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Marco Mandalà, MD; Daniele Nuti, MD; Aimee Teo Broman, MA; David Samuel Zee, MD

Arch Otolaryngol Head Neck Surg. 2008;134(2):164-169.

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.

Author Affiliations: Department of Orthopedics, Radiology, and Otolaryngology, University of Siena School of Medicine, Siena, Italy (Drs Mandalà and Nuti); and Wilmer Eye Institute, Department of Ophthalmology (Ms Broman) and Department of Neurology (Dr Zee), The Johns Hopkins University School of Medicine, Baltimore, Maryland.

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