What diagnosis should we make for long-lasting vertiginous sensation after acute peripheral vertigo?

Abstract

Background

Differential diagnosis of persistent vertigo/dizziness in patients with a past history of vestibular neuritis (VN) and sudden deafness with vertigo (SDV) could sometimes be difficult for physicians due to variable vertiginous symptoms from rotatory to floating sensation.

Objectives

The main purpose of the present study was to examine the associations between the findings of otology/neurotology examinations in patients at the chronic stage after VN and SDV.

Material and methods

We encountered 1789 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University between 2014 and 2018. Eighty-five patients were diagnosed as showing VN and 60 showed SDV according to the diagnostic guideline . The VN and SDV patients included 75 and 45 patients with chronic-stage of persistent vertigo/dizziness, of which 55 and 40 were enrolled into the present study.

Results

Persistent vertigo/dizziness after VN was attributable to delayed vestibular compensation (dVC: 33/55; 60.0%), secondary benign paroxysmal positional vertigo (sBPPV: 20/55; 36.4%), and secondary endolymphatic hydrops (sEH: 2/55; 3.6%), while that after SDV was attributable to sBPPV (20/40; 50.0%), sEH (16/40; 40.0%), and dVC (4/40; 10.0%).

Conclusion and significance

The present results could allow to simplify differential diagnosis of persistent vertigo/dizziness after VN and SDV such diseases as dVC, sBPPV, or sEH.

Chinese abstract

背景：对于没有耳科/神经内科专长的医生来说, 有时可能难以区别诊断 有前耳神经炎（VN）既往病史的患者和眩晕突发性耳聋（SDV）的患者的顽固性眩晕, 因为多种晕厥症状多种多样, 如旋转到漂浮的感觉。

目的：本研究的主要目的是检查对VN和SDV后慢性期持续头晕感患者进行的耳科/神经病学检查结果、内耳成像、血液检查和评分问卷之间的关联。我们旨在从疾病统计的角度, 利用获得的结果来简化对第一次发作后的持续性头晕感觉的鉴别诊断。

材料和方法：在2014年5月至2018年12月期间, 我们在奈良医科大学旋晕中心连续接看1789名眩晕/头晕患者。根据2015年国际前庭疾病分类诊断指南, 85名患者被诊断为显示VN（85/1789; 4.8％）, 而60例则显示SDV（60/1789; 3.4％）。VN和SDV患者包括75例和45例慢性期持续性眩晕/头晕的患者, 其中55例和40例入住医院并接受耳科/神经病学检查, 包括热量测试（C-test）、前庭诱发颈肌源性电位（cVEMP）测量、主观视觉垂直（SVV）测试、甘油测试（G-test）、心电图（ECoG）分析、内耳磁共振成像（ieMRI）、包括抗利尿激素（ADH）在内的血液检查以及抑郁评分（SDS）的自我评估问卷评估。数据表示为VN和SDV患者数量的比率（þ）, 他们的检查和问卷数据超出正常范围。

结果：比率（þ）的数据如下：C检验¼65.5％（36/55）和75.0％（30/40）, cVEMP¼32.7％（18/55）和45.0％（18/40）, SVV¼45.5％（25/55）和72.5％（29/40）, G检验¼3.6％（2/55）和22.5％（9/40） , ECoG¼3.6％（2/55）和25.0％（10/40）, ieMRI¼5.5％（3/55）和45.0％（18/40）, ADH¼7.3％（4/55）和37.5％（15/40）, 以及SDS¼18.2％（10/55）和22.5％（9/40）。在VN和SDV的慢性期之间的SVV、G检验、ECoG、ieMRI和ADH的结果有显著差异。 VN后持续性眩晕/头晕可归因于前庭延迟补偿（dVC：33/55; 60.0％）、继发性良性阵发性位置性眩晕（sBPPV：20/55; 36.4％）和继发性内淋巴积水（sEH：2/55; 3.6％）, 而SDV后的积水归因于sBPPV（20/40; 50.0％）、sEH（16/40; 40.0％）和dVC（4/40； 10.0％）。

结论和意义：本研究结果可简化VN和SDV后持续性眩晕/头晕如dVC、sBPPV或sEH等的鉴别诊断, 这有助于医生在初次问诊时进行适当的询问和检查。

Keywords:

• Vertigo/dizziness center
• vestibular neuritis
• sudden deafness with vertigo
• delayed vestibular compensation
• BPPV
• endolymphatic hydrops

Acknowledgements

The authors wish to thank Dr. Masashi Choubi, a registered statistician (certificate number: 622017) for helpful advice on statistical analyses.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported in part by JSPS KAKENHI Grant [2020-2022], AMED under Grant Number [18dk0310092h000a] and Health and Labour Sciences Research Grant for Research on Rare and Intractable Diseases [R02-Nanchito (Nan)-Ippan-004] from the Ministry of Health, Labour and Welfare of Japan.