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Otolith dysfunction in vestibular neuritis: Recovery pattern and a predictor of symptom recovery

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Author(s)
H.-A. KimJ.-H. HongH. LeeH.-A. YiS.-R. LeeS.-Y. LeeB.-C. JangB.-H. AhnR.W. Baloh
Keimyung Author(s)
Kim, Hyun AhHong, Jeong HoLee, HyungYi, Hyon AhLee, Seong RyongLee, Se YoupJang, Byeong ChurlAhn, Byung Hoon
Department
Dept. of Neurology (신경과학)
Dept. of Pharmacology (약리학)
Dept. of Ophthalmology (안과학)
Dept. of Molecular Medicine (분자의학)
Dept. of Otorhinolaryngology (이비인후과학)
Brain Research Institute (뇌연구소)
Journal Title
Neurology
Issued Date
2008
Volume
70
Issue
6
Abstract
Objectives: To prospectively follow patients with vestibular neuritis (VN), to compare the recovery
pattern of canal and otolith dysfunction, and to determine which tests best predict symptom
recovery.
Methods: Between March 2006 and December 2006, 51 consecutive patients with unilateral VN
were enrolled within 7 days of onset (average 3 days). Otolith function tests included ocular torsion
(OT), subjective visual vertical (SVV), and vestibular evoked myogenic potential (VEMP), and
canal function tests included head-shaking nystagmus (HSN), caloric stimulation, and head-thrust
testing. Patients returned for two follow-up evaluations at approximately 1 week and 6 weeks
after the initial evaluation.
Results: On the first examination, all patients had abnormal HSN, caloric, and head-thrust test
results, and at least one otolith-related test abnormality: abnormal tilt of SVV (48/51, 94%),
abnormal OT (42/51, 82%), or abnormal VEMPs (25/51, 49%). The degree of SVV tilts correlated
with the degree of OT for one or both eyes (p 0.05). Skew deviation was observed in 7
patients (14%), and a complete ocular tilt reaction was detected in only 2 patients. On follow-up,
otolith test results returned to normal more rapidly than canal test results. The head-thrust test
was the best predictor of symptom recovery. Eighty percent of patients who continued to report
dizziness at the last follow-up visit had a positive head-thrust test result, whereas only 10% of
patients who were not dizzy had a positive head-thrust test result.
Conclusion: Otolith-related test abnormalities improve more rapidly than canal-related test abnormalities
after vestibular neuritis. If patients have a positive head-thrust test result on followup,
they are more likely to be dizzy.
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