Dizziness stemming from viral infections presents a complex diagnostic landscape. While Vestibular Neuritis (VN) and Ramsay Hunt Syndrome (RHS) with dizziness are both recognized virus-associated peripheral vestibulopathies, the underlying pathophysiological mechanisms, particularly regarding neurovascular interactions, remain incomparably explored. Understanding these differences is crucial for refining diagnoses and exploring targeted interventions.
This research, published in ENT Discovery, employs high-resolution magnetic resonance imaging (MRI) to systematically evaluate and compare neurovascular compression at the root entry zone of the vestibulocochlear nerve in patients with VN and RHS. The study by Yingzhao Liu and colleagues demonstrates a significantly higher prevalence and severity of neurovascular contact in patients with RHS compared to those with VN. These findings suggest that in RHS, reactivation of the varicella-zoster virus may create a state of nerve hyperexcitability or vulnerability, potentially making the nerve more susceptible to symptomatic compression by adjacent blood vessels, thereby contributing to the more severe and complex symptomatology.
The identification of this structural difference offers a potential imaging biomarker to aid in the differential diagnosis of challenging cases and opens novel avenues for considering microvascular decompression as a therapeutic option for refractory RHS-related vertigo. However, the study’s cross-sectional design cannot establish causality, and larger prospective studies are needed to confirm if neurovascular contact is a predisposing factor, a consequence of inflammation, or an incidental finding. This work, entitled “Evaluating the Neurovascular Compression in Virus-associated Peripheral Vestibulopathies: A Comparative Study of Vestibular Neuritis and Ramsay Hunt Syndrome With Dizziness” was published on ENT Discovery (published on Dec. 31, 2025).
DOI：10.15302/ENTD.2025.120002