Vestibular neuronitis (VN) is a common condition that we treat. Despite this, many of us lack the in-depth knowledge and scientific reasons for doing what we do. Granted, the evidence is lacking in some areas but this paper is worth a read to know where we are up to in our understanding. This Swiss authored article is well written and referenced in a neutral/unbiased style as you would expect! A few points to take home. 1) There is evidence that the reactivation of Herpes Simplex Virus type 1 causes VN. It is highly unlikely to be transmitted to another human via transfer of saliva. 2) Increased inflammation occurs in patients with VN and this is likely to cause vascular changes that might affect the blood supply to the inner ear. 3) True recurrence of VN is rare we are told, although in practice I think we see this more commonly. 4) It is unclear whether the lesion in VN is in the vestibular nerve or in the vestibular organ (i.e. intralabyrinthic). Tests (i.e. vHIT, C-VEMP and O-VEMP) and scans can help. 5) A combination of systemic and intratympanic steroids may improve recovery rates of VN targeting both the vestibular nerve and vestibular organ. A large European study is soon to be under way although it is unclear if the UK will be part of the study! 6) Try and start vestibular physiotherapy early after the acute onset of VN and definitely by day three to improve rates of compensation 7) Distinguish VN from stroke; “HINTS” which stands for head impulse, nystagmus, test of skew, which are 100% sensitive and 96% specific for stroke. 8) The risk of BPPV developing in the affected ear rises to about 10-15% in the first few weeks after VN. The reasons are unclear. – AK

Diagnosis and treatment of vestibular neuritis/neuronitis or peripheral vestibulopathy (PVP)? Open questions and possible answers.
Hegemann SCA, Jackler AW.
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Anand Kasbekar

BMedSci, DOHNS, FRCS (ORL-HNS), DM, Nottingham University Hospitals NHS Trust; Associate, The University of Nottingham; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK.

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