Systemic inflammatory markers in vestibular neuritis and BPPV: A single-center retrospective study

Year 2026, Volume: 6 Issue: 1 , 91 - 97 , 12.03.2026

Özge Özen Gökmuharremoğlu , Yusuf Aydin

https://doi.org/10.66235/kumj.1906837

https://izlik.org/JA86LY23KW

Abstract

Aims: This study aimed to compare systemic inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), derived NLR (dNLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), in patients with vestibular neuritis (VN) and benign paroxysmal positional vertigo (BPPV) and to evaluate their potential role in differential diagnosis.

Methods: In this retrospective study, 109 patients diagnosed with VN (n=52) or BPPV (n=57) at Kastamonu Training and Research Hospital were included between January 2024 and December 2024. Demographic characteristics, clinical data, and laboratory parameters (leukocyte, neutrophil, lymphocyte, monocyte, platelet, CRP, and albumin levels) were recorded. NLR, dNLR, MLR, PLR, SII [(platelet × neutrophil)/lymphocyte], and SIRI [(neutrophil × monocyte)/lymphocyte] were calculated.

Results: The two groups were similar regarding age and sex distribution; however, bilateral involvement was significantly more common in the BPPV group (p=0.004). The VN group showed significantly higher leukocyte (p=0.027) and neutrophil (p=0.004) counts and significantly lower albumin levels (p=0.001). Among inflammatory markers, NLR (p=0.012), SII (p=0.023) and SIRI (p=0.035) were found to be significantly higher in VN patients than in BPPV patients.

Conclusion: The significant increase in NLR, SII, and SIRI levels in VN patients compared with BPPV patients suggests a more prominent role of inflammatory mechanisms in the pathogenesis of vestibular neuritis. These readily available and inexpensive biomarkers may serve as supportive tools in the differential diagnosis of peripheral vertigo in clinical practice.

Keywords

Vestibular neuritis , benign paroxysmal positional vertigo , systemic inflammatory markers , neutrophil-to-lymphocyte ratio , systemic immune-inflammation index

References

• 1. Petri M, Chirila M, Bolboaca S,et al. Unilateral peripheral vestibular disorders in the emergency room of the ENT Department of Cluj-Napoca, Romania. Clujul Med. 2015;88(2):181-187. doi:10.15386/cjmed-412
• 2. Hung SH, Xirasagar S, Dang LH, et al. Trends in the incidence of peripheral vestibular disorders: a Nationwide population-based study. Front Neurol. 2023;14:1322199. doi:10.3389/fneur.2023.1322199
• 3. von Brevern M, Bertholon P, Brandt T, et al. Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res. 2015;25(3-4):105-117. doi:10.3233/VES-150553
• 4. Bae CH, Na HG, Choi YS. Current diagnosis and treatment of vestibular neuritis: a narrative review. J Yeungnam Med Sci. 2022;39(2):81-88. doi:10.12701/yujm.2021.01228
• 5. Bucak A, Ulu S, Oruc S, et al. Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy. Laryngoscope. 2014;124(7):1678-1681. doi:10.1002/lary.24551
• 6. Ferroni P, Riondino S, Formica V, et al. Venous thromboembolism risk prediction in ambulatory cancer patients: clinical significance of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio. Int J Cancer. 2015;136(5):1234-1240. doi:10.1002/ijc.29076
• 7. Özler GS. Increased neutrophil-lymphocyte ratio in patients with idiopathic sudden sensorineural hearing loss. J Craniofac Surg. 2014;25(3):e260-263. doi:10.1097/SCS.0000000000000565
• 8. Chung JH, Lim J, Jeong JH, Kim KR, Park CW, Lee SH. The significance of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in vestibular neuritis. Laryngoscope. 2015;125(7):E257-261. doi:10.1002/lary.25204
• 9. Herdman D. Advances in the diagnosis and management of acute vertigo. The Journal of Laryngology & Otology. 2024;138(S2):S8-S13. doi:10.1017/S0022215123002232
• 10. von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710-715. doi:10.1136/jnnp.2006.100420
• 11. Koç A. Benign Paroxysmal Positional Vertigo: Is It Really an Otolith Disease? J Int Adv Otol. 2022;18(1):62-70. doi:10.5152/iao.2022.21260
• 12. Bisdorff A, Von Brevern M, Lempert T,et al. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009;19(1-2):1-13. doi:10.3233/VES-2009-0343
• 13. He Y, Guo T, Dai T,et al. Inflammatory proteins and vestibular neuronitis: A Mendelian randomization study. Medicine. 2024;103(51):e41081. doi:10.1097/MD.0000000000041081
• 14. Erbek S, Luis L. Vestibular Neuritis. In: Kalcioglu MT, Bayar Muluk N, Jenkins HA, eds. Neurotology Updates. Springer Nature Switzerland. 2024:185-199. doi:10.1007/978-3-031-77370-9_9
• 15. Aw ST, Fetter M, Cremer PD,et al. Individual semicircular canal function in superior and inferior vestibular neuritis. Neurology. 2001;57(5):768-774. doi:10.1212/wnl.57.5.768
• 16. Kamo T, Ogihara H, Azami M, et al. Effects of Early Vestibular Rehabilitation in Patients With Acute Vestibular Disorder: A Systematic Review and Meta-Analysis. Otology & Neurotology. 2023;44(9):e641. doi:10.1097/MAO.0000000000004006
• 17. Mulry E, Parham K. Inner Ear Proteins as Potential Biomarkers. Otology & Neurotology. 2020;41(2):145. doi:10.1097/MAO.0000000000002466
• 18. Klokman VW, Verhagen MJJ, Sanders MS,et al. Blood Biomarkers for the Diagnosis of Peripheral Causes of Vestibular Syndrome: A Systematic Review and Meta-Analysis. Otology & Neurotology. 2025;46(9):e359. doi:10.1097/MAO.0000000000004608
• 19. Gu L, Xia Z, Qing B, et al. Systemic Inflammatory Response Index (SIRI) is associated with all-cause mortality and cardiovascular mortality in population with chronic kidney disease: evidence from NHANES (2001-2018). Front Immunol. 2024;15:1338025. doi:10.3389/fimmu.2024.1338025
• 20. Yılmaz A, Taşkın Ö, Demir U,et al. Predictive Role of Biomarkers in COVID-19 Mortality. Cureus. 2023. doi:10.7759/cureus.34173
• 21. Tekeşin A , Tunç A . Inflammatory biomarkers in benign paroxysmal positional vertigo: A Turkey case-control study. Gyulladásos biomarkerek benignus paroxysmalis pozicionális vertigóban: törökországi eset-kontroll vizsgálat. Ideggyogy Sz. 2018;71(11-12):411-416.
• 22. Proctor MJ, McMillan DC, Morrison DS, et al. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012;107(4):695-699. doi:10.1038/bjc.2012.292
• 23. Hu G, Hu W, Wu X, et al. Correlation Analysis Between Inflammatory Biomarkers and Dizziness: A Cross-Sectional Analysis Based on NHANES 1999-2004. Research Square. 2025. doi:10.21203/rs.3.rs-6863186/v1
• 24. Yuan J, Dai J, Li WA, et al. Factors Associated with Benign Paroxysmal Positional Vertigo: A Chinese Case-Control Study. Med Sci Monit. 2017;23:3885-3889. doi:10.12659/msm.905716
• 25. Celikbilek A, Gencer ZK, Saydam L, et al. Serum uric acid levels correlate with benign paroxysmal positional vertigo. Eur J Neurol. 2014;21(1):79-85. doi:10.1111/ene.12248