vestibular neuritis
Introduction
Introduction to vestibular neuritis Vestibular neuritis is also known as epidemic vertigo, epidemic neuropathic inflammation, acute labyrinthitis or vestibular paralysis. The inflammation is limited to the vestibular system. The cochlear and central systems are normal. Most of them are adults aged 20-60 years old. They often have a history of upper respiratory tract infection before the disease. The disease can be divided into acute and chronic. In 1909, Ruttin first proposed the term vestibular neuritis. Clinically, it can be divided into three types: localized, serous and suppurative. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: labyrinthitis
Cause
Causes of vestibular neuritis
Infection (30%):
Serum determination after viral infection, herpes simplex, herpes zoster virus titer (the number of viruses in the sample to be tested is usually expressed as the number of infected units per unit volume of virus suspension) is significantly increased.
The vestibular nerve is stimulated (20%):
The vestibular nerve suffers from vascular compression or arachnoid adhesions, and even due to stenosis of the internal auditory canal, causing neuronal hypoxia and degeneration, which is caused by stimulating nerve discharge. No hearing change, that is, the chief complaint without tinnitus and deafness. Most patients have complete remission after two or three months.
Lesion factor (5%):
Its own immune response.
Diabetes (3%):
Schuknecht et al (1972) reported that diabetes can cause degeneration of vestibular neurons, leading to repeated vertigo attacks.
Some patients with pathological examination after vestibular nerve severing can be found that the vestibular nerve has arcing or scattered degeneration and regeneration, nerve fiber reduction, ganglion cell vacuolization, and increased neuronal collagen deposits.
Prevention
Vestibular neuritis prevention
1, no contagious, early symptoms similar to a cold, it is easy to be ignored by patients.
2, pay attention to enhance physical fitness and prevent upper respiratory tract infections.
3, early comprehensive treatment to reduce complications.
4, diet is light and nutritious, pay attention to dietary balance; avoid alcoholic beverages such as tobacco and alcohol, strong tea and spicy.
5, the prognosis is good, generally can be self-healing.
Complication
Vestibular neuritis complications Complication, labyrinthitis
Suppurative labyrinthitis invades the inner ear, causing a diffuse suppurative lesion, called suppurative labyrinthitis. The inner ear device is destroyed and all functions are lost. The infection can continue to spread into the brain, causing intracranial complications.
Symptom
Vestibular neuroinflammatory symptoms Common symptoms Dizzy drunken gait vestibular nerve damage tinnitus nystagmus palsy starburst gait mastoiditis nausea hearing loss
Localized labyrinthitis:
1, paroxysmal or stimulating vertigo, occasionally accompanied by nausea, vomiting, vertigo, more in the rapid turn, flexion, driving, operation in the ear (such as earing, ear washing, etc.), oppression of the tragus or nose blowing, continued The symptoms range from a few minutes to a few hours, and the symptoms of acute mastoid mastitis are exacerbated.
2. Spontaneous nystagmus can be seen in the onset of vertigo, and the direction is toward the affected side. This is the reason that the affected side is in a state of stimulation.
3, hearing loss: the nature and extent of deafness is consistent with the degree of otitis media lesions, the fistula is located in the drumsticks are mixed deafness.
4, the fistula test is positive, the fistula can be negative when blocked by pathological tissue.
5, the function of the vestibule is generally normal or hyperactive, it is not appropriate to use the hot and cold water test during the inspection to avoid the spread of infection.
Serous labyrinthitis:
1, dizziness, nausea, vomiting, balance disorders are the main symptoms of the disease, the patient is happy to the affected side (the eye movement fast phase side), when standing up to the healthy side.
2, nystagmus is horizontal - rotatory, the free side of the affected side is excited, irritating state, so the nystagmus is fast toward the affected side, the late affected side of the lost function is significantly reduced, the nystagmus is pointing to the healthy side, the vestibular function has different degrees The decline may be positive for the fistula test.
3, the hearing is obviously reduced, it is a sensory, but not full.
4, there may be deep pain in the ear.
Suppurative labyrinthitis:
1, dizziness, conscious foreign objects or self-rotation, nausea, frequent vomiting, patients closed their eyes, curled side lying on the side of the eye movement fast, do not dare to move.
2, balance imbalance.
3, tinnitus, suffering from full ear.
4, spontaneous nystagmus, fast phase to the healthy side, the intensity is greater, the trunk to the slow side of the nystagmus, when the nystagmus is moving from the healthy side to the affected side, should be alert to the possibility of intracranial complications.
5, body temperature is generally not high, if there is fever, headache, accompanied by changes in cerebrospinal fluid (such as leukocytosis, increased cerebrospinal fluid pressure), showing infection spread to the brain.
6. Because the lost path has been destroyed, the fistula test is negative.
Some patients with pathological examination after vestibular nerve severing can be found that the vestibular nerve has arcing or scattered degeneration and regeneration, nerve fiber reduction, ganglion cell vacuolization, and increased neuronal collagen deposits.
(1) Acute vestibular neuritis: 80% of patients have a sudden onset of dizziness after awakening in the respiratory or gastrointestinal tract, and reach a peak in a few hours, accompanied by nausea and vomiting, which lasts for several days, several weeks, and then Gradually return to normal, the elderly recover slowly, can be as long as several months, more than one ear is sick, occasionally two ears have been diagnosed, there is spontaneous paralytic nystagmus to the healthy side, can be a family of people sick, there are collective The incidence is a small epidemic phenomenon, no tinnitus in the disease period, and deafness is its characteristic.
(2) Chronic vestibular neuritis: Most of them are middle-aged and above, can have recurrent dizziness, the degree is light, and it is obvious when walking upright. It can last for several years, nausea and vomiting are rare, and often manifest as long-term instability.
Examine
Examination of vestibular neuritis
1. Head position nystagmus examination: Let the patient sit on the bed, first sit down on the head, observe 10 seconds without dizziness and nystagmus, then sit up and observe for another 10 seconds, then let the head side to the side and observe for 10 seconds. Then sit down on the other side and observe for 10 seconds. Each time you change your position, sit up and lie down should be completed within 3 seconds. If eye movement occurs in a certain position, you should continue to observe for 30 seconds, such as continuous nystagmus. If it does not disappear, it is positive for the test. If the right ear is down, the nystagmus is turned to the right, and when the eye is gazing to the left, vertical nystagmus occurs. The repeated tests are positive, which is called non-fatigue type. Otherwise, repeated tests no longer appear. The nystagmus is called fatigue type. The nystagmus direction appearing in different head positions is not called directional type; if nystagmus in different directions is called directional, the nystagmus appears in the unidirectional head position, duration Shorter, with incubation period, oriented fatigue responders, mostly peripheral lesions; otherwise, most of them are central lesions, and other tests such as visual tracking and visual acuity are generally normal.
2. The vestibular function test such as hot and cold temperature change is normal.
3, pure tone hearing test is more normal.
Diagnosis
Diagnosis and differentiation of vestibular neuritis
Simple peripheral vestibular vertigo, no cochlear involvement symptoms.
1. Hot and cold temperature test: Partial or complete loss of vestibular function, sometimes biased toward the healthy side.
2, no headaches and other neurological signs.
3. Blood cells can increase in the acute phase.
4. There is spontaneous nystagmus during the attack period.
