Is Vestibular Neuropathy Rather a Neuritis?

Background/objectives Vestibular neuritis (VN) is one of the most common causes of peripheral vestibular neuropathy. The goal of this study is to investigate the possible infectious causes of VN in a large cohort of patients. Material and methods In total, 98 consecutive VN patients were enrolled in this retrospective study over a four-year period (04/2015-04/2019). Diagnosis of VN was made by clinical examination and functional diagnostics. We focused on infectious causes such as neurotropic viruses and Lyme disease (LD) and evaluated infection parameters as well as the concomitant diseases. Results In this cohort, we found pathologically elevated leukocytes or C-reactive protein (CRP) levels, and/or acute herpes simplex virus (HSV) infection, cytomegalovirus (CMV) infection and LD in 42 patients (42.85%). Leukocytes were elevated in 39 of 98 patients (39.8%) and the mean count was 9717 ± 2991 /μl. The group comparison between patients with vestibular loss (n=42) and patients with vestibular hypofunction (n=45) revealed a significant difference in regard to elevated leukocytes (p=0.028). In total, 28 of 53 patients (52.8%) were positive for HSV immunoglobulin (Ig) G and four of 53 patients were positive for HSV IgM (7.5%). Six of 53 patients (11.3%) were positive for LD IgM. Conclusion In this cohort, there was a large number of VN patients with infectious signs; several patients tested positive for HSV and LD. Therefore we recommend testing VN patients not only for HSV but also for LD and other neurotropic viruses. This approach enables to complement the standard VN treatment with a specific treatment.