Predictors of clinical recovery from vestibular neuritis: a prospective study

Abstract

We sought to identify predictors of symptomatic recovery in vestibular neuritis. Forty VN patients were prospectively studied in the acute phase (median = 2 days) and 32 in the recovery phase (median = 10 weeks) with vestibulo‐ocular reflex, vestibular‐perceptual, and visual dependence tests and psychological questionnaires. Clinical outcome was Dizziness Handicap Inventory score at recovery phase. Acute visual dependency and autonomic arousal predicted outcome. Worse recovery was associated with a combination of increased visual dependence, autonomic arousal, anxiety/depression, and fear of bodily sensations, but not with vestibular variables. Findings highlight the importance of early identification of abnormal visual dependency and concurrent anxiety.

Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society

“…No epidemiologic studies are available for PPPD, but its prevalence and incidence may be estimated from research done on patients with PPV, VV, CSD, and chronic dizziness following acute vestibular syndromes [7,12,23,28,30,79].…”

“…The incidence of PPPD following neuro-otologic precipitants may be estimated from studies that followed patients prospectively after bouts of acute or episodic vestibular disorders (e.g., vestibular neuritis, BPPV, vestibular migraine, Menière's disease) [7,23,28,30]. These investigations found PPPD-like chronic dizziness [7,28,30] or persistent VV [23] in about 25% of patients after 3-12 months of follow-up, despite otherwise adequate compensation or recovery from the initial illnesses.…”

“…These investigations found PPPD-like chronic dizziness [7,28,30] or persistent VV [23] in about 25% of patients after 3-12 months of follow-up, despite otherwise adequate compensation or recovery from the initial illnesses. These results indicate that PPPD is likely to develop in a significant proportion of patients afflicted with acute or episodic vestibular syndromes.…”

“…SMD was described as a situational phenomenon, occurring during exposures to provocative stimuli [39,43]. The earliest reports of VV [15] also focused on situational symptoms, though recent investigations identified a link between persistent VV and chronic dizziness [22,23]. Definitions of CSD [75,79] emphasized chronic symptoms lasting throughout the day and exacerbated by motion stimuli.…”

“…The visual cues that triggered VV overlapped with the environmental stimuli that activated SMD [29,63]. One hypothesis [50] suggested that VV was caused by an incongruity between visual and vestibular information following peripheral vestibular injury, a process termed visual-vestibular mismatch (VVM), but later work by Bronstein's group placed the onus on a combination of increased vigilance about vestibular symptoms and higher than normal reliance on visual cues for spatial orientation (i.e., visual dependence) [22,23]. In 2009, the Bárány Society adopted the term visually induced dizziness or VID to replace VV in the ICVD nomenclature for vestibular symptoms [9].…”