| Description |
- Background: Vestibular neuritis and labyrinthitis (VNL) are common causes of vertigo and dizziness. While multiple treatment strategies have been proposed, no established consensus for the optimal way to manage VNL exists. Moreover, no research has investigated the impact of social health determinants on the management of VNL and patient performance in vestibular rehabilitation therapy, a leading treatment for VNL. The purpose of this study was to explore current clinical management practices for vestibular neuritis and labyrinthitis (VNL) by ENT providers in a single institution and determine whether 1) referral to vestibular rehabilitation therapy (VRT), 2) initiation of VRT, or 3) baseline function and symptoms at initial presentation to VRT vary as a function of the patient’s sex, race, or insurance status.
Methods: The patient cohort consisted of adult patients who visited a multi-provider tertiary ENT clinic visit between 2014-2023 and were given a single diagnosis of VNL (n=168). Demographic information was extracted from the medical record, and provider diagnosis, treatment recommendations, and referrals were extracted from the ENT clinical note. The type and scores of baseline vestibular rehabilitation assessments were obtained from the initial rehabilitation note of all referred patients who initiated VRT. Descriptive statistics were calculated to summarize clinical encounter and vestibular rehabilitation outcomes data in each cohort. Initial VRT assessment scores were determined to be normal or abnormal based on prior published normative data. To evaluate for sociodemographic differences in VRT referral rates, VRT initiation rates, and the proportion of patients with abnormal baseline VRT assessment scores, Chi-Square analyses and Fisher’s Exact test were performed. All analysis were run on SPSS (IBM SPSS Version 28), and p < 0.003 is considered significant to account for multiple comparisons.
Results: The majority of the VNL cohort was white (75.6%), female (56.5%), and had private insurance (57.8%). VRT was the primary treatment recommendation made by ENT providers across all evaluated sociodemographic groups, followed by no clinical management, and pharmacologic therapy. Corticosteroids were most frequently prescribed, and antihistamines were most frequently discontinued. No significant difference in VRT referral rates existed as a function of sex, race, or insurance status (p>0.003). 68.8% of referred patients initiated VRT, and no sociodemographic variation in initiation rates was observed (p> 0.003). Most patients who initiated VRT had at least one abnormal baseline assessment score. The number of patients with abnormal DGI scores, DVA scores, or gait speeds did not vary by sex or race (p>0.003). The proportion of patients with suboptimal DGI scores (p=0.001) and gait speeds (p<0.001) did differ by insurance status, such that public insurance holders more frequently had abnormal scores.
Conclusion: VRT was the most frequent clinical management strategy recommended to VNL patients by ENT providers. VRT referral rates did not vary based on sex, race, or insurance status. The majority of referred patients initiated VRT, and most patients who initiated VRT had identified vestibular dysfunction on baseline assessments or evidence for increased falls risk, suggesting appropriate referral of VRT to those who may benefit the most. Importantly, the magnitude of symptoms and functional impacts did not vary based on sex or race, suggesting that patients were referred to VRT for an equivalent symptom burden within most evaluated sociodemographic groups. Our study did observe differences in baseline function as it relates to falls risk by insurance status. Our findings demonstrate important insights about the practice patterns within a single-academic institution.
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