Reconsideration of acute unilateral vestibulopathy/vestibular neuritis: A prospective cohort study with function test-based classification.

Abstract

Background: Vestibular neuritis (VN) has faced various diagnostic challenges despite years of clinical use. This study analyzes 65 cases based on diagnostic criteria for acute unilateral vestibulopathy/vestibular neuritis (AUVP/VN) 2022.

Method: Through medical history, physical examinations, and vestibular function tests, including the caloric test, video-head impulse test (v-HIT), and vestibular evoked myogenic potentials (VEMPs), we thoroughly tested vestibular receptor dysfunction of AUVP/VN cases. Patients were divided into two groups: total vestibular nerve branch dysfunction (tVND) and partial vestibular nerve branch dysfunction (pVND). The tVND group was defined as involving all receptors innervated by the superior and/or inferior vestibular nerve. The pVND group was defined as involving any other combination pattern of vestibular receptors (at least one). Sociodemographic and clinical characteristics were analyzed. All patients were followed up for 6 months. Changes in DHI scale scores and residual or new symptoms were investigated.

Results: A total of 65 AUVP/VN patients with vestibular receptor dysfunction were included. There were 51 cases in the pVND group and 14 in the tVND group. Compared to the pVND group, the tVND group showed longer vertigo duration (p < 0.05), higher rates of postural symptoms (p < 0.01), higher rates of abnormal caloric tests (p < 0.05), higher canal paresis values (p < 0.001), and higher rates of deficient vestibulo-ocular reflex (VOR) gain in v-HIT (p < 0.001). After a 6-month follow-up, the pVND group showed lower DHI scores (p < 0.001) and higher cure rate (p < 0.001).

Conclusions: In general, patients in the tVND group showed a more severe disease and worse prognosis than those in the pVND group. The substitution of the term AUVP for VN is appropriate and aligns with the clinical characteristics of the cases. However, the diagnosis of AUVP should be further developed to include otolith organ dysfunction.