Vestibular neuritis affects both superior and inferior vestibular nerves.
OBJECTIVE
To characterize the profiles of afferent dysfunction in a cross section of patients with acute vestibular neuritis using tests of otolith and semicircular canal function sensitive to each of the 5 vestibular end organs.


METHODS
Forty-three patients fulfilling clinical criteria for acute vestibular neuritis were recruited between 2010 and 2016 and studied within 10 days of symptom onset. Otolith function was evaluated with air-conducted cervical and bone-conducted ocular/vestibular evoked myogenic potentials and the subjective visual horizontal test. Canal-plane video head impulse tests (vHITs) assessed the function of each semicircular canal. Patterns of recovery were investigated in 16 patients retested after a 6- to 12-month follow-up period.


RESULTS
Rates of horizontal canal (97.7%), anterior canal (90.7%), and utricular (72.1%) dysfunction were significantly higher than rates of posterior canal (39.5%) and saccular (39.0%) dysfunction (p < 0.008). Twenty-four patients (55.8%) had abnormalities localizing to both vestibular nerve divisions; 18 patients (41.9%) had superior neuritis; and 1 patient (2.3%) had inferior neuritis. A test battery that included horizontal and posterior canal vHIT and the cervical/vestibular evoked myogenic potentials identified superior or inferior neuritis in all patients tested acutely. Eight of 16 patients who were retested at follow-up had recovered a normal vestibular evoked myogenic potential and vHIT profile.


CONCLUSIONS
Acute vestibular neuritis most often affects both vestibular nerve divisions. The horizontal vHIT alone identifies superior nerve dysfunction in all patients with vestibular neuritis tested acutely, whereas both cervical/vestibular evoked myogenic potentials and posterior vHIT are necessary for diagnosing inferior vestibular nerve involvement.
From the Institute of Clinical Neurosciences (R.T., M.S.W.), Royal Prince Alfred Hospital, Central Clinical School, University of Sydney; and Institute of Clinical Neurosciences (L.A.M., N.R., A.S.Y., G.M.H.), Royal Prince Alfred Hospital, Sydney, Australia.
Rachael L
RL
Taylor
From the Institute of Clinical Neurosciences (R.T., M.S.W.), Royal Prince Alfred Hospital, Central Clinical School, University of Sydney; and Institute of Clinical Neurosciences (L.A.M., N.R., A.S.Y., G.M.H.), Royal Prince Alfred Hospital, Sydney, Australia.
Leigh A
LA
McGarvie
From the Institute of Clinical Neurosciences (R.T., M.S.W.), Royal Prince Alfred Hospital, Central Clinical School, University of Sydney; and Institute of Clinical Neurosciences (L.A.M., N.R., A.S.Y., G.M.H.), Royal Prince Alfred Hospital, Sydney, Australia.
Nicole
N
Reid
From the Institute of Clinical Neurosciences (R.T., M.S.W.), Royal Prince Alfred Hospital, Central Clinical School, University of Sydney; and Institute of Clinical Neurosciences (L.A.M., N.R., A.S.Y., G.M.H.), Royal Prince Alfred Hospital, Sydney, Australia.
Allison S
AS
Young
From the Institute of Clinical Neurosciences (R.T., M.S.W.), Royal Prince Alfred Hospital, Central Clinical School, University of Sydney; and Institute of Clinical Neurosciences (L.A.M., N.R., A.S.Y., G.M.H.), Royal Prince Alfred Hospital, Sydney, Australia.
G Michael
GM
Halmagyi
From the Institute of Clinical Neurosciences (R.T., M.S.W.), Royal Prince Alfred Hospital, Central Clinical School, University of Sydney; and Institute of Clinical Neurosciences (L.A.M., N.R., A.S.Y., G.M.H.), Royal Prince Alfred Hospital, Sydney, Australia. miriam@icn.usyd.edu.au.
Miriam S
MS
Welgampola
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003939:Diagnostic Techniques, Otological; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010037:Otolithic Membrane / Q000503:physiopathology; D011446:Prospective Studies; D012665:Semicircular Canals / Q000503:physiopathology; D058585:Vestibular Evoked Myogenic Potentials; D014725:Vestibular Nerve / Q000503:physiopathology*; D020338:Vestibular Neuronitis / Q000175:diagnosis / Q000503:physiopathology*