The Vestibular Function In Patients With Vestibular Neuritis

Objective Currently,The diagnosis of vestibular neuritis can be confirmed by clinical history,physical examination and related laboratory tests.However,little research has been done on the relationship between the functional abnormalities of the five peripheral vestibular apparatus in the course of the disease.In this study,we use the laboratory tests to evaluate the function of the three semicircular canals,Utricle and saccule.And we also want to analyze the characteristics and interrelationships of these laboratory tests in patients with vestibular neuritis and the extent of damage to the semicircular canals and otoliths.Methods From April 2017 to May 2018,in the vertigo clinic of department of otolaryngology head and neck surgery in Anhui Provincial Hospital,30 patients diagnosed with acute unilateral vestibular neuritis(VN group)and another 20 healthy volunteers(control group)were enrolled.The video head impulse test(vHIT),the calori test,the vestibular evoked myogenic potentials(VEMP)test,and the subjective visual vertical(SVV)test were performed to analysis the difference between the two groups.Results In the VN group,there were 24 males and 6 females,aged 14-76 years old,with an average age of 48.37±13.94 years,24 persons under 60 years old and 6 persons over 60 years old.Among them,22 patients had spontaneous nystagmus with the rapid movement phase all facing the healthy side.11 patients were positive for the closed eye erect test(Romberg sign)all of whom deviated to the affected side.The abnormal results of video head pulse test and caloric test were 30 cases(100%)and 29 cases(96.67%).The abnormal results of cervical vestibular evoked myogenic potentials(cVEMP)and ocular cervical vestibular evoked myogenic potentials(oVEMP)were 13 cases(43.33%)had 18 cases(60%).25 patients had abnormal SVV results(83.33 %).Rates of these 5 tests dysfunction were all significantly higher than the control group.In patients with vestibular neuritis,18 patients(60%)had abnormalities localizing to both vestibular nerve divisions,10 patients(33.3%)had superior neuritis and 2 patients(0.7%)had inferior neuritis.The results of caloric test showed a certain correlation with vHIT.The larger the canal paralysis(CP),the lower the horizontal semicircular canal gain value(rs=-0.410,P=0.024).There was also a significant positive correlation between the horizontal semicircular canal and the anterior semicircular canal gain values(rs=0.583,P=0.001),and the abnormal rate of both was significantly higher than that of the posterior semicircular canal.Conclusion In summary,the acute phase of vestibular neuritis is a full-frequency injury.The superior vestibular neuritis is more common with both the otoliths and the semicircular canals,and is more serious than the inferior vestibular neuritis.The five tests(cVEMP,oVEMP,and three semicircular canal vHITs)for assessing vestibular function can correctly identify all types of vestibular neuritis,including typical and atypical.They can also provides more detailed information and guidances of the treatment and rehabilitation of VN.Video head pulse test is not a substitute for the traditional caloric test.Meanwhile,SVV test can be used as an auxiliary means to better evaluate the characteristics of vestibular function in the acute stage of vestibular neuritis.Vestibular tests are complementary,one test cannot simply replace another test.