupo PMC: paresia mínima do canal < 25%). As características clínicas foram comparadas entre os dois grupos e o diagnóstico final foi revisado após o acompanhamento de longo prazo de ambos os grupos. Resultados De 201 pacientes, 57 apresentaram paresia mínima do canal (PC < 25%) e 144 apresentaram paresia definitiva do canal (PC ≥ 25%). Quarenta e oito pacientes (23,8%) apresentaram outro tipo de vertigem e foram diagnosticados novamente. Sintomas vestibulares recorrentes foram observados com mais frequência nos pacientes com paresia mínima do canal (p = 0,027). Sintomas recorrentes no mesmo lado afetado foram observados com mais frequência no Grupo PC. A proporção de diagnóstico final não foi diferente entre os dois grupos. Conclusão Os pacientes com paresia mínima do canal foram mais propensos a apresentar vertigem recorrente que os pacientes com paresia do canal definitiva. Não houve diferença significante na distribuição dos diagnósticos finais entre os dois grupos quando houve recorrência da vertigem.

25-Hydroxyvitamin D and C-reactive protein levels in Patients with Vestibular Neuritis / 中风与神经疾病杂志

@#Objective We evaluated serum levels of 25hydroxyvitamin D（25（OH）D）and Creactive protein（CRP）in patients presenting acutely with Vestibular neuritis（VN）and healthy controls and investigated the possible correlation of serum 25（OH）D and CRP levels with VN.Methods A total of 46 consecutive patients diagnosed with VN within 7 days of symptom onset and 66 ageand sexmatched healthy controls in NO731 Hospital，between March 2019 and August 2020 were recruited. Demographic and clinical data，such as age，sex，height，weight，living habits，ongoing health problems，and medication history，for all subjects were recorded，and levels of 25（OH）D and CRP were measured and compared. 〖WT5”HZ〗Results〖WT5”BZ〗Serum levels of 25（OH）D were significantly lower in patients with VN than in controls（18.30± 6.19 vs. 22.43±5.23 ng/ml，P<0.001）.whereas serum levels of CRP were higher in patients with VN than in controls （15.86±8.37 vs. ng/ml，P<0.001）Regression analyses demonstrated that vitamin D and CRP were associated with VN，with an odds ratio of 1.187 （95%CI 1.046～1.093，P=0.001）and 1.223 （95%CI=1.10～1.36，P=0.000）.Conclusion VN is associated with evidence of an acute inflammatory response，we found that serum 25（OH）D and CRP may be associated with VN occurrence.

Association of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with Vestibular Neuritis / 中风与神经疾病杂志

@#Objective　To study the association between neutrophil to lymphocyte ratio (NLR) or platelet to lymphocyte ratio (PLR) in patients with vestibular neuritis (VN).Methods　A total of 137 patients who were finally diagnosed as VN were selected as the study group and 192 healthy volunteers without a history of dizziness or vertigo were selected as the control group in Hwa Mei Hospital and Ningbo Women and Children’s Hospital from January 2016 to December 2020.The general information,complete blood counts,NLR and PLR were obtained and analyzed.Results　There were no significant differences in the age distribution,sex ratio,body mass index,comorbidities,hemoglobin,lymphocyte and platelet values between the study group and control group.White blood cell and neutrophil count were significantly higher in the study group and control group (P<0.001).NLR and PLR were significantly higher in the study group as well (2.5 vs 1.9,Z=-5.74,P<0.001;124.2 vs 109.5,Z=-2.727,P=0.003).Conclusion　The elevations of NLR and PLR in patients with VN indicate that inflammation is involved in the pathogenesis of VN.

Direction-Changing and Direction-Fixed Positional Nystagmus in Patients With Vestibular Neuritis and Meniere Disease

OBJECTIVES: Direction-changing positional nystagmus (PN) was considered to indicate the presence of benign paroxysmal positional vertigo involving lateral semicircular canal in most cases. We investigated the incidence of PN on the supine head-roll test and compared the characteristics of nystagmus in patients with vestibular neuritis (VN) and Meniere disease (MD). METHODS: A retrospective review of patients, who were diagnosed with unilateral VN or unilateral definite MD between September 2005 and November 2011, was conducted. Sixty-five VN patients and 65 MD patients were enrolled. Eye movements were recorded for 30–60 seconds at the positions of sitting, head roll to the right, and head roll to the left, and maximum slow-phase eye velocity was calculated. PN was classified as direction-fixed (paretic or recovery) and direction-changing (geotropic or apogeotropic). RESULTS: Spontaneous nystagmus was observed in 57 patients (87%, the slow-phase eye velocity of 7°/sec±5°/sec) with acute VN, 39 (60%, 2°/sec±1°/sec) with follow-up VN, and 32 (49%, 2°/sec±2°/sec) with MD. Direction-fixed PN was the most common type. Direction-fixed paretic type was most common in acute VN (80%) and follow-up VN (42%), and direction-fixed recovery type was most common in MD (31%). Paretic type was significantly more common in acute VN (80%) than in follow-up VN (42%) and MD (26%), and the recovery type was significantly more common in MD (31%) than in acute VN (3%) and follow-up VN (14%). Direction-changing PN was more common in MD (22%), followed by follow-up VN (14%) and acute VN (9%). CONCLUSION: Though direction-fixed paretic PN was most common in VN and MD patients, direction-changing PN could be observed in a few patients (9%–20%) with peripheral vestibular disorders regardless of the duration from the onset of dizziness, suggesting the presence of otolith-related dizziness.

A Case of Isolated Nodular Infarction Mimicking Vestibular Neuritis on the Contralateral Side

Differentiating central vestibulopathy from more common vestibular disorders is crucial because it often necessitates different treatment strategies, and early detection can help to minimize potential complications. Isolated nodular infarct is one of the central brain lesions that can mimic peripheral vertigo. We present a case of isolated nodular infarct that had been misdiagnosed as vestibular neuritis on the contralateral side at the initial evaluation. The patient was successfully treated with anticoagulants and antihyperlipidemic agents. Clinicians should keep in mind that some causes of central vertigo mimic peripheral vestibulopathy at the early stage.

Long-Term Changes in Video Head Impulse and Caloric Tests in Patients with Unilateral Vestibular Neuritis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Video head impulse tests (vHITs) and caloric tests are widely used to assess the loss of vestibular function in acute vestibular neuritis. Although previous studies have reported on the results of each test, longitudinal comparison of these tests is rare. In the present study, vHITs and caloric tests were performed in patients with unilateral vestibular neuritis during the acute phase and after a long follow-up period (>6 months). The goal of this study was to evaluate the changes in vHIT and caloric test results and to analyze the relationships between them. SUBJECTS AND METHOD: Between September 2013 and December 2015, charts from 13 patients with unilateral vestibular neuritis were retrospectively reviewed. Among the 13 patients, caloric tests and vHITs were performed in 9 and 10 patients, respectively. Results of the vHITs and caloric tests were analyzed and the changes were compared. RESULTS: During the acute phase of vestibular neuritis, the results of the caloric test showed an increase in canal paresis (CP), and the results of the vHIT showed a decrease in horizontal gain. Although subjective symptoms improved in all patients after a long follow-up period (mean: 13.9 months), the occurrence of CP determined from the caloric test was not significantly changed (p=0.889). On the other hand, the mean horizontal gain of the vHIT had improved significantly (p < 0.05). CONCLUSION: While CP determined from the caloric test did not change after a long follow-up period, the decreased horizontal gain in the vHIT was significantly recovered in patients with unilateral vestibular neuritis.

Visuospatial Dysfunction in Patients With the Right Vestibular Neuritis / 대한평형의학회지

Acute vestibular neuritis (VN) is characterized by acute/subacute vertigo with spontaneous nystagmus and unilateral loss of semicircular canal function. Vestibular system in human is represented in the brain bilaterally with functional asymmetries of the right hemispheric dominance in the right handers. Spatial working memory entails the ability to keep spatial information active in working memory over a short period of time which is also known as the right hemispheric dominance. Three patients (patient 1, 32-year-old female; patient 2, 18-year-old male; patient 3, 63-year-old male) suffered from acute onset of severe vertigo, nausea and vomiting. Patients 1 and 2's examination revealed VN on the right side showing spontaneous left beating nystagmus and impaired vestibular ocular reflex on the right side in video head-impulse and caloric tests. Patient 3's finding was fit for VN on the left side. We also evaluated visuospatial memory function with the block design test in these 3 VN patients which discovered lower scores in patients 1 and 2 and the average level in patient 3 compare to those of healthy controls. Follow-up block design test after resolved symptoms showed within normal range in both patients. Our cases suggest that the patients with unilateral peripheral vestibulopathy may have an asymmetrical effect on the higher vestibular cognitive function. The right VN can be associated with transient visuospatial memory dysfunction. These findings add the evidence of significant right hemispheric dominance for vestibular and visuospatial structures in the right-handed subjects, and of predominant dysfunction in the hemisphere ipsilateral to the peripheral lesion side.

Shoe-Type Wearable Sensors Measure Gait Parameters in Vestibular Neuritis: A Preliminary Study / 대한평형의학회지

OBJECTIVES: Despite patients with dizziness were reported of revealing gait problems, there is still lack of objective quantitative measurement of gait patterns of peripheral vestibular disorders. To demonstrate gait variability in acute unilateral peripheral vestibular deficit, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and healthy subjects by the use of shoe-type inertial measurement unit (IMU) with sensors mounted. METHODS: Between April 2017 and January 2019, 30 patients diagnosed with unilateral peripheral vestibular deficit presumed to be caused by VN were enrolled in this study. The shoe-type IMU was used to analysis subjects. We assessed gait speed, cadence, stride length, stance phase, normalized stride length, normalized step length, phase coordination index and gait asymmetry of data from shoe-type IMU sensors with the walking protocol. We tested 30 healthy volunteers as control group. RESULTS: We identified spatiotemporal parameters of human gait. The gait speed of patients with VN was decreased to 3.82±0.8 compared to 4.93±1.08 in control group. In addition, there were differences in normalized stride length, normalized gait speed and related gait parameters, when comparing VN group and control group. CONCLUSION: Gait analysis by the use of shoe-type IMU could provide important information regarding vestibular pathophysiology in patients with VN. Gait performance tests can examine gait variability quantitatively. It will be taken into consideration as a vestibular function test for patients with vertigo.

Relationship between Video Head Impulse Gain and Severity of Dizziness in Patients with Vestibular Neuritis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated the correlation between video head impulse test (vHIT) and dizziness handicap inventory (DHI), which is commonly used to quantify severity of dizziness in vestibular neuritis (VN). SUBJECTS AND METHOD: Twenty VN patients undergoing vHIT either at the acute or follow-up stages of treatment were assessed by DHI questionnaire. Gain and gain asymmetry (GA) were correlated with DHI scores and abnormal vHIT rates were compared according to the severity of dizziness (mild ≤30; moderate-to-severe ≥32). RESULTS: vHIT gains significantly increased from the acute to follow-up stages (from 0.45±0.18 to 0.70±0.25), whereas GA and DHI scores decreased (GA, from 0.36±0.15 to 0.22±0.18; DHI scores, from 35±26 to 23±23). Although vHIT gains or GA showed no correlation with DHI scores at the acute stage, vHIT gains showed significant correlation with DHI scores at the follow-up (R-sq=0.32, p=0.01) stage. vHIT gains and GA did not differ according to the severity of dizziness during the acute stage; however, vHIT gains (0.78±0.25) of patients with mild dizziness were significantly higher than those (0.51±0.14) with moderate-to-severe dizziness at the follow-up stage. During the follow-up, all patients with moderate-to-severe dizziness showed abnormal vHIT gain, but 43% of patients with mild dizziness showed abnormal vHIT gain, showing a significant difference (p<0.05). CONCLUSION: Reduced vHIT gain was significantly correlated with high degrees of dizziness at the follow-up, but not at the acute stage, suggesting that high-frequency canal dysfunction is contributed in part by the subjective dizziness at the follow-up. Our findings suggest that vHIT might give an indirect evidence for implementing vestibular rehabilitation for enhancing impaired vestibular function and relieving subjective dizziness.

A Case of Acute Vestibular Neuritis with Periodic Alternating Nystagmus / 대한이비인후과학회지

Detection of nystagmus is an important diagnostic clue in patients with acute vertigo. Patients with peripheral disorders exhibit nystagmus with a constant direction whereas those with central disorders exhibit nystagmus with changes in direction with or without gaze fixation. Periodic alternating nystagmus (PAN) is a horizontal or horizontal-rotary jerk-type nystagmus that reverses its direction with time. PAN is typically observed in patients with central disorders, such as cerebellar or pontomedullary lesions, but it is also observed in patients with peripheral disorders, albeit rarely. Here we report a rare case of a 58-year-old patient with vertigo with PAN, which was initially suspected as a central disorder, but eventually diagnosed as a peripheral vestibular disorder. We investigated the characteristics and mechanisms of peripheral PAN in this case. The absence of central disorder symptoms, visual suppression of PAN, normal oculomotor findings, and transient persistence are important diagnostic clues for differentiating peripheral from central PAN.

Application of video head impulse test in detecting damage and recovery features of semicircular canal of patients with acute vestibular neuritis / 第二军医大学学报

Objective To investigate the application of video head impulse test in detecting the impairment of semicircular canal of patients with acute vestibular neuritis and the recovery features of the damaged semicircular canal. Methods The clinical data of 28 patients with acute vestibular neuritis, who were diagnosed in the Department of Neurology, Changzheng Hospital, Second Military Medical University from Mar. 2015 to Mar. 2016, were analyzed and regularly followed up. The damage and recovery of each semicircular canal function were evaluated by video head impulse test. Results During the onset period, the horizontal semicircular canal function was abnormal in 28 patients (100.00%), the anterior semicircular canal function was abnormal in 24 cases (85.71%), and the posterior semicircular canal function was abnormal in 4 cases (14.29%). After 2 months of follow-up, the gain of the patients with severe damage of horizontal semicircular canal (gain0.5) at onset did not return to normal, while that of 80.00% (12/15) of the patients with less damage of horizontal semicircular canal (gain ranged from 0.5 to 0.8) recovered; 82.35% (14/17) of the patients with severe damage of anterior semicircular canal (gain0.5) at onset did not recover, while that of the patients with less damage of anterior semicircular canal (gain ranged from 0.5 to 0.7) returned to normal. Conclusion In patients with vestibular neuritis, the damage of semicircular canal dominated by superior vestibular nerve is more severe than that dominated by inferior vestibular nerve. Video head impulse test is suitable for the detection and follow-up of the function of impaired semicircular canal. The recovery of impaired semicircular canal is related to its severity at onset.

Compensation of the Postural Instability in Patients with Acute Unilateral Vestibular Neuritis: The Usefulness of Computerized Dynamic Posturography as an Objective Indicator / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the usefulness of computerized dynamic posturography (CDP) in patients with acute vestibular neuritis (AVN) by identifying the recovery period of Sensory Organization Test (SOT) and comparing the result of SOT with those of the vestibulo-ocular reflex (VOR) tests and subjective symptoms. SUBJECTS AND METHOD: A prospective study was conducted on 41 patients who were diagnosed with AVN. The SOT was measured daily until the equilibrium composite score recovered the normal value. A survey, composing of questionnaires on Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI), motion sensitive quotient (MSQ) and Activities-Specific Balance Confidence Scale (ABC), was conducted on the patient's initial visit and on the day the normal value of SOT was recovered. Videonystagmography and the caloric test were also performed, and the results were compared with those of the SOT. RESULTS: The mean duration from the onset of vertigo to the recovery of SOT scores was 3.7±2.9 days (median 3.0 days) and that from the onset of vertigo to the disappearance of spontaneous nystagmus was 17.1±27.2 days (median 6.0 days). The scores of 4 questionnaires (VAS, DHI, MSQ, and ABC) were significantly different between the initial day and the day of recovery to the normal value of SOT (p<0.001). However, the velocity of spontaneous nystagmus on the initial visit and the degree of canal paresis from the caloric test showed no significant correlations to recovery duration from the onset of vertigo to the normalization of SOT score. CONCLUSION: The recovery duration of vestibulospinal reflex (VSR) is much shorter than that of VOR in patients with AVN. The recovery of subjective symptoms showed close correlation with the recovery of VSR, but the results of VSR was not correlated with that of VOR. Therefore, CDP could be a very useful test for monitoring the resolution of subjective symptoms in patients with AVN.

Cardiovascular Risk Factors in Total or Divisional Vestibular Neuritis / 대한평형의학회지

OBJECTIVES: In vestibular neuritis (VN), the lesion preferentially affects the superior vestibular nerve because of the anatomic arrangement. It is well known that VN patients have a higher score of metabolic syndrome or a higher incidence of vertebral artery hypoplasia than controls. However, it is unclear whether the frequency of cardiovascular risk factors can affect the selective involvement of the branch of the vestibular nerve. Thus, we investigated the influence of cardiovascular risk factors on the development of total- or divisional VN. METHODS: 61 patients with VN were enrolled. Video head impulse tests and caloric tests were performed to determine which vestibular divisionswere affected. The patients were divided into divisional-VN (superior or inferior) and total-VN groups. Statistical analysis of the frequency of cardiovascular risk factors was performed only in superior and total VN groups because the number of inferior VN patients was too small to be statistically analyzed. RESULTS: Nineteen (31.1%) patients were classified as the total-VN group. In the divisional-VN group (42 patients, 65.6%), 40 were superior VN. The frequency of cardiovascular risk factors are not significantly different in superior VN and total-VN groups (All patients 50/61 [82.0%], superior-VN 36/40 [90.0%], total-VN 13/19 [68.4%]). The frequency of having more than one cardiovascular risk factor was slightly higher in the superior VN group, (13 [68.4%] vs. 36 [90.0%], p=0.062) but did not show any significant difference. CONCLUSIONS: The number of cardiovascular risk factors did not differ in superior VN patients compared to total VN patients.

Herpes Zoster Oticus without Facial Palsy and Hearing Loss Masquerading as Vestibular Neuritis

Herpes zoster oticus, also called Ramsay-Hunt syndrome, involves the geniculate ganglion and presents with facial nerve palsy, sensorineural hearing loss, vestibular dysfunction, and auricular vesicular lesion. In this case, the patient presented with isolated vestibular dysfunctions without facial palsy and hearing impairment, and these findings were confirmed by electrophysiologic studies including video head impulse testing. Clinicians should be aware of this variation, and differentiate it from vestibular neuritis which usually does not require intensive antiviral therapies.

Vestibular Neuritis With Minimal Canal Paresis: Characteristics and Clinical Implication

OBJECTIVES: To analyze the clinical characteristics of vestibular neuritis patients with minimal canal paresis (canal paresis <25%). METHODS: Patients clinically diagnosed with vestibular neuritis and treated at our institute (n=201) underwent otoneurological examination and vestibular function tests. Patients were categorized in terms of the results of caloric testing (canal paresis<25%, n=58; canal paresis≥25%, n=143). Clinical characteristics and laboratory outcomes were compared between two groups. RESULTS: Existence of underlying diseases, preceding symptoms, and direction of spontaneous nystagmus were not different between the groups. The mean duration of spontaneous nystagmus was shortest in the minimal canal paresis group (P<0.001) and the direction of spontaneous nystagmus changed more frequently in this group (P<0.001) during recovery. Among the subgroup with minimal canal paresis, only 29.5% had an abnormal finding on the rotatory chair test, as compared to 81.5% of the canal paresis group. The minimal canal paresis group showed higher sensory organization test scores in computerized dynamic posturography. CONCLUSION: Patients with minimal canal paresis (canal paresis <25%) show similar clinical manifestations as conventional vestibular neuritis patients, but have faster recovery of symptoms and a higher incidence of recovery nystagmus. This finding support that the minimal canal paresis could be considered as a milder type of vestibular neuritis.

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.

Frequency and position characteristics of the vestibular dysfunction in vestibular neuritis patients / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate frequency and position characteristics of the vestibular dysfunction in vestublar neuritis patients. Method:Colaric test (CT), head impulse test (HIT), cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) were applied in 43 vestublar neuritis patients to assess their vestublar dysfunction. Superior vestublar nerve (S-VN), inferior vestibular nerve (I-VN), total vestibular nerve (T-VN) and each vestibular end organ incidence rate were calculated and statistically analyzed. Result:CT incidence rate (93.0%) was statistically higher than that of HIT (72.1%) (P<0.01). Total frequency incidence rate (72.1%) was statistically higher than that of low frequency (20.9%) (P<0.01). No high frequency only case was observed. The incidence rate of S-VN only, I-VN only and T-VN was 44.2%, 4.7% and 51.2% respectively. Among them, the incidence rate of I-VN was significantly lower than the others (P<0.01). The incidence rate of vestibular end organs was 17.4% (S-SCC), 44.2% (H-SCC), 20.9% (P-SCC), 39.5% (utricule) and 26.7% (saccule) respectively. The incidence rate of H-SCC was remarkably higher than the other semicircular canals (P<0.01). The difference between utricule and saccule was not statistically significant. Conclusion:The semicricular canal dysfunction in vestibular neuritis patients mainly involves total frequency of vestibular function, low frequency is more common than high frequency. Total vestibular nerve and single S-VN are mostly involved in vestibular neuritis.

Normal Caloric Responses during Acute Phase of Vestibular Neuritis

BACKGROUND AND PURPOSE: We report a novel finding of caloric conversion from normal responses into unilateral paresis during the acute phase of vestibular neuritis (VN). METHODS: We recruited 893 patients with a diagnosis of VN at Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2014 after excluding 28 patients with isolated inferior divisional VN (n=14) and those without follow-up tests despite normal caloric responses initially (n=14). We retrospectively analyzed the neurotological findings in four (0.5%) of the patients who showed a conversion from initially normal caloric responses into unilateral paresis during the acute phase. RESULTS: In those four patients, the initial caloric tests were performed within 2 days of symptom onset, and conversion into unilateral caloric paresis was documented 1-4 days later. The clinical and laboratory findings during the initial evaluation were consistent with VN in all four patients except for normal findings in bedside head impulse tests in one of them. CONCLUSIONS: Normal findings in caloric tests should be interpreted with caution during the acute phase of suspected VN. Follow-up evaluation should be considered when the findings of the initial caloric test are normal, but VN remains the most plausible diagnosis.