Multiple ipsilateral recurrences of vestibular neuritis: longitudinal vestibular findings

Abstract

OBJECTIVE: Recurrent vestibular neuritis (RVN) is a rare peripheral vestibular disease whose clinical course remains poorly understood. This study aimed to examine temporal changes in vestibular findings in a patient with multiple RVN attacks and to evaluate the effects of vestibular rehabilitation. DESIGN: This study employs a case report design and clinical assessment-based analysis with longitudinal follow-up. The patient underwent a structured, individualised vestibular rehabilitation program, including conventional and virtual reality-based exercises. Vestibular assessment included analysis of spontaneous nystagmus using subjective visual vertical (SVV), caloric testing, video head impulse test (vHIT), and computerised dynamic posturography (Sensory Organisation Test, SOT). Measurements were compared across acute, subacute, and post-rehabilitation periods. STUDY SAMPLE: A patient with recurrent ipsilateral vestibular neuritis attacks. RESULTS: In the acute phase, spontaneous nystagmus, SVV deviation, reduced lateral canal gain, and overt/covert saccades were observed, with unilateral canal paresis on caloric testing. In the subacute phase, nystagmus decreased, while vestibular hypofunction persisted. Following rehabilitation, vHIT gain improved, overt saccades diminished, SOT performance increased, and visual dependence decreased. CONCLUSIONS: This case illustrates dynamic vestibular changes during a presumed recurrent ipsilateral vestibular neuritis episode and suggests that early, structured vestibular rehabilitation may support central compensation and functional recovery. However, given the single-case design and the possible contributions of spontaneous recovery and medical treatment, the therapeutic effect of rehabilitation should be interpreted cautiously.