Vestibular Compensation in Vestibular Neuronitis. Long-term Follow-up Evaluation

Imate, Yuji; Sekitani, Toru

doi:10.3109/00016489309135846

Cited by 35 publications

(24 citation statements)

References 5 publications

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“…However, approximately 50% of patients suffers from positional vertigo even 10 years after vestibular neuritis. [13]. The only clinical parameter that predicts the development of chronic vestibular insufficiency is a positive head impulse test result at follow-up in one study [12].…”

Section: Discussionmentioning

confidence: 96%

Predictors of development of chronic vestibular insufficiency after vestibular neuritis

Adamec

Skorić

Ozretić

et al. 2014

Journal of the Neurological Sciences

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Section: Discussionmentioning

confidence: 96%

Predictors of development of chronic vestibular insufficiency after vestibular neuritis

Adamec

Skorić

Ozretić

et al. 2014

Journal of the Neurological Sciences

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“…15,55 For those with APV, underuse of corticosteroids is probably associated with unnecessary morbidity. Chronic dizziness, imbalance, head motion intolerance, and oscillopsia associated with poorly compensated unilateral vestibulopathy occur after untreated APV in about half of patients, 56,57 but corticosteroids reduce nonrecovery roughly threefold. 29 Because chronic dizziness is an independent risk factor for falls and hip fractures, 58 additional adverse health effects and costs 59 probably accrue from failure to optimally manage APV.…”

Section: Discussionmentioning

confidence: 99%

Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample

Newman‐Toker

Camargo

Hsieh

et al. 2009

Academic Emergency Medicine

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Objectives: The most common vestibular disorders seen in the emergency department (ED) are benign paroxysmal positional vertigo (BPPV) and acute peripheral vestibulopathy (APV; i.e., vestibular neuritis or labyrinthitis). BPPV and APV are two very distinct disorders that have different clinical presentations that require different diagnostic and treatment strategies. BPPV can be diagnosed without imaging and is treated with canalith-repositioning maneuvers. APV sometimes requires neuroimaging by magnetic resonance imaging (MRI) to exclude posterior fossa stroke mimics and should be treated with vestibular sedatives and corticosteroids. We sought to determine if emergency physicians (EPs) apply best practices to diagnose and treat these common vestibular disorders.Methods: This was a cross-sectional study of ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS). A weighted sample of U.S. ED visits (1993ED visits ( -2005 was used. Patients at least 16 years of age who were given a final ED diagnosis of BPPV (International Classification of Diseases, 9th Revision [ICD-9], 386.11) or APV (ICD-9 386.12 or 386.3x) comprised the study population. The frequency of imaging and drug therapy in those diagnosed as BPPV or APV versus controls was the main outcome measure.Results: A total of 9,472 dizzy patient visits were sampled over 13 years (weighted estimate 33.6 million U.S. ED visits over that period). A weighted estimate of 2.5 million patients (7.4%) were given a vestibular diagnosis, mostly BPPV (weighted 0.2 million) or APV (weighted 1.9 million). Patients given BPPV (19%) and APV (19%) diagnoses were more likely to undergo imaging (all by computed tomography [CT]) than controls (7%; p < 0.001). Patients given BPPV (58%) and APV (70%) diagnoses were more likely to receive meclizine than controls (0.1%; p < 0.001). Corticosteroid administration was rarely documented (2% BPPV, 1% APV).Conclusions: Patients given a vestibular diagnosis in the ED may not be managed optimally. Patients given BPPV and APV diagnoses undergo imaging (predominantly CT) with equal frequency, suggesting overuse of CT (BPPV) and probably underuse of MRI (APV). Most patients diagnosed with BPPV are given meclizine, which is not indicated. Specific therapy for APV (corticosteroids) is probably underutilized. Educational initiatives and clinical guidelines merit consideration.ACADEMIC EMERGENCY MEDICINE 2009; 16:970-977 ª

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“…Recovery is due to a combination of peripheral vestibular restoration and central compensation [4]. The time course of recovery varies between individuals and, contrary to conventional clinical knowledge [3], almost 50 % of patients with VN report sustained dizziness and disequilibrium [2,5,6,9,11,12]. Vestibular function when assessed by caloric irrigation, rotatory chair testing, posturography, or clinical balance testing does not seem to differ between patients with sustained symptoms and symptom-free patients [2,6,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Vestibular neuritis: Vertigo and the high-acceleration vestibulo-ocular reflex

2008

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Acknowledgements:The authors thank Dr. S. Marti and Dr. K. Weber for performing some of the measurements as well as A. Züger, T. Schmückle, and E. Schafflützel for technical assistance. Disclosure:The authors have reported no conflicts of interest. -Palla et al. ABSTRACTPatients after vestibular neuritis (VN) often report persistent dizziness and disequilibrium. We correlated persistent symptoms with sustained impairment of the high-acceleration horizontal vestibulo-ocular reflex as determined by quantitative search-coil head-impulse testing (qHIT). In 47 patients, qHIT was recorded 0-60 months and symptoms assessed with the Yardley Vertigo Symptom Scale short form ≥18 months after VN onset. No correlation between the magnitude of highacceleration vestibular impairment and the severity of vertigo symptoms was observed. The lack of symptom-qHIT correlation suggests that defective compensation at more rostral level in the central nervous system may be responsible for protracted symptoms in VN patients.3 -Palla et al.

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Vestibular Compensation in Vestibular Neuronitis. Long-term Follow-up Evaluation

Cited by 35 publications

References 5 publications

Predictors of development of chronic vestibular insufficiency after vestibular neuritis

Predictors of development of chronic vestibular insufficiency after vestibular neuritis

Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample

Vestibular neuritis: Vertigo and the high-acceleration vestibulo-ocular reflex

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