The article presents a literature review based on Scopus, Pubmed and Elibrary databases on etiology, pathogenesis, clinical manifestations and treatment of vestibular neuritis. Recent international clinical criteria for diagnosis and classification of this disease are given. Clinical and instrumental diagnostic methods for unilateral vestibular hypofunction are discussed, as well as differential diagnosis with other acute and episodic vestibular disorders, especially with acute vertebrobasilar insufficiency. Controversial issues of medical and physical treatment of vestibular neuritis are considered.

Bilateral sequential vestibular neuritis is a rare condition reported in literature involving the vestibular nerve sequentially. Nowadays, the video head impulse test (vHIT) and vestibular-evoked myogenic potentials provide specific patterns of reduced vestibulo-ocular reflex (VOR) that allow differentiation between complete and partial nerve involvement. These tests are essential in cases of bilateral vestibular loss to monitor vestibular compensation. The case of a 56-year-old man who presented to a tertiary vestibular center with acute left-sided vestibular loss, following a documented contralateral acute vestibular loss 4 years earlier. To the best of current knowledge, this report presents, for the first time in the literature, vHIT in Suppression Head Impulse Paradigm modality data as an expression of compensation. A review of the literature was also performed according to PRISMA statements.

Dizziness is a common complaint among the elderly, with as much as 30% of the population of older adults reporting dizziness with increased prevalence in women compared to men.[1] Dizziness and associated postural imbalance have been shown to increase the risk of falls with a resulting significant impact on quality of life, mortality, and the economic burden of associated costs.[1][2][3]  Vestibular hypofunction has an estimated prevalence of 35.4% within the United States (US) adult population, with dizziness and postural imbalance noted as a primary complaint.[4] Research has indicated moderate to strong evidence to support exercise-based rehabilitation of the vestibular system as an effective treatment in populations including unilateral and bilateral vestibular hypofunction. It has shown promising research in treatments for central vestibular hypofunction.[2][5][6][7]

Objective:To identify the factors influencing the visual analogue scale（VAS） scores for distress experienced by patients with vestibular diseases during caloric tests, and to explore the value of VAS scores in disease diagnosis and treatment. Methods:A retrospective analysis was performed on 420 patients diagnosed with vestibular migraine（VM）, Meniere's disease（MD）, persistent postural-perceptual dizziness（PPPD）, vestibular neuritis（VN）, and sudden deafness with vertigo, respectively, who underwent caloric tests. The patients were asked to rate the most severe subjective discomfort they experienced during the test using the VAS. Statistical analysis was conducted to explore the correlations between VAS scores（dependent variable） and potential influencing factors, including disease type, gender, age, and maximum slow-phase velocity（SPV[max]）of the caloric test. Results:①The subjective VAS scores of patients during the caloric test, ranked from highest to lowest, were as follows: VM（5.83）>PPPD（4.56）>MD（3.84）>VN（3.24）>sudden deafness with vertigo（2.60）. ②The results of univariate analysis showed that age, SPV, gender, and disease type all had a significant impact on the dependent variable VAS. ③Multivariate analysis revealed that there were significant differences in VAS scores among patients with different vestibular diseases（P<0.01）; VAS scores were significantly negatively correlated with age（P<0.001） and significantly positively correlated with SPV（max） values（P<0.001）; the VAS scores of female patients were significantly higher than those of male patients（P=0.004）. Conclusion:The subjective degree of distress in response to similar vestibular stimulation varies considerably among patients with different vestibular disorders. Patients with VM and PPPD, which are associated with central nervous system dysfunction-experience higher distress levels than those with MD and VN. Additionally, female patients and younger patients tend to have more severe subjective distress.

ObjectivesThis study aims to develop a prognostic model, based on the video Head Impulse Test (vHIT)-Vestibulo-Ocular Reflex (VOR) gain, of vestibular loss after an acute Unilateral Vestibulopathy (aUVP) predicting the probability of an objective and significant recovery.DesignData gathered prospectively in patients with aUVP were re-analyzed. After an exploratory cluster analysis, a multivariate PROBIT regression model was used to objectively pinpoint the value of vHIT-VOR gain at baseline that predicts a significant recovery after 10 weeks. Significant recovery was defined as a vHIT-VOR gain superior or equal to 0.70 after 10 weeks.ResultsA total of 48 subjects were included. The final model identified 2 thresholds, respectively, at 0.53 and 0.74, to classify severe (vHIT-VOR gain ≤0.53), moderate (0.53 < vHIT-VOR gain ≤0.74), and non-significant (0.74 < vHIT-VOR gain) vestibular loss. The probability of a significant recovery was 20% ((Prediction Interval 95% (PI) [0%-43%]) for a gain of 0.50 at baseline, while it doubles (45% (PI [0%-63%]) for an initial gain of 0.60. Our final model demonstrated a good area under the curve (AUC) of 0.85. The corrected AUC after bootstrap resampling was 0.81 (CI 95% [0.74, 0.89]). A good Brier score of the predicted probabilities was also obtained, at 0.15.Conclusions and relevanceFor the first time, this paper proposes a model that objectively defines the severity of vestibular loss at baseline after an aUVP. This research lays the groundwork for future studies to validate our prognostic model and perform more precise analyses of vestibular compensation patterns.

Dizziness is a common condition that can significantly reduce quality of life and increase the risk of falls. This review examines frequent vestibular causes, including benign paroxysmal positional vertigo, vestibular migraine, Ménière's disease, and vestibular neuritis. Vestibular rehabilitation is evidence-based and enhances compensation, balance, gaze, and functional mobility in daily life through tailored exercises, that include adaptation, substitution, and habituation. Given the significant variation in implementation across Denmark, it is essential to prioritise efforts for improved quality, standardisation, and comprehensive training nationwide.

Objective:This study aimed to assess the clinical application of subjective visual vertical（SVV） and subjective visual horizontal（SVH） tests at different head deflection angles in the diagnosis of vestibular neuritis（VN）, offering insights for a more precise evaluation of otolith dysfunction. Methods:A total of 40 patients with VN who were diagnosed at the Hearing Impairment and Vertigo Centre, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, between January and December 2024 were retrospectively analysed, and 31 healthy adults served as the control group. All participants underwent computer-assisted SVV/SVH tests at three head tilt angles: upright head position 0°（0°）, left head deflection 45°（L45°）, and right head deflection 45°（R45°）, and the deviation values were recorded and compared with those of the healthy control group for statistical analysis. Results:①Compared with normal controls, the difference in the rate of SVV/SVH abnormalities at 0°, L45° and R45° deflection angles was statistically significant in patients with VN（P<0.05）, with the highest rate of abnormality at 0°; ②The rate of abnormalities on the affected side of SVV and SVH was significantly higher in VN patients than on the healthy side（P<0.05）; ③Statistically significant differences were found in the comparison of the absolute values of different head deflection angles of SVV between VN patients and healthy controls（P<0.05）, and in the comparison of the absolute values of SVH in upright head position 0° and L45° between VN patients and healthy controls（P<0.05）, while the difference in the comparison of the absolute values of R45° was not statistically significant（P>0.05）. Conclusion:The SVV and SVH tests are important tests for assessing otolith dysfunction in patients with VN, with high sensitivity, and can quickly determine the side and degree of damage, of which the upright head position 0o is the most helpful for diagnosis, and is recommended as a routine examination head position, and this test can be an important method for the refined assessment of otolith dysfunction in patients with VN.

Attacks of bilateral simultaneous acute angle closure glaucoma are rare. A 59-year-old man developed vertigo and vomiting, with nystagmus in primary gaze, left-beating nystagmus in left gaze and a positive head impulse test. He was diagnosed with acute vestibular neuritis and received standard therapy, using four drugs that have anticholinergic effects. He subsequently developed bilaterally red eyes, initially diagnosed as bacterial conjunctivitis, and then blurred vision with ocular pain. An ophthalmological assessment identified mid-dilated, non-reactive pupils with corneal oedema and markedly elevated intraocular pressures, consistent with bilateral acute angle closure glaucoma. This was treated with topical and oral ocular hypotensive therapy, pupillary constriction and corneal indentation. Following peripheral iridotomies with the Yttrium Aluminum Garnet laser, his acute angle closure glaucoma rapidly and totally resolved. The use of multiple medications with anticholinergic effects in people with acute vestibular neuritis, and especially in those with a shallow anterior chamber, may cause acute angle closure glaucoma, requiring urgent ophthalmological assessment.