From the Guidelines
Vestibular neuritis should be managed with corticosteroids, such as prednisone, and vestibular rehabilitation exercises, rather than relying on vestibular suppressant medications like antihistamines and/or benzodiazepines. Vestibular neuritis is an inner ear disorder characterized by sudden, severe vertigo (spinning sensation), nausea, vomiting, and balance problems due to inflammation of the vestibular nerve. The primary goal of treatment is to reduce inflammation and manage symptoms, with a focus on improving quality of life and reducing morbidity.
According to the clinical practice guideline for benign paroxysmal positional vertigo (BPPV) 1, clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines, which can be applied to vestibular neuritis management as well. Instead, treatment should focus on:
- Corticosteroids like prednisone (60mg daily for 5 days, then tapered over 5 more days) to reduce inflammation if started within 3 days of symptom onset
- Vestibular rehabilitation exercises to retrain the brain to compensate for the vestibular deficit, which should begin as soon as acute symptoms subside, typically within a week
- Anti-nausea medications such as ondansetron (4-8mg every 8 hours) may also help manage symptoms
Key considerations for managing vestibular neuritis include:
- Avoiding driving or operating machinery while experiencing vertigo
- Moving carefully to prevent falls during the acute phase
- Focusing on recovery and rehabilitation to improve quality of life and reduce morbidity
- Recognizing that most patients recover completely within 6-8 weeks, though some may have residual symptoms.
From the Research
Vestibular Neuritis Treatment
- The treatment of vestibular neuritis involves symptomatic treatment and rehabilitation 2.
- Corticosteroids have been shown to be effective in reducing the severity of the attack and improving vestibular function, especially when administered within 24 hours of onset 3.
- The use of corticosteroids has been found to have long-term beneficial effects on the recovery of vestibular function and allows for better vestibular compensation 2, 4.
Rehabilitation and Recovery
- Rehabilitation plays a crucial role in the recovery of patients with vestibular neuritis, with exercises such as visual fixation and vestibular rehabilitation programs being effective in accelerating the recovery process 2, 5.
- Physical activity has been found to be an important factor in the recovery of patients with vestibular neuritis, with patients who engage in regular physical activity experiencing better symptomatic outcomes 5.
- The evaluation of vestibular neuritis should not be limited to the assessment of the vestibulo-ocular reflex, but should also include posturography and symptomatic scales to assess the state of health 5.
Medications and Treatment Options
- Corticosteroids, such as prednisolone and betamethasone, have been found to be effective in the treatment of vestibular neuritis 3, 4.
- Ondansetron, an anti-emetic, has been found to have a functional vestibuloprotective effect in the treatment of vestibular neuritis 6.
- The timing of steroid treatment may be important, with treatment within 24 hours of onset resulting in better outcomes 3.