Clinical Aspect of Acute Vestibular Neuritis

Chung, Woon Kyo; Lee, Won Sang; Lee, Seung Soo; Lee, Sung Min; Lee, Ek Ho

Abstract

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.