From the Guidelines
Vestibular neuritis is a viral infection of the vestibular system, leading to acute prolonged vertigo with nausea, vomiting, and severe rotational vertigo lasting 12 to 36 hours, without hearing loss, tinnitus, or aural fullness. This condition is characterized by a sudden onset of symptoms, which can be debilitating for the patient. According to the clinical practice guideline for Ménière's disease 1, vestibular neuritis is distinct from other causes of vertigo due to its lack of association with hearing loss, tinnitus, or aural fullness. The symptoms of vestibular neuritis can be managed with medications such as meclizine, diazepam, or promethazine for vertigo and nausea, and corticosteroids like prednisone may help reduce inflammation if started early. Some key features of vestibular neuritis include:
- Sudden onset of severe vertigo
- Nausea and vomiting
- Severe rotational vertigo lasting 12 to 36 hours
- No hearing loss, tinnitus, or aural fullness
- Symptoms typically improve over several weeks as the brain compensates for the imbalanced signals. It is essential to differentiate vestibular neuritis from other causes of vertigo, such as labyrinthitis, benign paroxysmal positional vertigo, and vestibular migraine, to provide appropriate treatment and management. A thorough otologic history and physical examination are crucial in establishing the clinical diagnosis of vestibular neuritis 1.
From the Research
Definition and Causes of Vestibular Neuritis
- Vestibular neuritis, also known as vestibular neuronitis, is a peripheral vestibular disorder characterized by abrupt true-whirling vertigo lasting for more than 24 hours, without cochlear symptoms or other neurological symptoms and signs 2.
- The cause of vestibular neuritis remains unclear, but it is thought to be caused by a viral infection of the vestibular nerve or ischemia of the anterior vestibular artery 2.
- Recent studies have also reported immune-mediated mechanisms as a possible cause of vestibular neuritis 2.
Symptoms and Diagnosis
- The characteristic clinical features of vestibular neuritis include vertigo, which is the sensation of self-motion of the head or body when no self-motion is occurring or the sensation of distorted self-motion during an otherwise normal head movement 2.
- Diagnostic tests such as the head impulse test, bithermal caloric test, and vestibular-evoked myogenic potential test are conducted to accurately diagnose vestibular neuritis 2.
Treatment and Rehabilitation
- Various treatments for vestibular neuritis have been reported, including symptomatic therapy, specific drug therapy, and vestibular rehabilitation therapy 2.
- Symptomatic therapies include generalized supportive care and administration of vestibular suppressants and antiemetics 2.
- Specific drug therapies include steroid therapy, antiviral therapy, and vasodilator therapy, with methylprednisolone showing significant improvement in the recovery of peripheral vestibular function in patients with vestibular neuritis 3.
- Vestibular rehabilitation therapies include generalized vestibular and customized vestibular exercises, which can accelerate the recovery process and improve vestibular compensation 4.