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Vestibular Neuronitis in Pilots: Follow‐up Results and Implications for Flight Safety
Author(s) -
Shupak Avi,
Nachum Zohar,
Stern Yoram,
Tal Dror,
Gil Am,
Gordon Carlos R.
Publication year - 2003
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200302000-00022
Subject(s) - medicine , paresis , caloric theory , audiology , vestibular system , nystagmus , electronystagmography , vertigo , caloric test , surgery
Objectives To report our experience over the past 12 years with the evaluation and follow‐up of pilots with vestibular neuronitis and to discuss points relevant to flight safety and the resumption of flying duties. Study Design A retrospective, consecutive case series. Methods Eighteen military pilots with vestibular neuronitis were examined and followed up. A complete otoneurological workup was performed, including both physical examination and laboratory evaluation. The latter included electro‐oculography (EOG) and a rotatory chair test using the smooth harmonic acceleration protocol. Results The mean patient age was 35 ± 6 years (range, 23 to 42 y), and the average follow‐up period was 20.5 ± 12.8 months (mean ± standard deviation [SD]; (range, 11 to 48 mo). Electro‐oculography caloric test on presentation documented significant unilateral hypofunction in all patients. Thirteen of the 18 patients (72%) had abnormal smooth harmonic acceleration test results. None of the pilots reported any symptoms on follow‐up. However, five (28%) had positive otoneurological examination findings, and eight (44%) still had significant caloric lateralization (>25%). The average caloric hypofunction was reduced from 67.8% ± 29.3% at onset to 40% ± 16% (mean ± SD, P <.05, paired t test). Seven of the patients (39%) had additional electro‐oculography findings beyond caloric hypofunction. These included spontaneous, positional, and positioning nystagmus. Smooth harmonic acceleration disease on follow‐up was documented in eight patients (44%), five of whom had canal paresis. Eleven patients (61%) demonstrated residual vestibular damage on follow‐up. In 6 of these 11 cases (55%), the laboratory evaluation revealed vestibular deficits otherwise undiagnosed by the bedside test battery. Conclusions The vestibular system plays a central role in orientation awareness and is often challenged by flying conditions. The finding that approximately 60% of pilots who have had vestibular neuronitis continue to show signs of vestibular malfunction, despite apparent clinical recovery, emphasizes the need for a complete vestibular evaluation, including specific bedside testing and laboratory examinations, before flying duties can be resumed.