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

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.