Management of Recurrent Vestibular Neuritis in a Patient Treated for Rheumatoid Arthritis Purpose This clinical report is presented to describe how results of vestibular function testing were considered along with other medical history to develop a management plan that was ultimately successful. Method The patient underwent audio-vestibular assessment including comprehensive audiogram, videonystagmography, cervical vestibular evoked myogenic potential, and postural stability ... Clinical Focus
Clinical Focus  |   March 08, 2018
Management of Recurrent Vestibular Neuritis in a Patient Treated for Rheumatoid Arthritis
 
Author Affiliations & Notes
  • Richard A. Roberts
    Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Nashville, TN
  • Disclosure: The author has declared that no competing interests existed at the time of publication.
    Disclosure: The author has declared that no competing interests existed at the time of publication. ×
  • Correspondence to Richard A. Roberts: richard.a.roberts@vanderbilt.edu
  • Editor-in-Chief: Sumitrajit Dhar
    Editor-in-Chief: Sumitrajit Dhar×
  • Editor: Ann Eddins
    Editor: Ann Eddins×
Article Information
Balance & Balance Disorders / Clinical Focus
Clinical Focus   |   March 08, 2018
Management of Recurrent Vestibular Neuritis in a Patient Treated for Rheumatoid Arthritis
American Journal of Audiology, March 2018, Vol. 27, 19-24. doi:10.1044/2017_AJA-17-0090
History: Received September 7, 2017 , Revised September 28, 2017 , Accepted October 11, 2017
 
American Journal of Audiology, March 2018, Vol. 27, 19-24. doi:10.1044/2017_AJA-17-0090
History: Received September 7, 2017; Revised September 28, 2017; Accepted October 11, 2017

Purpose This clinical report is presented to describe how results of vestibular function testing were considered along with other medical history to develop a management plan that was ultimately successful.

Method The patient underwent audio-vestibular assessment including comprehensive audiogram, videonystagmography, cervical vestibular evoked myogenic potential, and postural stability testing.

Results Results from initial testing were most consistent with uncompensated peripheral vestibular dysfunction affecting the right superior vestibular nerve. These results, considered along with history and symptoms, supported vestibular neuritis. After a second vertigo event, we became concerned about the potential temporal association between the patient's rheumatoid arthritis treatment and symptom onset. It is established that treatment for rheumatoid arthritis can exacerbate latent viral issues, but this has not specifically been reported for vestibular neuritis. There are reports in the literature in which patients successfully used viral suppressant medication to decrease viral activity while they were able to continue benefiting from immunosuppressive therapy. We hypothesized that, if the current patient's vestibular neuritis events were related to her treatment for rheumatoid arthritis, she may also benefit from use of viral suppressant medication while continuing her otherwise successful immunosuppressive intervention.

Conclusions Patients treated with biologic disease-modifying antirheumatic drugs are more susceptible to viral issues, and this may include vestibular neuritis. For the current case, identifying this possibility and recommending viral suppressant medication allowed her to continue with successful treatment of rheumatoid arthritis while avoiding additional vertigo events.

Acknowledgments
Portions of this work were presented at the annual meeting of the American Academy of Audiology in Phoenix, AZ, in 2016.
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