Vestibüler Nörit
Özet
Vestibüler nörit (VN), ani başlangıçlı şiddetli vertigo, bulantı ve kusma ile karakterize, işitme kaybının eşlik etmediği akut periferik vestibülopati tablosudur. Etyolojisi tam olarak aydınlatılamamış olmakla birlikte, viral enfeksiyonlar, vestibüler arter iskemisi ve immün mekanizmalarla ilişkilendirilmektedir. En sık etkilenen yapı süperior vestibüler sinirdir. Tanıda klinik muayene bulgularına ek olarak baş savurma testi, kalorik test, vestibüler uyarılmış miyojenik potansiyel (VEMP) ve rotasyonel test gibi vestibüler fonksiyon testleri kullanılır. Manyetik rezonans görüntüleme, santral nedenleri dışlamakta yardımcıdır. Tedavi, semptomatik yaklaşımlar, spesifik ilaç tedavisi ve vestibüler rehabilitasyon egzersizlerinden oluşur. Akut dönemde vestibülosüpresanlar ve antiemetikler semptomları hafifletir; ancak uzun süreli kullanımları santral kompansasyonu geciktirebilir. Glukokortikoidlerin erken dönemde başlanmasının vestibüler fonksiyon iyileşmesini hızlandırabileceği bildirilmektedir. Vestibüler rehabilitasyon, denge ve yürüyüş egzersizleri ile santral kompansasyonu destekleyerek hastaların yaşam kalitesini artırır. Sonuç olarak vestibüler nörit, doğru tanı yöntemleri ve uygun rehabilitasyonla genellikle iyi prognoz gösteren bir hastalıktır.
Referanslar
Bae CH, Na HG, Choi YS. Current diagnosis and treatment of vestibular neuritis: a narrative review. Journal of Yeungnam Medical Science. 2022;39(2): 81-88. doi:10.12701/yujm.2021.01228
Crane BT, Minor LB. Peripheral Vestibular Disorders. In: Flint PW, Haughey BH, Lund V (eds.) Cummings Otolaryngology - Head and Neck Surgery. 6nd ed. Canada: Elsevier Saunders; 2015. p. 2548-2566.
Strupp M, Mandala M, Lopez-Escamez JA. Peripheral vestibular disorders: an update. Current Opinion in Neurology. 2019;32(1): 165-173. doi:10.1097/WCO.0000000000000649
Brandt T. Vestibular neuritis. In: Brandt T (ed) Vertigo: its multisensory syndrome. 2nd ed. London: Springer-Verlag; 2003. p. 67–81.
Nylen CO. Some cases of ocular nystagmus due to certain positions of the head. Acta Otolaryngologica. 1924;6(1): 106-137. doi:10.3109/00016482409123851
Lumio JS, Aho J. Vestibular neuronitis. Annals of Otology, Rhinology, and Laryngology. 1965;74: 264-270. doi:10.1177/000348946507400125
Strupp M, Magnusson M. Acute unilateral vestibulopathy. Neurologic Clinics. 2015;33(3): 669-685. doi10.1016/j.ncl.2015.04.012
Jeong SH, Kim HJ, Kim JS. Vestibular neuritis. Seminars in Neurology. 2013;33(3): 185-194. doi:10.1055/s-0033-1354598
Greco A, Macri GF, Gallo A, et al. Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo? Journal of Immunology Research. 2014;2014: 459048. doi:10.1155/2014/459048
Kim JS. When the room is spinning: experience of vestibular neuritis by a neurotologist. Frontiers in Neurology. 2020;11: 157. doi:10.3389/fneur.2020.00157
Baloh RW. Clinical practice. Vestibular neuritis. New England Journal of Medicine. 2003;348(11): 1027-1032. doi:10.1056/NEJMcp021154
Halmagyi GM, Gresty MA, Gibson WP. Ocular tilt reaction with peripheral vestibular lesion. Annals of Neurology. 1979;6(1): 80-83. doi:10.1002/ana.410060122
Choi KD, Oh SY, Kim JS. Head thrust test. Annals of Clinical Neurophysiology. 2006;8(1): 1-5.
Lee YJ, Shin JE, Park MS, et al. Comprehensive analysis of head-shaking nystagmus in patients with vestibular neuritis. Audiology & Neuro-otology. 2012;17(4): 228-234. doi:10.1159/000336958
Sharpe JA. Neurophysiology and neuroanatomy of smooth pursuit: lesion studies. Brain and Cognition. 2008;68(3): 241-254. doi:10.1016/j.bandc.2008.08.015
Han SB, Yang HK, Hyon JY, et al. Efficacy of a computerized optokinetic nystagmus test in prediction of visual acuity of better than 20/200. Investigative Ophthalmology & Visual Science. 2011;52(10): 7492-7497. doi:10.1167/iovs.11-7663
Okinaka Y, Sekitani T, Okazaki H, et al. Progress of caloric response of vestibular neuronitis. Acta Otolaryngologica. Supplementum. 1993;503: 18-22. doi:10.3109/00016489309128064
Rosengren SM, Colebatch JG, Young AS, et al. Vestibular evoked myogenic potentials in practice: methods, pitfalls and clinical applications. Clinical Neurophysiology Practice. 2019;4: 47-68. doi:10.1016/j.cnp.2019.01.005
Shim DB, Song MH, Park HJ. Typical sensory organization test findings and clinical implication in acute vestibular neuritis. Auris Nasus Larynx. 2018;45(5): 916-921. doi:10.1016/j.anl.2017.11.018
Hong HR, Shim DB, Kim TS, et al. Results of caloric and sensory organization testing of dynam- ic posturography in migrainous vertigo: comparison with Meniere’s disease and vestibular neuritis. Acta Oto-laryngologica. 2013;133(12): 1236-1241. doi:10.3109/00016489.2013.820343
Ahmed MF, Goebel JA, Sinks BC. Caloric test versus rotational sinusoidal harmonic acceleration and step-velocity tests in patients with and without suspected peripheral vestibulopathy. Otology & Neurotology. 2009;30(6): 800-805. doi:10.1097/MAO.0b013e3181b0d02d
Hamid MA. Clinical value of sinusoidal harmonic acceleration test results. Site of lesion and side of lesion. Neurologic Clinics. 1990;8(2): 287-295.
Karlberg M, Annertz M, Magnusson M. Acute vestibular neuritis visualized by 3-T magnetic resonance imaging with high- dose gadolinium. Archives of Otolaryngology - Head & Neck Surgery. 2004;130(2): 229-232. doi:10.1001/archotol.130.2.229
Ariyasu L, Byl FM, Sprague MS, et al. The beneficial effect of methylprednisolone in acute vestibular vertigo. Archives of Otolaryngology - Head & Neck Surgery. 1990;116(6): 700-703. doi:10.1001/archotol.1990.01870060058010
Sjögren J, Magnusson M, Tjernström F, et al. Steroids for acute vestibular neuronitis-the earlier the treatment, the better the outcome? Otology & Neurotology. 2019;40(3): 372-374. doi:10.1097/MAO.0000000000002106
Shupak A, Issa A, Golz A, et al. Prednisone treatment for vestibular neuritis. Otology & Neurotology.2008; 29(3): 368-374. doi:10.1097/MAO.0b013e3181692804.
Goudakos JK, Markou KD, Psillas G, et al. Corticosteroids and vestibular exercises in vestibular neuritis. Single-blind randomized clinical trial. JAMA Otolaryngology - Head & Neck Surgery. 2014;140(5): 434-440. doi:10.1001/jamaoto.2014.48
Strupp M, Zingler VC, Arbusow V, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. New England Journal of Medicine. 2004;351(4): 354-361. doi:10.1056/NEJMoa033280
Karlberg ML, Magnusson M. Treatment of acute vestibular neuronitis with glucocorticoids. Otology & Neurotology. 2011;32(7): 1140-1143. doi:10.1097/MAO.0b013e3182267e24
Fishman JM, Burgess C, Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database of Systematic Reviews. 2011;11(5): CD008607. doi:10.1002/14651858.CD008607.pub2
Walker MF: Treatment of vestibular neuritis. Current Treatment Options in Neurology. 2009;11(1): 41-45. doi:10.1007/s11940-009-0006-8
Ramos Alcocer R, Ledezma Rodríguez JG, Navas Romero A, et al. Use of betahistine in the treatment of peripheral vertigo. Acta Otolaryngologica. 2015;135(12): 1205-1211. doi:10.3109/00016489.2015.1072873
