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ent.vestibular-neuritis.core.v1PRODUCTION
ent.vestibular-neuritis.core.v1

Vestibular neuritis / acute labyrinthitis (acute vestibular syndrome, peripheral)

general_internal_medicineacutesubacuteadultgeriatric
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Encounter flow

12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Frame the encounter as a TWO-CHANNEL acute-vestibular-syndrome problem: positively diagnose PERIPHERAL AVS (vestibular neuritis / labyrinthitis) AND robustly exclude the can't-miss central mimic (~25% of AVS is posterior-circulation/AICA stroke). The peripheral-vs-central HINTS decision is the spine of this engine. Definitive stroke/SSNHL/Ménière/migraine/falls management is routed OUT by engine_id, not re-authored.

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two-channel AVS scope confirmed; out-of-scope definitive management flagged for engine_id routing

Patient inputs (15)

Unidirectional horizontal-torsional, fixation-suppressed, direction-FIXED nystagmus = peripheral; direction-CHANGING gaze-evoked, pure-vertical or pure-torsional = central (Kattah Stroke 2009; Bárány AUVP criteria 2022)

New unilateral SNHL/tinnitus/aural fullness in AVS = labyrinthitis OR AICA-territory infarct OR SSNHL — HINTS-"plus" positive raises central/AICA risk and is itself a time-critical ENT emergency; route to ent.sudden-sensorineural-hearing-loss.core.v1 (Newman-Toker AEM 2013 HINTS-plus; Saber Tehrani 2014)

Age, HTN, DM, AF, smoking, prior stroke/TIA, recent neck trauma/manipulation (vertebral dissection) raise the pre-test central prior in AVS and lower the imaging threshold even with a peripheral-appearing HINTS (Kattah Stroke 2009; Saber Tehrani Neurology 2014 — nonlacunar mechanisms in ~half of small strokes)

Elderly AVS carries higher vascular-stroke prior (lower imaging threshold, HINTS caveats), greater fall-injury risk, and slower central compensation modifying rehab/disposition (Kattah Stroke 2009; McDonnell Cochrane 2015 — community-dwelling adults)

TiTrATE pivot 1 — continuous sustained vertigo ≥24 h (AVS) is this engine's channel where HINTS governs; brief recurrent position-triggered spells are BPPV (route to ent.bppv.core.v1, Dix-Hallpike not HINTS) (Newman-Toker Neurol Clin 2015 TiTrATE; Bárány AUVP 2022)

AVS is SPONTANEOUS and continuous (no obligate positional trigger); an obligate head-position trigger with <1-min fatiguing spells redirects to BPPV — this gates which exam (HINTS vs Dix-Hallpike) is even valid (Bárány AUVP criteria 2022; Newman-Toker Neurol Clin 2015)

In AVS an ABNORMAL (positive, corrective catch-up saccade) horizontal head-impulse toward the affected ear SUPPORTS peripheral vestibular neuritis; a NORMAL head-impulse with spontaneous nystagmus is the single most ominous central sign (Kattah Stroke 2009 — HINTS 100% sens / 96% spec)

Direction-CHANGING gaze-evoked / pure-vertical / pure-torsional nystagmus = central; unidirectional fixation-suppressible horizontal-torsional = peripheral (Kattah Stroke 2009; Newman-Toker AEM 2013)

Vertical ocular misalignment on alternate cover (skew) = brainstem/central; present in ~17% and rescues a false-localising abnormal head-impulse (lateral pontine stroke can mimic peripheral HIT) (Kattah Stroke 2009 — skew predicts brainstem)

The 4 D's (diplopia, dysarthria, dysphagia, dysmetria), severe truncal/gait ataxia (cannot stand/walk unaided — peripheral AVS patients can usually walk with lateropulsion), limb ataxia or new severe headache/neck pain → posterior-circulation stroke until excluded; route OUT (Kattah Stroke 2009; Saber Tehrani Neurology 2014)

MRI-DWI is indicated when HINTS is central / cannot be applied / red flags present — but a single early (<48 h) DWI is falsely negative in ~12-15% (~50% for small strokes), so a negative early scan does NOT exclude stroke when HINTS is central (Kattah Stroke 2009; Saber Tehrani Neurology 2014)

Antecedent URI/viral prodrome supports the post-viral vestibular-neuritis hypothesis (HSV-1 reactivation) and frames the (debated) corticosteroid discussion; absence does not exclude (Strupp NEJM 2004; Bárány AUVP criteria 2022 — etiology section)

Severe persistent vomiting / inability to tolerate oral intake → short-term parenteral antiemetic + IV rehydration and an admission threshold; disproportionate vomiting should also re-prompt a central re-screen (Bárány AUVP criteria 2022; clinical)

Pregnancy: minimise/avoid prolonged vestibular suppressants and gate antiemetic safety; favour early vestibular rehabilitation and avoid routine corticosteroids absent clear indication (Strupp NEJM 2004; safety)

Diabetes/immunocompromise raise infective-labyrinthitis and vascular concerns, alter corticosteroid risk-benefit (glycaemic destabilisation), and lower the threshold to investigate a non-idiopathic cause (Bárány AUVP criteria 2022; clinical)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (7)

7 need judgement
  • informationallife_threateningcentral_avs_hints_stroke_route_out
    In acute vestibular syndrome: NORMAL horizontal head-impulse, OR direction-CHANGING gaze-evoked / pure-vertical / pure-torsional nystagmus, OR skew deviation (any one — "INFARCT" central HINTS), OR any 4 D's / severe truncal ataxia / focal sign (Kattah Stroke 2009; Newman-Toker AEM 2013)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverelabyrinthitis_acute_hearing_loss_route_ssnhl
    Acute prolonged vertigo PLUS new unilateral sensorineural hearing loss / tinnitus / aural fullness — labyrinthitis (cochleovestibular); HINTS-plus positive (Newman-Toker AEM 2013; Bárány AUVP criteria 2022)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereatypical_or_non_resolving_avs
    AVS not improving (no compensation) by 24-72 h, evolving toward direction-changing/vertical nystagmus, or atypical features inconsistent with a single peripheral lesion (Saber Tehrani Neurology 2014; Bárány AUVP criteria 2022)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereimmunocompromised_or_infectious_labyrinthitis
    AVS with fever / systemic infective features, immunocompromise, otitis media / mastoiditis, or meningitis context — suspected suppurative or infective (bacterial/meningogenic) labyrinthitis (Bárány AUVP criteria 2022; clinical)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderateintractable_vomiting_dehydration
    Severe persistent vomiting / inability to tolerate oral intake / clinical dehydration with acute vertigo (Bárány AUVP criteria 2022; clinical)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderateelderly_fall_risk_incomplete_compensation
    Older / frail patient with AVS plus impaired gait-balance, incomplete central compensation, anticoagulation, osteoporosis, or no home support — high fall-injury risk (McDonnell Cochrane 2015; clinical)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmildprolonged_vestibular_suppressant_compensation_harm
    Patient still on a vestibular suppressant / benzodiazepine beyond 48-72 h (or using it chronically) for vestibular neuritis (Strupp NEJM 2004 context; McDonnell Cochrane 2015)
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Vestibular neuritis — strictly short-course symptomatic suppressant (≤48-72 h) → early vestibular rehabilitation (definitive recovery lever) + debated corticosteroid
axis: vestibular_neuritis_shortcourse_symptomatic_then_rehabstep 1 - Step 1 — Strictly short-course vestibular suppressant + antiemetic (acute phase ONLY, ≤48-72 h)
Selected step "Step 1 — Strictly short-course vestibular suppressant + antiemetic (acute phase ONLY, ≤48-72 h)" — Confirmed peripheral AVS (all-peripheral HINTS, no central sign, no acute hearing loss) with disabling acute vertigo / nausea / vomiting in the first 24-72 h
  • meclizine
    first line
    antihistamine_vestibular_suppressant
    25 mg • PO • q6-8h PRN (≤48-72 h ONLY) (max: max 100 mg/day; STOP by 48-72 h)
    triggers: acute_severe_vertigo, first_72h
    Symptomatic acute-phase suppressant ONLY. Prolonged vestibular-suppressant use RETARDS central vestibular compensation and delays recovery — explicitly time-limited to ≤48-72 h (Strupp NEJM 2004 context; McDonnell Cochrane 2015 — rehab, not suppression, drives recovery)
    rxcui 6676
  • dimenhydrinate
    first line
    antihistamine_antiemetic
    50 mg • PO/IM/IV • q4-6h PRN (≤48-72 h ONLY) (max: max 400 mg/day; STOP by 48-72 h)
    triggers: acute_nausea, vomiting
    Short-course antiemetic/suppressant bridge for distressing acute nausea/vomiting; same compensation-retarding caveat — discontinue by 48-72 h once acute phase settles
    rxcui 3444
  • prochlorperazine
    rescue
    antidopaminergic_antiemetic
    5-10 mg • PO/IM/IV • q6-8h PRN (short course) (max: max 40 mg/day; short course only)
    triggers: intractable_vomiting, dehydration
    Parenteral antiemetic for intractable vomiting/dehydration enabling rehydration; counsel extrapyramidal/akathisia risk; avoid repeated/chronic dosing (compensation + EPS/falls in elderly)
    rxcui 8704
  • ondansetron
    add on
    5HT3_antagonist_antiemetic
    4-8 mg • PO/IV • q8h PRN (short course) (max: max 24-32 mg/day; QT-caution)
    triggers: vomiting, antidopaminergic_contraindicated, pregnancy_antiemetic_choice
    Antiemetic that does NOT suppress the vestibular system (no compensation penalty) — useful when an antidopaminergic/antihistamine is contraindicated or in pregnancy; counsel QT prolongation
    rxcui 26225
  • diazepam
    rescue
    benzodiazepine_vestibular_suppressant
    2-5 mg • PO/IV • single / very short course only (max: single low dose; avoid repeat)
    triggers: extreme_refractory_vertiginous_distress
    Reserve a single low dose for extreme refractory acute distress ONLY — benzodiazepines markedly IMPAIR vestibular compensation and increase falls (especially elderly); explicitly avoid ongoing use (Strupp NEJM 2004 context)
    rxcui 3322

outpatient playbook — drug actions (2)

  1. 1. stop short-course suppressant if still taking
    rxcui 6676
    discontinue • PO • STOP (>72 h = compensation-retarding)
    trigger: Patient still on a vestibular suppressant beyond 48-72 h
    Prolonged suppression delays compensation — actively de-prescribe (McDonnell Cochrane 2015)
  2. 2. optional tapered prednisone ONLY if early + shared decision favours
    rxcui 8640
    ~1 mg/kg/day tapered ~3 wk • PO • once daily tapering
    trigger: Early (≤3 d) presentation, objective recovery prioritised, no contraindication, patient-shared decision
    DEBATED — caloric benefit only (Strupp NEJM 2004); no long-term/symptomatic benefit (Fishman Cochrane 2011; Leong OHNS 2021); equipoise, not routine

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Acute or subacute SUSTAINED spinning vertigo lasting ≥24 h with nausea/vomiting, head-motion intolerance and gait unsteadiness — acute vestibular syndrome (AVS); apply HINTS first, NOT positional testing (Bárány AUVP criteria, Strupp J Vestib Res 2022; Newman-Toker Neurol Clin 2015 TiTrATE); Spontaneous unidirectional horizontal-torsional nystagmus, direction-fixed, suppressed by visual fixation and enhanced by Frenzel/cover removal — the leading peripheral-AVS sign (Bárány AUVP criteria, Strupp J Vestib Res 2022; Kattah Stroke 2009); Acute prolonged vertigo PLUS new unilateral sensorineural hearing loss / tinnitus / aural fullness — labyrinthitis (cochleovestibular); HINTS-plus positive — raises AICA-stroke risk and routes to the SSNHL pathway (Newman-Toker AEM 2013 HINTS-plus; Saber Tehrani Neurology 2014).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Vestibular neuritis / acute labyrinthitis (acute vestibular syndrome, peripheral)** (ent.vestibular-neuritis.core.v1).
Phenotype framing: Terminal vestibular differential with named pivots: vestibular neuritis (continuous AVS, unidirectional fixation-suppressed nystagmus, ABNORMAL head-impulse, NO skew, NO central signs, NO hearing loss) vs labyrinthitis (same + acute SNHL → ent.sudden-sensorineural-hearing-loss.core.v1) vs posterior-circulation/AICA stroke (NORMAL head-impulse OR direction-changing/vertical nystagmus OR skew OR 4 D's — route to neuro.posterior-circulation-stroke.core.v1) vs BPPV (triggered-episodic <1 min, positional, fatiguing canal-specific nystagmus — route to ent.bppv.core.v1) vs Ménière (recurrent spontaneous spells minutes-hours + fluctuating low-frequency SNHL/fullness — route to ent.meniere-disease.core.v1) vs vestibular migraine (episodic spontaneous + migraine features — route to neuro.vestibular-migraine.core.v1). The decisive pivot = HINTS + continuous-vs-episodic + hearing.
Scope: Frame the encounter as a TWO-CHANNEL acute-vestibular-syndrome problem: positively diagnose PERIPHERAL AVS (vestibular neuritis / labyrinthitis) AND robustly exclude the can't-miss central mimic (~25% of AVS is posterior-circulation/AICA stroke). The peripheral-vs-central HINTS decision is the spine of this engine. Definitive stroke/SSNHL/Ménière/migraine/falls management is routed OUT by engine_id, not re-authored.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Vestibular neuritis — strictly short-course symptomatic suppressant (≤48-72 h) → early vestibular rehabilitation (definitive recovery lever) + debated corticosteroid** — step "Step 1 — Strictly short-course vestibular suppressant + antiemetic (acute phase ONLY, ≤48-72 h)".
1. meclizine 25 mg PO q6-8h PRN (≤48-72 h ONLY) (antihistamine_vestibular_suppressant, first line) — Symptomatic acute-phase suppressant ONLY. Prolonged vestibular-suppressant use RETARDS central vestibular compensation and delays recovery — explicitly time-limited to ≤48-72 h (Strupp NEJM 2004 context; McDonnell Cochrane 2015 — rehab, not suppression, drives recovery)
2. dimenhydrinate 50 mg PO/IM/IV q4-6h PRN (≤48-72 h ONLY) (antihistamine_antiemetic, first line) — Short-course antiemetic/suppressant bridge for distressing acute nausea/vomiting; same compensation-retarding caveat — discontinue by 48-72 h once acute phase settles
3. prochlorperazine 5-10 mg PO/IM/IV q6-8h PRN (short course) (antidopaminergic_antiemetic, rescue) — Parenteral antiemetic for intractable vomiting/dehydration enabling rehydration; counsel extrapyramidal/akathisia risk; avoid repeated/chronic dosing (compensation + EPS/falls in elderly)
4. ondansetron 4-8 mg PO/IV q8h PRN (short course) (5HT3_antagonist_antiemetic, add on) — Antiemetic that does NOT suppress the vestibular system (no compensation penalty) — useful when an antidopaminergic/antihistamine is contraindicated or in pregnancy; counsel QT prolongation
5. diazepam 2-5 mg PO/IV single / very short course only (benzodiazepine_vestibular_suppressant, rescue) — Reserve a single low dose for extreme refractory acute distress ONLY — benzodiazepines markedly IMPAIR vestibular compensation and increase falls (especially elderly); explicitly avoid ongoing use (Strupp NEJM 2004 context)

Setting playbook (outpatient) — Confirm peripheral AVS by clinical Bárány AUVP criteria, stop any short-course suppressant, drive recovery with early vestibular rehabilitation, hold a documented shared-decision corticosteroid discussion, withhold antivirals, and screen for post-neuritis BPPV / incomplete compensation at follow-up (Bárány AUVP criteria 2022; McDonnell Cochrane 2015; Fishman Cochrane 2011)
6. stop short-course suppressant if still taking discontinue PO STOP (>72 h = compensation-retarding) — Patient still on a vestibular suppressant beyond 48-72 h (Prolonged suppression delays compensation — actively de-prescribe (McDonnell Cochrane 2015))
7. optional tapered prednisone ONLY if early + shared decision favours ~1 mg/kg/day tapered ~3 wk PO once daily tapering — Early (≤3 d) presentation, objective recovery prioritised, no contraindication, patient-shared decision (DEBATED — caloric benefit only (Strupp NEJM 2004); no long-term/symptomatic benefit (Fishman Cochrane 2011; Leong OHNS 2021); equipoise, not routine)

Non-pharmacologic actions:
- Structured vestibular rehabilitation (clinician- or home-based) — the definitive recovery lever (McDonnell Cochrane 2015 — dizziness OR 2.67, DHI SMD −0.83)
- Counsel: residual unsteadiness for weeks is expected and is NOT treatment failure; recovery is by central compensation (Bárány AUVP criteria 2022)
- Withhold antivirals (Strupp NEJM 2004)
- Educate central return precautions (new diplopia/dysarthria/dysphagia/dysmetria, severe headache, hearing loss → urgent re-eval) (Kattah Stroke 2009)

AVOID / contraindication checks:
- Vestibular suppressant strictly short course leq 48 72h (prolonged use retards central compensation and delays recovery — Strupp NEJM 2004 context; McDonnell Cochrane 2015)
- Benzodiazepine and antihistamine fall and sedation and compensation risk elderly (minimise in geriatric/frail; single dose only for benzodiazepine)
- Antivirals NOT recommended for idiopathic vestibular neuritis (Strupp NEJM 2004 — valacyclovir ineffective, combo not superior)
- Corticosteroid is debated shared decision not routine (Fishman Cochrane 2011 / Leong OHNS 2021 — insufficient evidence; weigh diabetes/immunocompromise/pregnancy)
- Prochlorperazine extrapyramidal akathisia counsel (avoid repeated dosing; caution Parkinsonism/elderly)
- Ondansetron QT prolongation counsel (preferred non suppressant antiemetic incl. pregnancy; monitor QT/electrolytes)
- Do not treat undiagnosed central AVS as neuritis (central HINTS / 4 D's / acute hearing loss → image + route to neuro.posterior circulation stroke.core.v1 / ent.sudden sensorineural hearing loss.core.v1, NOT suppressants)

Monitoring

Regimen monitoring:
- re examine 24-72h expect gradual peripheral improvement (Bárány AUVP criteria 2022)
- STOP short course suppressant by 48-72h regardless (compensation-retarding if continued; McDonnell Cochrane 2015)
- begin early vestibular rehabilitation once acute vomiting settles (McDonnell Cochrane 2015 — dizziness OR 2.67)
- re triage any new or evolving neuro or auditory feature as central (Saber Tehrani Neurology 2014 — small posterior-fossa strokes missed on early MRI-DWI ~50%)
- corticosteroid glycaemic and adverse effect monitoring if used (Fishman Cochrane 2011; Leong OHNS 2021)
- reassess 1-4 weeks for compensation vs persistent imbalance (McDonnell Cochrane 2015)

Setting (outpatient) monitoring:
- ~1-4 week reassessment for compensation vs persistent imbalance (McDonnell Cochrane 2015)
- Audiometry follow-up if labyrinthitis (Newman-Toker AEM 2013)
- Screen for post-neuritis BPPV at follow-up (Bárány AUVP criteria 2022)

Follow-up plan: Reassess at ~1-4 weeks: most recover via central compensation over weeks; persistent imbalance/oscillopsia → structured vestibular rehabilitation (clinician- or home-based — McDonnell Cochrane 2015). Pursue secondary substrate: post-neuritis BPPV (utricular otoconia shed → new positional spells → route to ent.bppv.core.v1), incomplete compensation in the elderly (fall-injury risk → route to geriatrics.falls.core.v1), and audiometry follow-up if labyrinthitis. Educate on recovery trajectory, that residual unsteadiness for weeks is expected and NOT failure, and central return precautions.
- Close-out criterion: 1-4 week reassessment booked; vestibular-rehab + secondary-substrate plan documented; falls/BPPV/audiometry referral made if criteria met

Monitoring phase: Re-examine within the first 24-72 h: peripheral AVS should show GRADUAL improvement (nystagmus decreasing, gait improving) as central compensation begins. NON-resolution, worsening, NEW neuro/auditory features, or evolving direction-changing nystagmus → re-triage as CENTRAL (small posterior-fossa strokes are missed on early MRI-DWI ~50% — Saber Tehrani Neurology 2014); image / route OUT. STOP the short-course suppressant by 48-72 h regardless; persisting symptomatic suppressant use is itself a compensation-retarding error.

Disposition

Current setting: outpatient — Confirm peripheral AVS by clinical Bárány AUVP criteria, stop any short-course suppressant, drive recovery with early vestibular rehabilitation, hold a documented shared-decision corticosteroid discussion, withhold antivirals, and screen for post-neuritis BPPV / incomplete compensation at follow-up (Bárány AUVP criteria 2022; McDonnell Cochrane 2015; Fishman Cochrane 2011)

Disposition criteria:
- Compensating + safe gait → continue vestibular rehab, recurrence/secondary-BPPV education (McDonnell Cochrane 2015)
- Persistent/incomplete compensation → structured vestibular-rehab referral + evaluate for alternative diagnosis (Bárány AUVP criteria 2022)

Escalation triggers (move to higher acuity):
- New/evolving central feature → route to neuro.posterior-circulation-stroke.core.v1 (Saber Tehrani Neurology 2014)
- New unilateral hearing loss → route to ent.sudden-sensorineural-hearing-loss.core.v1 (Newman-Toker AEM 2013)
- New positional spells → post-neuritis secondary BPPV, route to ent.bppv.core.v1 (Bárány AUVP criteria 2022)
- Elderly + incomplete compensation + falls → route to geriatrics.falls.core.v1 (McDonnell Cochrane 2015)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] In acute vestibular syndrome: NORMAL horizontal head-impulse, OR direction-CHANGING gaze-evoked / pure-vertical / pure-torsional nystagmus, OR skew deviation (any one — "INFARCT" central HINTS), OR any 4 D's / severe truncal ataxia / focal sign (Kattah Stroke 2009; Newman-Toker AEM 2013)
- [SEVERE] Acute prolonged vertigo PLUS new unilateral sensorineural hearing loss / tinnitus / aural fullness — labyrinthitis (cochleovestibular); HINTS-plus positive (Newman-Toker AEM 2013; Bárány AUVP criteria 2022)
- [SEVERE] AVS not improving (no compensation) by 24-72 h, evolving toward direction-changing/vertical nystagmus, or atypical features inconsistent with a single peripheral lesion (Saber Tehrani Neurology 2014; Bárány AUVP criteria 2022)

Citations

- Bárány Society — Acute Unilateral Vestibulopathy / Vestibular Neuritis: Diagnostic Criteria (Strupp et al, J Vestib Res 2022, PMID 35723133) + Strupp et al, NEJM 2004 (methylprednisolone improves caloric recovery, valacyclovir ineffective; PMID 15269315) + Fishman et al, Cochrane 2011 (corticosteroids — insufficient evidence; PMID 21563170) + Leong et al, OHNS 2021 (PMID 33525978) + McDonnell & Hillier, Cochrane 2015 (vestibular rehabilitation; PMID 25581507) + HINTS (Kattah Stroke 2009 PMID 19762709; Newman-Toker AEM 2013 PMID 24127701; Saber Tehrani Neurology 2014 PMID 24920847) + TiTrATE (Newman-Toker & Edlow Neurol Clin 2015 PMID 26231273). Reconciled 2026-05-17 — PubMed-verified; the 2022 Bárány AUVP criteria are the current operational standard, no superseding guideline. [PMID:35723133](https://pubmed.ncbi.nlm.nih.gov/35723133/)
- Cited evidence (PMID 15269315) [PMID:15269315](https://pubmed.ncbi.nlm.nih.gov/15269315/)
- Cited evidence (PMID 21563170) [PMID:21563170](https://pubmed.ncbi.nlm.nih.gov/21563170/)
- Cited evidence (PMID 33525978) [PMID:33525978](https://pubmed.ncbi.nlm.nih.gov/33525978/)
- Cited evidence (PMID 34687143) [PMID:34687143](https://pubmed.ncbi.nlm.nih.gov/34687143/)

Last reconciled with current guidelines: 2026-05-17.
References
  • Bárány Society — Acute Unilateral Vestibulopathy / Vestibular Neuritis: Diagnostic Criteria (Strupp et al, J Vestib Res 2022, PMID 35723133) + Strupp et al, NEJM 2004 (methylprednisolone improves caloric recovery, valacyclovir ineffective; PMID 15269315) + Fishman et al, Cochrane 2011 (corticosteroids — insufficient evidence; PMID 21563170) + Leong et al, OHNS 2021 (PMID 33525978) + McDonnell & Hillier, Cochrane 2015 (vestibular rehabilitation; PMID 25581507) + HINTS (Kattah Stroke 2009 PMID 19762709; Newman-Toker AEM 2013 PMID 24127701; Saber Tehrani Neurology 2014 PMID 24920847) + TiTrATE (Newman-Toker & Edlow Neurol Clin 2015 PMID 26231273). Reconciled 2026-05-17 — PubMed-verified; the 2022 Bárány AUVP criteria are the current operational standard, no superseding guideline. — PMID:35723133
  • Cited evidence (PMID 15269315) — PMID:15269315
  • Cited evidence (PMID 21563170) — PMID:21563170
  • Cited evidence (PMID 33525978) — PMID:33525978
  • Cited evidence (PMID 34687143) — PMID:34687143