Predictors of clinical recovery from vestibular neuritis: A prospective study
Open accessAbstract
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.
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These investigations found PPPD-like chronic dizziness or persistent VV 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.”
Three prospective studies found that high anxiety about dizziness during and after bouts of acute vestibular neuritis or BPPV predicted continued dizziness three, six, and twelve months later.
“Three prospective studies found that high anxiety about dizziness during and after bouts of acute vestibular neuritis or BPPV predicted continued dizziness three [30], six [23], and twelve [28] months later.”
These initial psychological responses had far greater effects on long-term outcomes than the initial or subsequent states of patients' peripheral vestibular functioning or vestibulo-ocular reflexes.
“These initial psychological responses had far greater effects on long-term outcomes than the initial or subsequent states of patients’ peripheral vestibular functioning or vestibulo-ocular reflexes.”
Investigators studying PPV, CSD, SMD, and VV have identified pathophysiologic processes that may be applicable to PPPD, including anxiety-related personality traits as a possible risk factor and high levels of anxiety and vigilance about acute symptoms during precipitating events as initial pathologic responses.
“Investigators studying PPV, CSD, SMD, and VV have identified pathophysiologic processes that may be applicable to PPPD, including anxiety-related personality traits as a possible risk factor [86, 88, 89] and high levels of anxiety and vigilance about acute symptoms during precipitating events as initial pathologic responses [7, 23, 28, 30].”
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.
“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].”
Alterations in postural control strategies, shifts in multi-sensory integration, and reduced cortical integration of spatial orientation and threat assessment networks may be sustaining mechanisms.
“Alterations in postural control strategies [33, 46, 59, 67, 68, 71], shifts in multi-sensory integration [23], and reduced cortical integration of spatial orientation and threat assessment networks [37, 88] may be sustaining mechanisms.”
In a prospective study, Cousins et al. found that patients who had persistent dizziness for at least six months following bouts of acute vestibular neuritis had greater visual dependence than those who recovered without chronic symptoms.
“In a prospective study, Cousins et al., [23] found that patients who had persistent dizziness for at least six months following bouts of acute vestibular neuritis had greater visual dependence than those who recovered without chronic symptoms.”
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Electroencephalography Microstate Alterations in Otogenic Vertigo: A Potential Disease Marker
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Electroencephalographic response to transient adaptation of vestibular perception
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- Authors
- Cousins, S., Kaski, D., Cutfield, N., Arshad, Q., Ahmad, H., Gresty, M. A., Seemungal, B. M., Golding, J., & Bronstein, A. M.
- Affiliations
- Charing Cross Hospital (GB)
- Dunedin Public Hospital (NZ)
- University of Westminster (GB)
- Corresponding author
- Bronstein, Adolfo M.
- ORCID
- Venue
- Annals of Clinical and Translational Neurology
- Publisher
- Wiley
- Published
- 2017-03-22
- Volume
- 4
- Issue
- 5
- Pages
- 340-346
- ISSN
- 2328-9503 (ISSN-L)
- PMC
- PMC5420806
- OpenAlex
- W2592983132
- Cited by
- 156
- References
- 25
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 17 · 2023: 24 · 2022: 24 · 2021: 17 · 2020: 22 · 2019: 11 · 2018: 8 · 2017: 6
- FWCI
- 6.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Clinical and Translational Neurology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- WestminsterResearch (University of Westminster) (acceptedVersion)
- WestminsterResearch (University of Westminster) (acceptedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, cc-by)
- Bristol Research (University of Bristol) (submittedVersion, cc-by)
- Explore Bristol Research (submittedVersion, cc-by)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Funders
- Medical Research Council (G0600183)
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- vestibular neuritis, clinical recovery, prognostic factors, visual dependence, autonomic arousal, anxiety, depression, dizziness, Dizziness Handicap Inventory, vestibulo-ocular reflex
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