Comparative Study of Video Head Impulse Testing in Ménière’s Disease and Vestibular Neuritis in the Acute Setting

Background/objectives: Distinguishing an acute Ménière’s disease (MD) attack from acute vestibular neuritis (VN) can be difficult in the emergency setting, where both may present as an acute vestibular syndrome. Video head impulse testing (vHIT) reliably separates peripheral vestibular loss from central causes, but its behavior during the acute phase of MD relative to VN is not well characterized. Methods: In this retrospective cohort study, horizontal vHIT gain (regression slope) on the affected side was compared between 10 acute MD attacks and 12 acute VN cases (tested within 72 h of onset) Results: Mean vHIT gain was higher in MD (0.48 ± 0.24) than in VN (0.28 ± 0.13; p = 0.033, Student’s t-test; p = 0.060, Mann–Whitney U). Receiver operating characteristic analysis yielded an area under the curve of 0.742; a cutoff of ≤0.39 provided 83.3% sensitivity and 70.0% specificity for VN. Absolute ranges overlapped substantially (0.10–0.78 for MD, 0.12–0.57 for VN). Conclusions: Horizontal canal vHIT gain exhibits a more prominent reduction in acute vestibular neuritis than in acute Ménière’s disease attacks, and a gain threshold near 0.39 may provide a modest adjunct for distinguishing the two peripheral conditions once a central cause has been excluded. Nonetheless, VOR gain analysis in isolation does not permit reliable clinical distinction between these entities.