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  • Vestibular neuronitis
  • Acute (or recurrent) peripheral vestibulopathy
  • Vestibular hypofunction or loss

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  • 386.12 Vestibular neuronitis
  • 386.53 Hypoactive labyrinth unilateral

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  • H81.20 Vestibular neuronitis, unspecified ear
  • H81.21 Vestibular neuronitis, right ear
  • H81.22 Vestibular neuronitis, left ear
  • H81.23 Vestibular neuronitis, bilateral

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Description

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  • Disorder of the peripheral vestibular system (part of the inner ear)
  • The peripheral vestibular system of each ear is made up of five sensory organs (hair-cell receptors contained within the superior, posterior, and horizontal semicircular canals as well as within the utricle and saccule) and the vestibular nerve.
  • The vestibular sensory organs detect head position and head motion to provide input for gaze stability, orientation, and balance.
  • Reduction or loss of function of one of the systems causes an imbalance of neural activity between the two inner ears, which causes the central nervous system to interpret the aberrant sensory input as head rotation.
  • Results in a spontaneous, severe attack of rotary vertigo (the illusion of spinning motion of the room or self) that lasts from 48 to 72 hours.

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Essentials of Diagnosis

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  • Physical exam normal
  • Audiogram normal
  • Neurotologic exam abnormal
  • Thorough and detailed history is essential to distinguish vestibular neuritis from other vestibular disorders and central pathology.

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General Considerations

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  • Initially
    • Patients report persistent, severe feeling of rotary vertigo that occurs spontaneously but worsens with head movement.
    • Nausea and vomiting
    • Difficulty standing and walking without assistance
    • Blurred vision due to oscillopsia (apparent movement of the environment)
    • These initial symptoms improve over a period of a few days.
  • After initial episode
    • Patients typically continue to present with a general feeling of dizziness (disorientation, wooziness, off balance, etc.).
    • Imbalance that mostly occurs with quick head movements
    • They may continue to have difficulty reading.
    • This phase may manifest for up to 6 weeks or longer until recovery and compensation occur.
  • No audiological symptoms with vestibular neuritis.

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Demographics

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  • Can occur at any age
  • Primarily occurs in individuals 30 to 60 years with women having peak occurrence in fourth decade and men in the sixth decade
  • In clinics specializing in vestibular disorders, may account for between 3% and 10% of diagnoses

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Signs and Symptoms

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  • Acute presentation
    • Report of persistent, prolonged episode of severe rotary vertigo, nausea and vomiting, unsteadiness, and/or jumping, bouncing vision
    • Imbalance manifested by inability to stand and walk without assistance
    • Increased risk of falling
    • No report of hearing loss, and audiological exam normal
    • Observe nystagmus in room light and with fixation removed.
    • Abnormal neurotologic exam (impulse test, headshake test, dynamic visual acuity test, caloric test, vestibular evoked myogenic potential [VEMP] test, and/or subjective visual vertical [SVV] test)
    • No central signs (diplopia, dysarthria, dysphagia, ...

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