From the Research
The best management approach for vestibular neuritis involves a combination of vestibular rehabilitation therapy (VRT) and corticosteroids, with VRT being the primary option and corticosteroids added to provide better recovery in the absence of contraindications. Initially, symptomatic treatment with vestibular suppressants is recommended, including diazepam (2-5 mg orally every 4-6 hours), meclizine (25-50 mg orally every 4-6 hours), or promethazine (25 mg orally, rectally, or intramuscularly every 4-6 hours) for the first 1-3 days to control severe vertigo, nausea, and vomiting 1. Corticosteroids such as methylprednisolone (100 mg daily for 3 days followed by a taper) or prednisone (60 mg daily for 5 days followed by a taper) should be started within 3 days of symptom onset to potentially improve vestibular function recovery.
Some key points to consider in the management of vestibular neuritis include:
- The use of antivirals like acyclovir is not routinely recommended as evidence doesn't support their efficacy 2.
- After the acute phase, vestibular suppressants should be discontinued as they can delay central compensation.
- Vestibular rehabilitation exercises should be initiated as soon as the patient can tolerate them, typically within a week of symptom onset, to promote central compensation and accelerate recovery.
- These exercises include gaze stabilization, habituation exercises, and balance training.
- Most patients recover significantly within 4-6 weeks, though complete recovery may take several months, and some may have residual symptoms requiring longer rehabilitation 1.
The recent study by 1 provides the most up-to-date evidence on the management of vestibular neuritis, and its findings support the use of VRT as the primary option, with corticosteroids added as needed. This approach prioritizes the improvement of morbidity, mortality, and quality of life outcomes for patients with vestibular neuritis.