Format

Send to

Choose Destination
Arch Otolaryngol Head Neck Surg. 2008 Feb;134(2):164-9. doi: 10.1001/archoto.2007.35.

Effectiveness of careful bedside examination in assessment, diagnosis, and prognosis of vestibular neuritis.

Author information

1
Department of Orthopedics, Radiology, and Otolaryngology, University of Siena School of Medicine, Viale Bracci 16, Siena 53100, Italy. scmarcos@tin.it

Abstract

OBJECTIVE:

To determine whether the use of 4 bedside tests (head-impulse, head-heave, head-shake, and vibration tests) can be as effective as the caloric test, a widely accepted standard, in the diagnosis and prediction of the time to recovery from vestibular neuritis.

DESIGN:

Inception cohort (1-year follow-up), criterion standard study.

SETTING:

Primary referral center.

PATIENTS:

All patients had acute vertigo, and those having a diagnosis of vestibular neuritis were eligible for inclusion in the study. Sixty-eight patients (43 men and 25 women; mean age, 54.9 years) met this criterion, and 53 of them (77.9%) completed the study.

MAIN OUTCOME MEASURES:

Spontaneous head-shaking and vibration-induced nystagmus elicited with a battery-powered device were tested wearing Frenzel goggles. The head-impulse and head-heave tests were performed manually. Caloric irrigation was administered with hot, cold, and ice water.

RESULTS:

At baseline, more than half of the patients exhibited positive signs with all 4 tests and all had caloric paralysis or paresis. Signs with the head-impulse and head-heave tests correlated highly (odds ratio, 24.9; P < .001), as did those with the head-shake and vibration tests (odds ratio, 22.8; P < .001). Patients with a positive sign with the head-impulse or vibration test were 70% less likely to recover than were those with a negative sign. Head-impulse (hazard ratio, 0.08; P = .002) and head-shake (hazard ratio, 0.23; P = .01) test results were associated with the outcome of the caloric test.

CONCLUSION:

Careful bedside examination of patients with vestibular neuritis has both diagnostic value in the short term and prognostic value in the long term.

PMID:
18283159
DOI:
10.1001/archoto.2007.35
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center