From the Research
The prognosis for recovery from vestibular neuritis is generally favorable, with most patients experiencing significant improvement within several weeks to months, and corticosteroids started within 24 hours of symptom onset, such as prednisone 50mg/d for 5 days, may improve outcomes 1. The recovery process typically occurs in three phases: an acute phase lasting 1-3 days with severe vertigo, a subacute phase of gradual improvement over 1-3 weeks, and a chronic recovery phase that may last several months. During recovery, the brain compensates for the vestibular deficit through a process called vestibular compensation. Some key points to consider include:
- Medications like vestibular suppressants are helpful only in the first few days to manage acute vertigo.
- Vestibular rehabilitation exercises should be initiated as soon as tolerable to promote faster and more complete recovery by enhancing central compensation.
- Factors that may negatively affect prognosis include advanced age, severe initial symptoms, delayed treatment, and conditions that impair central compensation like visual or proprioceptive deficits.
- About 10-15% of patients may develop chronic dizziness or imbalance, particularly with head movements or in visually complex environments. A recent meta-analysis found that corticosteroid treatment resulted in a statistically significant benefit compared to control therapies, with an odds ratio of 3.1 for good outcome in the acute phase and 2.4 for restoration of vestibular function in the follow-up 2. However, it's essential to note that the quality of the studies was mostly low-grade, and there was a high risk of bias, which puts the findings into perspective and allows only a careful judgment of some benefit of corticosteroids. Physical activity is also an essential factor in the recovery process, and patients with higher physical activity levels tend to have better outcomes 3. Overall, the prognosis for recovery from vestibular neuritis is generally good, and treatment with corticosteroids and vestibular rehabilitation exercises can improve outcomes.