Kim Keun-Tae, Park Arim, Lee Sun-Uk, Park Euyhyun, Kim Byungjun, Kim Ji-Soo
Department of Neurology, Korea University Medical Center, Seoul, South Korea.
Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Eur J Neurol. 2025 Jul;32(7):e70278. doi: 10.1111/ene.70278.
Unlike acute unilateral vestibulopathy or vestibular neuritis (AUVP/VN), of which the diagnosis is made based on well-established neurotologic findings, the diagnosis of idiopathic acute unilateral audiovestibulopathy (iAUAV, also known as labyrinthitis) still requires further elucidation.
We retrospectively reviewed the medical records of patients with first-onset acute audiovestibulopathy (AAVS) in a referral-based university hospital in South Korea between March 2018 and September 2024. The results of video-oculography, video head-impulse, and other neurotologic evaluations were included for analysis. In addition, an MRI dedicated to the inner ear was conducted. The findings were compared with 80 patients with AUVP/VN.
A total of 73 patients with iAUAV (age range = 20-85 years, mean age ± SD = 60 ± 18 years, 33 male) were included in the analyses. 26% and 12% of patients showed ipsilesional nystagmus and predominant downbeat nystagmus, respectively. The vestibulo-ocular reflex (VOR) gain was decreased in horizontal (HC, n = 41), posterior (PC, n = 23), and anterior canals (AC, n = 9), showing more frequent involvement of PC compared to those with AUVP/VN (p = 0.002). Positive MRI results were found in 28 patients with iAUAV (28/68, 41%), showing high signal intensities over the vestibule (n = 27), cochlea (n = 25), HC (n = 21), PC (n = 21), and AC (n = 7) on MRIs.
Patients with iAUAV can show various neurotologic findings that deviate from typical AUVP/VN. Recognition of these findings can aid in a deeper understanding of the pathophysiology of iAUAV, which is distinct from AUVP/VN, and differentiation from other etiologies of AAVS that can have a debilitating prognosis.
与急性单侧前庭病或前庭神经炎（AUVP/VN）不同，后者的诊断基于已确立的神经耳科学发现，特发性急性单侧听觉前庭病（iAUAV，也称为迷路炎）的诊断仍需进一步阐明。
我们回顾性分析了2018年3月至2024年9月期间韩国一家转诊制大学医院中首次发作急性听觉前庭病（AAVS）患者的病历。纳入视频眼震图、视频头脉冲及其他神经耳科学评估结果进行分析。此外，还进行了内耳专用MRI检查。将结果与80例AUVP/VN患者进行比较。
共73例iAUAV患者（年龄范围20 - 85岁，平均年龄±标准差 = 60 ± 18岁，男性33例）纳入分析。分别有26%和12%的患者出现同侧眼震和以向下跳动性眼震为主。水平半规管（HC，n = 41）、后半规管（PC，n = 23）和前半规管（AC，n = 9）的前庭眼反射（VOR）增益降低，与AUVP/VN患者相比，PC受累更频繁（p = 0.002）。28例iAUAV患者（28/68，41%）MRI结果呈阳性，MRI显示前庭（n = 27）、耳蜗（n = 25）、HC（n = 21）、PC（n = 21）和AC（n = 7）有高信号强度。
iAUAV患者可表现出各种不同于典型AUVP/VN的神经耳科学发现。认识这些发现有助于更深入地理解与AUVP/VN不同的iAUAV的病理生理学，并与其他可能导致预后不良的AAVS病因相鉴别。
