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.