From the Guidelines
Vestibular neuritis is diagnosed through a combination of clinical evaluation, physical examination, and sometimes specialized testing, with a focus on sudden onset of vertigo, nausea, vomiting, and balance problems without hearing loss or neurological symptoms, as outlined in the most recent guidelines 1. The diagnosis begins with a thorough medical history and assessment of symptoms, particularly the nature of the onset, duration of active vertigo, and concurrent otologic symptoms, as described in the clinical practice guideline for Ménière's disease 1. A physical examination includes observing for nystagmus (involuntary eye movements), which typically beats away from the affected ear. The head impulse test is particularly valuable, showing impaired vestibulo-ocular reflex on the affected side, as noted in the guideline for benign paroxysmal positional vertigo 1. Other tests may include:
- The Romberg test and gait assessment to evaluate balance
- Videonystagmography (VNG) or electronystagmography (ENG) to measure eye movements
- Rotary chair testing
- Vestibular evoked myogenic potentials (VEMP)
- Video head impulse testing (vHIT) to assess vestibular function MRI scans may be ordered to rule out other conditions like stroke or tumors, as suggested in the ACR appropriateness criteria for dizziness and ataxia 1. Audiometry (hearing tests) helps differentiate vestibular neuritis from labyrinthitis, as hearing remains normal in vestibular neuritis. This comprehensive approach allows healthcare providers to distinguish vestibular neuritis from other conditions with similar symptoms, such as benign paroxysmal positional vertigo (BPPV), Meniere's disease, or central nervous system disorders, and is supported by the most recent and highest quality study 1.
From the Research
Diagnostic Features of Vestibular Neuritis
The diagnosis of vestibular neuritis is based on a combination of clinical features and diagnostic tests. The key signs and symptoms include:
- Rotatory vertigo with an acute onset lasting several days 2
- Horizontal spontaneous nystagmus (with a rotational component) toward the unaffected ear 2
- A pathologic head-impulse test toward the affected ear 2
- A deviation of the subjective visual vertical toward the affected ear 2
- Postural imbalance with falls toward the affected ear 2
- Nausea 2
Diagnostic Tests
Various diagnostic tests are used to confirm the diagnosis of vestibular neuritis, including:
- Head impulse test 3, 4, 5
- Bithermal caloric test 4
- Vestibular-evoked myogenic potential test 3, 4, 5
- Video head impulse test 5
- Cervical and ocular vestibular evoked myogenic potential 5
Differential Diagnosis
Vestibular neuritis is a diagnosis of exclusion, and relevant differential diagnoses include: