Vestibular neuritis

Abstract

Because the cause of vestibular neuritis is unknown, this disorder is best understood as a constellation of characteristic clinical symptoms and signs. The differential diagnosis includes peripheral otologic disorders, including Meniere's disease, perilymph fistula, and vestibular atelectasis; and central disorders, including vascular insufficiency, acoustic neuroma, migraine equivalent, paraneoplastic syndrome, metastatic carcinoma, and multiple sclerosis. The site of lesion, as evaluated by clinical signs and symptoms, is controversial because concomitant central nervous system abnormalities have been described. The histopathology of temporal bones from persons who in life had symptoms characteristic of vestibular neuritis demonstrates degeneration of branches of the vestibular nerve and the neuroepithelium of vestibular end organs. Possible causes of vestibular neuritis include viral or other infectious agents and vascular or immune-mediated disorders. The natural history of this disorder is variable. In some patients complete recovery of acute signs and symptoms, including loss of vestibular response, is seen, whereas in others permanent changes have been reported. Initial treatment is generally symptomatic only. Patients with poor recovery may benefit from vestibular rehabilitation or, occasionally, from surgical intervention. The elucidation of the pathogenesis of vestibular neuritis and the development of logical guidelines for individual rehabilitation are needed.

Vibration‐ and Hyperventilation‐Induced Nystagmus in Patients with Ramsay Hunt Syndrome with Vertigo

“…Radiological evidence for the pathologic condition within the inner ear in SSNHL‐V has been demonstrated, 30 and clinical findings suggesting end organ damage have been reported 31,32 . In VN, the pathologic site is believed to lie within the vestibular nerve, and degeneration of the vestibular nerve with or without vestibular hair cell damage has been observed in VN 33,34 . In contrast, the lesioned site of RHS‐V that is responsible for the vestibular deficit is still a subject of great controversy.…”

Diagnosis and Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

“…The superior vestibular nerve innervates the lateral semicircular canal crista, superior canal crista, macula utriculi, and dorsum of the macula sacculi. Nadol 15 has shown degeneration of the lateral canal crista in association with superior division vestibular neuritis. Neuritis could also affect the utricular nerve, thus removing otolith inhibition from the lateral semicircular canal efferents at the level of the vestibular nuclei.…”

Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria

“…A viral etiology of AUVP is -in analogy to Bell's palsy and some types of acute hearing loss -likely but so far not proven [13,14,54,86,117,137]. There are several lines of evidence for such an etiology: a) a post-mortem study showed inflammatory degeneration of the vestibular nerve [136], b) demonstration of HSV-1, latency-associated transcripts in vestibular ganglia, and activated CD8 + T cells [3, 5-8, 68, 150].…”