| Objective:To investigate the dynamic changes in the clinical characteristics of patients with vestibular neuritis during the process of the disease and to clarify the internal patterns,to analyze the influence of different factors on clinical performance and prognosis,and to explore the indicators that can accurately evaluate the changes in patients’condition and prognosis.Methods:The present study is a prospective observational research.We followed up the changes in clinical features during the course of acute single vestibular neuritis in 41patients attending the Department of Neurology of the Third Affiliated Hospital of Shanxi Medical University.Basic clinical information and other disease histories and detailed records of the present medical history,neurological physical examination,clinical signs such as spontaneous nystagmus,bedside head impulse test,Fukuda test,and closed-eye difficult-to-stand sign were recorded for all patients;and the assessment of the dizziness handicap inventory and the European Evaluation of Vertigo scale and video head impulse test,caloric test,vestibular evoked myogenic potentials and other tests.The first information was taken within 3 days of the onset of vertigo symptoms,and the above-mentioned history taking,physical examination and vestibular function tests were completed again at the follow-up visits of patients at 4 and 12 weeks after the onset of the disease.We analyzed the changes in subjective vertigo symptoms,the differences in static and dynamic vestibular function damage changes and recovery trends in patients with vestibular neuritis at different time points,and analyzed the differences between the various index trends and interpreted their clinical significance.The impact of common interventions such as hormone therapy and vestibular recovery on the recovery of the condition was analyzed.Finally,reliable objective examination indices associated with changes in patients’subjective vertigo symptoms were explored.All data were statistically analyzed using SPSS 26.0 statistical software,and all tests were two-sided,and P<0.05 was considered statistically significant.Results:The dizziness handicap inventory score,the slow-phase horizontal angular velocity of spontaneous nystagmus,the abnormal rate of the head impulse test test,the positive rate of the Fukuda test,the positive rate of the closed-eye difficult-to-stand sign,the value of unilateral weakness in the caloric test and unilateral horizontal hemianopsia gain reduction and the ratio of bilateral gain asymmetry in the video head impulse test test in patients with vestibular neuritis were statistically different at the onset,at 4 weeks after the onset,and at 12 weeks.(P<0.001).There was no statistical difference between the group with a positive Fukuda test and the group with a positive head impulse test test for more than 12 weeks,while there was a statistical difference between the group with a positive closed-eye refractory sign and the group with a positive head impulse test test for more than 12 weeks(χ~2=14.519,P<0.001).At 12 weeks post-onset,28 patients with vestibular neuritis had impaired static vestibular function and 27 patients had impaired dynamic vestibular function,and the composition ratio of patients with impaired dynamic and static vestibular function was statistically different between the two groups(χ~2=8.26,P<0.05).At 4 weeks of illness,34 of the 41 patients with vestibular neuritis had unilateral reduced horizontal semicircular gain,of which 22 patients with unilateral reduced horizontal semicircular gain had an abnormal gain asymmetry ratio,12 patients with unilateral reduced horizontal semicircular gain had a normal gain asymmetry ratio,0 patients with abnormal gain asymmetry ratio had unilateral reduced horizontal semicircular gain,and 7 patients had both indicators normal.In the group with abnormal gain asymmetry ratio,there was a statistically significant difference between the composition of the gain reduction in the group with abnormal gain asymmetry ratio and the composition of the gain reduction in the group with normal gain asymmetry ratio(χ~2=7.345,P<0.01).At 4 weeks after the onset of the disease,there was a statistically significant difference in the European Evaluation of Vertigo scale score(t=2.252,P<0.05),gain value(t=2.028,P<0.05),and unilateral weakness(t=2.234,P<0.05)between the group with underlying disease and the group without underlying disease,and the group without underlying disease had better recovery of the European Evaluation of Vertigo scale score,unilateral weakness,and gain values were better recovered in the group without underlying disease.At 12 weeks after the onset of the disease,there was a statistically significant difference in the dizziness handicap inventory score between the group with underlying disease and the group without underlying disease(t=2.150,P<0.05),and the recovery of the dizziness handicap inventory score was worse in the group with underlying disease compared with the group without underlying disease,while there was no statistically significant difference in the European Evaluation of Vertigo scale score,gain,and hemiplegia value between the two groups.At 4 weeks after the onset of the disease,there were statistically significant differences between the hormonal treatment group and the empirical treatment group in the values of the change in the dizziness handicap inventory score(t=2.956,P<0.01),the change in the European Evaluation of Vertigo scale score(t=3.575,P<0.01),the change in the gain of the affected horizontal semicircular canal(t=2.515,P<0.05),and the change in the value of the unilateral weakness(t=2.168,P<0.05)were statistically different,and the degree of recovery of these indicators was greater in the hormone treatment group than in the experienced treatment group.At 12 weeks after the onset of the disease,there was a statistically significant difference between the two groups only in the change in the European Evaluation of Vertigo scale score(t=3.198,P<0.01),but there was no statistically significant difference in the rest of the observed indexes.By progressive regression analysis,the change in vertigo disability scale score at 4 and 12 weeks after onset and the change in European vertigo assessment scale were positively and linearly correlated with the change in horizontal semicircular gain on the affected side in the video pulse headshake test(t=7.406/8.470,P<0.001).In the latter case,the change in the horizontal semicircular canal gain on the affected side was mainly positively and linearly correlated with the change in the European Evaluation of Vertigo scale at 4 and 12 weeks after the onset of the disease(t=7.669,P<0.001).。Conclusion:All patients with vestibular neuritis showed gradual improvement in subjective vertigo symptoms,positive signs and adjunctive examination results,with a greater degree of recovery especially within 4 weeks after onset.The single gain reduction in the video head impulse test in patients with vestibular neuritis was more sensitive than the unilateral weakness in the caloric test,amplitude asymmetry ratio of vestibular evoked myogenic potentials and the bilateral gain asymmetry in the video head impulse test during the follow-up.The presence or absence of a history of anterior infection,the duration of improvement in unsteadiness,and the presence or absence of comorbid underlying disease,as well as the receipt of therapeutic measures such as hormone therapy and vestibular recovery,did not affect the medium-to long-term prognosis of vestibular neuritis patients.In contrast,the absence of comorbid underlying disease and the acceptance of hormonal therapy significantly contributed to the recovery of objective vestibular function findings in the short period of time.We concluded that the change in the horizontal semicircular canal gain value on the affected side in the video head impulse test could be considered as a control indicator for the recovery of vestibular symptoms in the same period,with a good temporal correlation between the two. |
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