Vestibular neuritis is a disorder resulting from an infection that inflames the nerve connecting the inner ear to the brain. This inflammation disrupts the transmission of sensory information from the ear to the brain. Vertigo, dizziness, and difficulties with balance result.
The exact cause is unknown but it is suspected to be due to viral infections of the nerve connecting the inner ear to the brain. This may have started after a sore throat, middle ear infection, flu or cold. Less commonly, it is due to reduced blood supply to the inner ear.
It presents as sudden onset severe vertigo with nausea and vomiting and unsteadiness. The vertigo is described as head spinning and may be associated with head movements.
After a period of gradual recovery that may last several weeks, some people are completely free of symptoms. Others have chronic dizziness if the virus has damaged the vestibular nerve.
Many people with chronic neuritis have difficulty describing their symptoms, and often become frustrated because although they may look healthy, they don’t feel well. Without necessarily understanding the reason, they may observe that everyday activities are fatiguing or uncomfortable, such as walking around in a store, using a computer, being in a crowd, standing in the shower with their eyes closed, or turning their head to converse with another person at the dinner table.
Some people find it difficult to work because of a persistent feeling of disorientation or “haziness,” as well as difficulty with concentration and thinking.
The doctor will take a comprehensive history about your vertiginous episodes as well as perform a physical examination.
During a physical examination, your doctor or audiologist will likely look for:
- Signs and symptoms of dizziness that are prompted by eye or head movements and then decrease in less than one minute
- Dizziness with specific eye movements that occur when you lie on your back with your head turned to one side and tipped slightly over the edge of the examination bed
- Involuntary movements of your eyes from side to side (nystagmus)
- Inability to control your eye movements
Other tests that may be ordered for are VNG (to detect abnormal eye movement) or an MRI (an imaging test to look inside of your body).
Lab test are not necessary but may be useful in distinguishing vestibular neuritis from other causes of dizziness.
In most people, vertigo is bothersome but it is not caused by a serious problem. Treatment for vertigo aims to treat the underlying cause (if the cause is known), relieve the bothersome symptoms, and help with recovery. The symptoms of vestibular neuritis usually settle over a few weeks, even without treatment. This section will discuss treatment for symptoms and treatments to help with recovery.
If you have spells of vertigo that are severe or last for hours or days, your ENT doctor may recommend a medication to relieve severe vertigo symptoms, like vomiting. Treatment with medication is not usually recommended if your vertigo lasts only second or minutes.
Possible medication treatments include:
- An antihistamine, such as the prescription medicine meclizine,
- Prescription anti-nausea medicines, such as promethazine, metoclopramide, or ondansetron.
- Prescription sedative medicines, such as diazepam, lorazepam, or clonazepam.
Most of these medicines make you sleepy, and you should not take them before you work or drive. You should only take prescription medicines to treat severe vertigo symptoms, and you should stop the medicine when your symptoms improve.
Most patients with vertigo prefer to keep their head still. However, staying still and not moving your head can make it harder to cope with vertigo. The vestibular system includes parts of the inner ear and nervous system, which controls balance.
The rehabilitation works by helping your brain adjust its response to changes in the vestibular system. The therapy can also help train your eyes and other senses to “learn” how to compensate. This therapy is most helpful when it is started as soon as possible after you develop vertigo.
During rehabilitation, you will work with a therapist who will teach to you perform exercises at home. For example, you might start by focusing on an object with a blank background and move your head slowly to the right and left and up and down. You would perform this exercise for several minutes two to three times per day.
If you have trouble standing or walking because of vertigo, you are at risk for falling. In older adults, falls can lead to serious complications, such as a broken hip. Talk to your doctor, audiologist, or therapist about your concerns. To reduce the risk of falls, get rid of hazards in your home, such as loose electrical cords and slippery rugs, and avoid walking in unfamiliar areas that are not lighted.
The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.
- Dommaraju, Sindhu, and Eshini Perera. “An approach to vertigo in general practice.” Australian family physician4 (2016): 190.
- Greco, Antonio, et al. “Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo?.” Journal of immunology research2014 (2014).