Discrepancies of video head impulse test results in patients with idiopathic sudden sensorineural hearing loss with vertigo and vestibular neuritis

Abstract

Objective: Sudden sensorineural hearing loss with vertigo (SHLV) and vestibular neuritis (VN) remain frequent causes of acute vestibular syndrome (AVS). The aim of study was to compare the results of video head impulse test (vHIT) in patients with SHLV and VN. The characteristics of high-frequency vestibule-ocular reflex (VOR) and the differences of the pathophysiological mechanisms underlying these two AVS were explored.

Methods: Fifty-seven SHLV patients and 31 VN patients were enrolled. vHIT was conducted at the initial presentation. The VOR gains and occurrence of corrective saccades (CSs) of anterior, horizontal, and posterior semicircular canals (SCCs) in two groups were analyzed. Pathological vHIT results refer to impaired VOR gains and presence of CSs.

Results: In SHLV group, pathological vHIT results was most prevalent in the posterior SCC on the affected side (30/57, 52.63%), followed by horizontal (12/57, 21.05%) and anterior SCC (3/57, 5.26%). In VN group, pathological vHIT preferentially affected horizontal SCC (24/31, 77.42%), followed by anterior (10/31, 32.26%) and posterior SCC (9/31, 29.03%) on the affected side. As for anterior and horizontal SCC on the affected side, the incidences of pathological vHIT results in VN group were significantly higher than those in SHLV group (β = 2.905, p < 0.01; β = 2.183, p < 0.001). There were no significant differences in the incidence of pathological vHIT result in posterior SCC between two groups.

Conclusion: Comparison of vHIT results in patients with SHLV and VN revealed discrepancies in the pattern of SCCs impairments, which may be explained by different pathophysiological mechanisms underlying these two vestibular disorders presenting as AVS.

Keywords: gain; idiopathic sudden sensorineural hearing loss with vertigo; saccade; vestibular neuritis; vestibulo-ocular reflex; video head impulse test.

Figure 1

Comparison between the incidences of pathological video head impulse test (vHIT) results of anterior semicircular canal (ASCC), horizontal semicircular canal (HSCC) and posterior semicircular canal (PSCC) on the affected sides in sudden sensorineural hearing loss with vertigo (SHLV) patients and vestibular neuritis (VN) patients. **p < 0.01, ***p < 0.001, ^##p < 0.01, ^###p < 0.001. Dotted line: comparison between SHLV and VN group. Solid line: comparison between three semicircular canals (SCCs) within SHLV or VN group.

Figure 2

Comparison between the incidences of saccade occurrence in anterior semicircular canal (ASCC), horizontal semicircular canal (HSCC) and posterior semicircular canal (PSCC) on the affected sides in SHLV patients and VN patients. *p < 0.05, ***p < 0.001, ^##p < 0.01. Dotted line: comparison between SHLV and VN group. Solid line: comparison between three semicircular canals within SHLV or VN group.

Figure 3

Comparison between the incidences of decreased VOR gain in anterior semicircular canal (ASCC), horizontal semicircular canal (HSCC) and posterior semicircular canal (PSCC) on the affected sides in SHLV patients and VN patients. *p < 0.05, ***p < 0.001.

Figure 4

Comparison between the vHIT gain in anterior semicircular canal (ASCC), horizontal semicircular canal (HSCC) and posterior semicircular canal (PSCC) on the affected sides in SHLV patients and VN patients. **p < 0.01, ***p < 0.001.