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Abstract
Objective: To characterize the profiles of afferent dysfunction in a cross section of patients with acute vestibular neuritis using tests of otolith and semicircular canal function sensitive to each of the 5 vestibular end organs.
Methods: Forty-three patients fulfilling clinical criteria for acute vestibular neuritis were recruited between 2010 and 2016 and studied within 10 days of symptom onset. Otolith function was evaluated with air-conducted cervical and bone-conducted ocular/vestibular evoked myogenic potentials and the subjective visual horizontal test. Canal-plane video head impulse tests (vHITs) assessed the function of each semicircular canal. Patterns of recovery were investigated in 16 patients retested after a 6- to 12-month follow-up period.
Results: Rates of horizontal canal (97.7%), anterior canal (90.7%), and utricular (72.1%) dysfunction were significantly higher than rates of posterior canal (39.5%) and saccular (39.0%) dysfunction (p < 0.008). Twenty-four patients (55.8%) had abnormalities localizing to both vestibular nerve divisions; 18 patients (41.9%) had superior neuritis; and 1 patient (2.3%) had inferior neuritis. A test battery that included horizontal and posterior canal vHIT and the cervical/vestibular evoked myogenic potentials identified superior or inferior neuritis in all patients tested acutely. Eight of 16 patients who were retested at follow-up had recovered a normal vestibular evoked myogenic potential and vHIT profile.
Conclusions: Acute vestibular neuritis most often affects both vestibular nerve divisions. The horizontal vHIT alone identifies superior nerve dysfunction in all patients with vestibular neuritis tested acutely, whereas both cervical/vestibular evoked myogenic potentials and posterior vHIT are necessary for diagnosing inferior vestibular nerve involvement.
GLOSSARY
- AC=
- anterior semicircular canal;
- cVEMP=
- cervical vestibular evoked myogenic potential;
- HC=
- horizontal semicircular canal;
- HINTS=
- head impulse, nystagmus, test of skew;
- HIT=
- head impulse test;
- oVEMP=
- ocular evoked myogenic potential;
- PC=
- posterior semicircular canal;
- SVH=
- subjective visual horizontal;
- VEMP=
- vestibular evoked myogenic potential;
- vHIT=
- video head impulse test;
- VN=
- vestibular neuritis;
- VOR=
- vestibulo-ocular reflex
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received October 10, 2015.
- Accepted in final form June 30, 2016.
- © 2016 American Academy of Neurology
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