What is vestibular neuritis?
Vestibular neuritis is a disorder that affects the nerve of the inner ear called the vestibulocochlear nerve. This nerve sends balance and head position information from the inner ear to the brain. When this nerve becomes swollen (inflamed), it disrupts the way the information would normally be interpreted by the brain.
Vestibular neuritis can occur in people of all ages, but is rarely reported in children.
The vestibulocochlear nerve sends balance and head position information from the inner ear (see left box) to the brain. When the nerve becomes swollen (right box), the brain can’t interpret the information correctly. This results in a person experiencing such symptoms as dizziness and vertigo.
Symptoms and Causes
What are the symptoms of vestibular neuritis?
- Sudden, severe vertigo (spinning/swaying sensation)
- Balance difficulties
- Nausea, vomiting
- Concentration difficulties
Vestibular neuritis and labyrinthitis are closely related disorders. Vestibular neuritis involves swelling of a branch of the vestibulocochlear nerve (the vestibular portion) that affects balance. Labyrinthitis involves the swelling of both branches of the vestibulocochlear nerve (the vestibular portion and the cochlear portion) that affects balance and hearing. The symptoms of labyrinthitis are the same as vestibular neuritis plus the additional symptoms of tinnitus (ringing in the ears) and/or hearing loss.
Generally, the most severe symptoms (severe vertigo and dizziness) only last a couple of days, but while present, make it extremely difficult to perform routine activities of daily living. After the severe symptoms lessen, most patients make a slow, but full recovery over the next several weeks (approximately three weeks). However, some patients can experience balance and dizziness problems that can last for several months.
What causes vestibular neuritis?
Researchers think the most likely cause is a viral infection of the inner ear, swelling around the vestibulocochlear nerve (caused by a virus), or a viral infection that has occurred somewhere else in the body. Some examples of viral infections in other areas of the body include herpes virus (causes cold sores, shingles, chickenpox), measles, flu, mumps, hepatitis and polio. (Genital herpes is not a cause of vestibular neuritis.)
Diagnosis and Tests
How is vestibular neuritis diagnosed?
In most patients, a diagnosis of vestibular neuritis can be made with an office visit to a vestibular specialist. These specialists include an otologist (ear doctor) or neurotologist (doctor who specializes in the nervous system related to the ear). Referral to an audiologist (hearing and vestibular [balance] clinician) may be made to perform tests to further evaluate hearing and vestibular damage. Tests to help determine if symptoms might be caused by vestibular neuritis include hearing tests, vestibular (balance) tests and a test to determine if a portion of the vestibulocochlear nerve has been damaged. Another specific test, called a head impulse test, examines how difficult it is to maintain focus on objects during rapid head movements. The presence of nystagmus, which is uncontrollable rapid eye movement, is a sign of vestibular neuritis.
If symptoms continue beyond a few weeks or become worse, other tests are performed to determine if other illnesses or diseases are causing the same symptoms. Some of these other possible health conditions include stroke, head injury, brain tumor, and migraine headache. To rule out some of the disorders of the brain, an MRI with dye (called a contrast agent) may be ordered.
Management and Treatment
What is the treatment for vestibular neuritis?
Treatment consists of managing the symptoms of vestibular neuritis, treating a virus (if suspected), and participating in a balance rehabilitation program.
Managing symptoms. When vestibular neuritis first develops, the focus of treatment is to reduce symptoms. Drugs to reduce nausea include ondansetron (Zofran®) and metoclopramide (Reglan®). If nausea and vomiting are severe and not able to be controlled with drugs, patients may be admitted to the hospital and given IV fluids to treat dehydration.
To reduce dizziness, drugs such as meclizine (Antivert®), diazepam (valium), compazine and lorazepam (Ativan®) are prescribed. The different types of drugs used to reduce dizziness are group together and called by the general name, vestibular suppressants. Vestibular suppressants should be used no longer than three days. They are not recommended for long-term use and may make recovery more difficult.
Sometimes steroids are also used.
Treating a virus. If a herpes virus is thought to be the cause of the vestibular neuritis, antiviral medicine such as acyclovir is used. (Antibiotics are not used to treat vestibular neuritis because this disorder is not caused by bacteria.)
What is a balance rehabilitation program?
If balance and dizziness problems last longer than a few weeks, a vestibular physical therapy program may be recommended. The goal of this program is to retrain the brain to adapt to the changes in balance that a patient experiences.
As the first step in this program, a vestibular physical therapist evaluates the parts of the body that affect balance. These areas include:
- The legs (how well the legs "sense" balance – when attempting to stand or walk)
- The eyes (how well the sense of vision interprets the body’s position in relation to its surroundings)
- The ears (how well the inner ear functions to maintain balance)
- The body as a whole (how well the body interprets its center of gravity – does the body sway or have unsteady posture)
Based on the results of the evaluation, an exercise program is designed specifically for the patient. Some examples of balance exercises:
Overall body posture balance exercises:
- Exercises that shift body weight forward and backward and from side-to-side while standing
Eye/ear head-turn exercises:
- Focusing eyes on an object while turning head from side to side
- Keeping vision steady while making rapid side-to-center head turns
- Focusing eyes on a distant object, with brief glances at floor, while continuing to walk toward the object
The key to a successful balance rehabilitation program is to repeat the set of personalized exercises 2 to 3 times a day. By repeating these exercises, the brain learns how to adjust to the movements that cause dizziness and imbalance. Many of the exercises can be done at home, which will speed recovery. Vestibular rehabilitation specialists provide specific instructions on how to perform the exercises, identify which exercises can be done at home, and provide other home safety tips to prevent falls.
Can vestibular neuritis recur?
In most patients (95 percent and greater) vestibular neuritis is a one-time experience. Most patients fully recover.