What diagnosis should we make for long-lasting vertiginous sensation after acute peripheral vertigo?

Abstract

Background: Differential diagnosis of persistent vertigo/dizziness in patients with a past history of vestibular neuritis (VN) and sudden deafness with vertigo (SDV) could sometimes be difficult for physicians due to variable vertiginous symptoms from rotatory to floating sensation.

Objectives: The main purpose of the present study was to examine the associations between the findings of otology/neurotology examinations in patients at the chronic stage after VN and SDV.

Material and methods: We encountered 1789 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University between 2014 and 2018. Eighty-five patients were diagnosed as showing VN and 60 showed SDV according to the diagnostic guideline . The VN and SDV patients included 75 and 45 patients with chronic-stage of persistent vertigo/dizziness, of which 55 and 40 were enrolled into the present study.

Results: Persistent vertigo/dizziness after VN was attributable to delayed vestibular compensation (dVC: 33/55; 60.0%), secondary benign paroxysmal positional vertigo (sBPPV: 20/55; 36.4%), and secondary endolymphatic hydrops (sEH: 2/55; 3.6%), while that after SDV was attributable to sBPPV (20/40; 50.0%), sEH (16/40; 40.0%), and dVC (4/40; 10.0%).

Conclusion and significance: The present results could allow to simplify differential diagnosis of persistent vertigo/dizziness after VN and SDV such diseases as dVC, sBPPV, or sEH.

Keywords: BPPV; Vertigo/dizziness center; delayed vestibular compensation; endolymphatic hydrops; sudden deafness with vertigo; vestibular neuritis.