Vestibular Neuronitis

Question 1

What is vestibular neuronitis?

Answer 1

It is defined as an inner ear condition in which there is inflammation of the vestibulocochlear nerve

Question 2

What is the pathophysiological cause of vestibular neuronitis?

Answer 2

Viral Infection

Question 3

What are the two classifications of vestibular neuronitis?

Answer 3

Acute Vestibular Neuronitis

Chronic Vestibular Neuronitis

Question 4

What is acute vestibular neuronitis?

Answer 4

It is defined as the initial phase which occurs for one week

The clinical features are sudden and severe

Question 5

What is chronic vestibular neuronitis?

Answer 5

It is defined as the secondary phase which occurs for weeks to months

The clinical features are milder

Question 6

What are the five clincial features associate with vestibular neuronitis?

Answer 6

Nausea & Vomiting

Sudden, Severe Vertigo

Intense Dizziness

Severe Ataxia

Horizontal Nystagmus

Question 7

How long does vertigo last for in vestibular neuronitis?

Answer 7

Hours to Days

Question 8

What investigation is used to diagnose vestibular neuronitis?

Answer 8

HINTS Examination

Question 9

What is the HINTS examination?

Answer 9

It is an examination involving the head impulse test, nystagmus and test of skew

Question 10

How is the head impulse test conducted?

Answer 10

It involves asking individuals to keep their eyes fixed on a target, and the examiner moving the patient’s head quickly and unpredictably to 10 – 15 degrees of neck rotation

Question 11

What is normal head impulse test result?

Answer 11

The head movement should stimulate the vestibulo ocular reflex, in which the patient’s eye remain on the target following movement

Question 12

What is a positive head impulse test result?

Answer 12

The head movement results in the patient’s eyes moving off the target, followed by a corrective saccade back to the target

Question 13

How is the test of skew conducted?

Answer 13

It involves asking individuals to look at the examiners nose

The examinaer covers one of their eyes

The examiner then quickly moves their hand to cover the patient’s other eye - observing the uncovered eye for any vertical and/or diagnal corrective movement

Question 14

What is a normal test of skew result?

Answer 14

There is no vertical and/or diagnoal corrective movement

Question 15

What is a positive test of skew result?

Answer 15

There is vertical and/or diagonal corrective movement

Question 16

What three HINTS examination results indicate vestibular neuronitis?

Answer 16

Abnormal Head Impulse Test

Unidirectional Horizontal Nystagmus

No Vertical Skew

Question 17

What are the two pharmacological management options of acute vestibular neuronitis?

Answer 17

Anti-Emetics

Antihistamines

Question 18

What is the first line management option of acute vestibular neuronitis?

Answer 18

Anti-Emetics

Question 19

Name an anti-emetic used to manage acute vestibular neuronitis

Answer 19

Prochlorperazine

Question 20

What administeration route of prochlorperazine is recommended in mild acute vestibular neuronitis?

Answer 20

Oral

Question 21

What course duration of oral prochlorperazine is recommended to manage acute vestibular neuronitis? Why?

Answer 21

Short course

This is due to the fact that long term treatment will delay recovery by interfering with central compensatory mechanisms

Question 22

What two administeration routes of prochlorperazine are recommended in severe acute vestibular neuronitis?

Answer 22

Buccal

Intramuscular

Question 23

What is the second line management option of acute vestibular neuronitis?

Answer 23

Antihistamines

Question 24

Name three antihistamines are used to manage acute vestibular neuronitis

Answer 24

Cinnarizine

Cyclizine

Promethazine

Question 25

What is the conservative management option of chronic vestibular neuronitis?

Answer 25

Vestibular rehabilitation exercises

Question 26

What condition does viral neuronitis present similarly to?

Answer 26

Viral Labyrinthitis

Question 27

How do we differentiate between viral labyrinthitis and vestibular neuronitis?

Answer 27

Labyrinthitis involves both the vestibular nerve and labyrinth, resulting in vertigo and hearing impairment

Vestibular neuronitis only involves the vestibular nerve and therefore there is vertigo but no hearing impairment