Definition

Vestibular neuritis is a disorder of the inner ear that causes symptoms such as sudden spinning sensation (vertigo), dizziness, balance disturbances, nausea, and vomiting. Vestibular neuritis is more commonly experienced by children but can affect any age group. Vestibular neuritis accounts for 8.1% of vertigo syndrome causes.

The disorder causing vestibular neuritis occurs in the VIII cranial nerve (vestibulocochlear). This nerve sends signals regarding balance and head position from the inner ear to the brain. When this nerve becomes inflamed and swollen, it disrupts the transmission of information from the inner ear to the brain, causing balance symptoms.

Causes

About 23% of vestibular neuritis incidents are preceded by upper respiratory tract infections. Researchers suspect a connection between viral infections in the inner ear, leading to inflammation and swelling of the VIII cranial nerve, or viral infections in other areas that affect the VIII cranial nerve. Examples of such viruses include herpes virus (causing chickenpox and shingles), Paramyxovirus (causing measles), influenza virus (causing flu), Mumps virus (causing mumps), hepatitis virus, and poliovirus.

Risk factor

Factors that can increase the risk of vestibular neuritis include:

• History of viral infections
• Risk of atherosclerosis, such as age ≥60 years, having other medical conditions like hypertension, diabetes, hyperlipidemia, coronary heart disease, and a history of stroke

Symptoms

Symptoms of vestibular neuritis include:

• Severe and sudden spinning sensation (vertigo) lasting for hours to days
• Dizziness or headache
• Balance disturbances
• Nausea and vomiting
• Difficulty concentrating

Vestibular neuritis and labyrinthitis are closely related conditions. Vestibular neuritis involves swelling of one branch of the VIII cranial nerve, the vestibular branch, which specifically controls balance. In labyrinthitis, inflammation affects both branches of the nerve, the vestibular and cochlear branches, resulting in both balance and hearing symptoms. Labyrinthitis can cause tinnitus (ringing in the ears) and/or hearing loss.

The most severe symptom of vestibular neuritis, vertigo, can last for several days. During this time, patients may have difficulty performing daily activities. After symptoms improve, patients can gradually recover fully within a few weeks (typically three weeks), although balance disturbances and dizziness may persist for several months.

Diagnosis

Vestibular neuritis can be diagnosed clinically. Your doctor will ask about your main complaints when they started, any history of vertigo, hearing disturbances, and previous respiratory or general viral infections. The doctor may also perform hearing and balance tests to examine your condition more closely. Several maneuvers can be used, such as the head impulse test (to see how well you can maintain focus on a fixed object while moving your head) and checking for nystagmus (uncontrolled eye movements).

If symptoms persist and worsen after several weeks, additional tests may be needed to rule out other diseases with similar symptoms, such as stroke, head injury, brain tumor, and migraine. If necessary, the doctor will perform a contrast MRI to look for abnormalities in your brain.

Management

Medical Therapy

Treatment for vestibular neuritis includes antiviral therapy and a rehabilitation program. If the suspected cause of vestibular neuritis is herpes, antivirals like Acyclovir may be used. Consult your doctor about this medication option.

Symptom management can be done using antiemetics (anti-nausea medications). If oral medications do not control nausea and vomiting, the doctor will administer intravenous (IV) medications to manage dehydration. To reduce headaches, the doctor will use vestibular suppressant drugs. These medications should not be used for more than three days and are not recommended for long-term use. In certain conditions, steroids may be used.

Rehabilitation Program

If balance disturbances and dizziness persist for more than a few weeks, physical therapy is necessary. The goal of this therapy is to train the brain to adapt to the new balance conditions. The first stage of therapy is evaluating the parts of the body affecting balance, including the limbs, eyes, ears, and entire body. Specific exercises can help the body adapt to the new balance capabilities. These exercises include:

• Overall body posture balance exercise, involving rocking back and forth while standing.
• Head-turn exercise, focusing on a fixed object while moving the head side to side.

The key to successful rehabilitation is performing exercises 2–3 times a day at home. Ask family or close friends to help you with these exercises.

Home Care

The following steps can help alleviate symptoms of vestibular neuritis:

• Lie down in a dark room if you experience spinning dizziness
• Drink more water during an attack, taking small sips more frequently
• Avoid loud noises and bright lights
• Get enough sleep, as fatigue can worsen symptoms
• Start walking outside again as soon as possible, asking a close person to accompany you until you feel confident walking alone
• Focus your gaze on a non-moving object during an attack
• Do not drive or operate machinery if you experience dizziness or an attack
• Avoid alcohol as it can worsen symptoms

Complications

Vestibular neuritis generally does not cause significant complications and can fully recover. About 15% of patients experience persistent symptoms for one year. Recurrence is rare, occurring in only 2–11% of patients.

Two main complications that can occur are benign paroxysmal positional vertigo (BPPV) and persistent postural-perceptual dizziness (PPPD). BPPV occurs in 10–15% of patients with vestibular neuritis in the affected ear. PPPD is a newly recognized syndrome consisting of subjective vertigo and dizziness symptoms, found in 25% of vestibular neuritis patients 3–12 months after the first attack.

Prevention

Because it can be caused by the virus, the prevention of vestibular neuritics is to maintain the body's resistance so as not to be infected with the virus and vaccinate viruses that can be prevented by vaccines. Maintaining personal hygiene can help you avoid viral infection. 

When to see a doctor?

Seek immediate medical attention if you experience:

• Symptoms of vestibular neuritis that do not improve after several weeks
• Symptoms of vestibular neuritis that worsen despite treatment
• Sudden hearing loss in one ear
• Symptoms of vestibular neuritis accompanied by limb weakness, facial drooping, or slurred speech. These symptoms indicate a stroke and require prompt treatment.

Looking for more information about other diseases? Click here!