Appropriate Testing for Suspected Vestibular Neuritis

Clinical Diagnosis and Testing Strategy

The American Academy of Otolaryngology-Head and Neck Surgery suggests that brain imaging (MRI) is indicated when the patient has additional neurological symptoms suggesting central pathology 2

Vestibular function testing should not be routinely ordered if the clinical diagnosis is clear, according to the American College of Physicians, as stated by Praxis Medical Insights 1
Testing is appropriate when the diagnosis of vertigo/dizziness is unclear, the clinical presentation is atypical, unusual nystagmus patterns are observed, additional symptoms suggest accompanying CNS or otologic disorders, or multiple concurrent peripheral vestibular disorders are suspected, as recommended by Praxis Medical Insights 1
The American Academy of Otolaryngology-Head and Neck Surgery recommends that if diagnosis is clear with typical features, no additional testing is needed, and to order vestibular function testing if the clinical presentation is atypical, nystagmus patterns are unusual, or additional symptoms suggest other disorders 2

Ordering routine vestibular testing for clear clinical diagnoses leads to unnecessary costs and delays in treatment, as stated by Praxis Medical Insights 1
Normal vestibular test results do not necessarily rule out vestibular disorders, according to Praxis Medical Insights 1
Results of vestibular testing often fluctuate throughout the course of vestibular disorders, and the degree of damage detected correlates poorly with patient-perceived disability, as reported by Praxis Medical Insights 1