Vestibular Neuritis

What Is Vestibular Neuritis?

Vestibular neuritis is a rare condition of inflammation of the inner ear balance system.  It affects the sensory cells of the vestibule and balance canals and also the nerve that sends signals from these cells to the brain.   

What Are the Symptoms of Vestibular Neuritis?

Vertigo, nausea, vomiting, imbalance, and difficulty concentrating can all occur when suffering from vestibular neuritis.  The symptoms change over time.  Initially, severe, constant, room-spinning vertigo with nausea and possible vomiting occur suddenly.  These symptoms last many hours and even days.  Slowly, however, they become less severe.  Vomiting stops first, then nausea, and finally vertigo.  At this point, intermittent vertigo may occur with movement.  This too, will slowly resolve.  After a few weeks, residual imbalance may be all that is left. 

What Causes Vestibular Neuritis?

Patients often have or have had a cold when vestibular neuritis starts.  Many different viruses can cause vestibular neuritis.  Certain viruses have a tendency to infect nerve tissue.  Viruses that cause cold sores, chicken pox, and shingles prefer to infect nerve tissue.  Other viruses that cause the common cold, the flu, gastritis, etc may also cause vestibular neuritis. 

How Is Vestibular Neuritis Diagnosed?

Because the main symptoms of vestibular neuritis may be caused by many different problems with the ear, a battery of hearing and balance tests may be required to help you doctor sort out what is going on with you.  These tests include a basic hearing test (audiogram), a balance test (VNG), and an MRI.  A normal MRI ensures that no brain tumor or stroke is causing the symptoms.  A normal hearing test ensures that you do not have labyrinthitis or Meniere’s disease.  An abnormal balance test implies inflammation isolated to the balance system of the inner ear and leads to the diagnosis of vestibular neuritis. 

What Are My Options to Treat Vestibular Neuritis?

Treatment for vestibular neuritis depends on the stage at which you come to the doctor.  In the early stage when there is nausea and vomiting, treatment suppresses symptoms and treats inflammation.  Corticosteroids (prednisone, Medrol) and vestibular suppressants (Valium) are given.  In the later stages, if problems persist they are typically trouble with sudden movements or imbalance.  Steroids and vestibular suppression do little to help these symptoms because the inflammation is already gone.  Symptoms at this stage are due to chronic damage to the balance system, not ongoing inflammation.  Vestibular rehabilitation is useful to improve sudden movements and balance.  This may be done at home or in severe cases with a physical therapist.