Vestibular Compensation after Vestibular Neuronitis in Elderly Patients

Abstract

Central vestibular compensation after vestibular neuronitis consists of the following stages: inhibition of the contralesional medial vestibular nucleus (contra-MVe) activity in the acute stage after unilateral vestibular dysfunction (UVD) and recovery and maintenance of the spontaneous activity of the ipsilesional MVe (ipsi-MVe) in the chronic stage after UVD. Once vestibular compensation has been accomplished, patients no longer have persistent positional nystagmus or dizziness. In clinical practice, however, some elderly patients are seen to suffer from UVD-induced persistent canal paresis and subsequent motion-evoked dizziness, i.e., delayed vestibular compensation. To elucidate the relationships between aging and the activities of daily living in patients with UVD caused by vestibular neuronitis, we conducted caloric tests and administered dizziness questionnaires to patients with vestibular neuronitis treated at our hospital between 1997 and 2006. We found that elderly patients (age y.o.≥50) with UVD (canal paresis (CP) %≥25) (age y.o.≥50) had significantly more severe handicaps in daily life due to dizziness induced by head and body movements than younger patients (age y.o.<50). It is suggested that attempts must be made to improve the peripheral vestibular function in the acute stage and/or investigate the breakthrough [?] in the central vestibular rehabilitation in the chronic stage.