title: Visual dependency and dizziness after vestibular neuritis.
abstract: Symptomatic recovery after acute vestibular neuritis (VN) is variable, with around 50% of patients reporting long term vestibular symptoms; hence, it is essential to identify factors related to poor clinical outcome. Here we investigated whether excessive reliance on visual input for spatial orientation (visual dependence) was associated with long term vestibular symptoms following acute VN. Twenty-eight patients with VN and 25 normal control subjects were included. Patients were enrolled at least 6 months after acute illness. Recovery status was not a criterion for study entry, allowing recruitment of patients with a full range of persistent symptoms. We measured visual dependence with a laptop-based Rod-and-Disk Test and severity of symptoms with the Dizziness Handicap Inventory (DHI). The third of patients showing the worst clinical outcomes (mean DHI score 36-80) had significantly greater visual dependence than normal subjects (6.35° error vs. 3.39° respectively, p = 0.03). Asymptomatic patients and those with minor residual symptoms did not differ from controls. Visual dependence was associated with high levels of persistent vestibular symptoms after acute VN. Over-reliance on visual information for spatial orientation is one characteristic of poorly recovered vestibular neuritis patients. The finding may be clinically useful given that visual dependence may be modified through rehabilitation desensitization techniques.
authors.affiliation: Neuro-otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom.
authors.forename: Sian
authors.initials: S
authors.lastname: Cousins
authors.affiliation: Neuro-otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Cutfield
authors.affiliation: Neuro-otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom.
authors.forename: Diego
authors.initials: D
authors.lastname: Kaski
authors.affiliation: Interdisciplinary Centre for Vertigo & Balance Disorders, Department of Neurology, Zürich, Switzerland.
authors.forename: Antonella
authors.initials: A
authors.lastname: Palla
authors.affiliation: Neuro-otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom.
authors.forename: Barry M
authors.initials: BM
authors.lastname: Seemungal
authors.affiliation: Department of Psychology, University of Westminster, London, United Kingdom.
authors.forename: John F
authors.initials: JF
authors.lastname: Golding
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Staab
authors.affiliation: Neuro-otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom.
authors.forename: Adolfo M
authors.initials: AM
authors.lastname: Bronstein
mesh_terms: D000328:Adult; D000368:Aged; D004244:Dizziness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D065855:Spatial Processing / Q000502:physiology*; D016896:Treatment Outcome; D014717:Vertigo; D014724:Vestibular Function Tests; D014725:Vestibular Nerve / Q000473:pathology; D020338:Vestibular Neuronitis / Q000628:therapy; D014722:Vestibule, Labyrinth; D014785:Vision, Ocular / Q000502:physiology*; D055815:Young Adult