What is the recommended treatment for vestibular neuritis?

Treatment of Vestibular Neuritis

The recommended treatment for vestibular neuritis includes early corticosteroid therapy (within 24 hours of symptom onset when possible), symptomatic management with vestibular suppressants during the acute phase, and vestibular rehabilitation therapy to promote central compensation.

Acute Phase Management

Corticosteroid Therapy

• Early administration is critical - treatment within 24 hours of symptom onset results in better vestibular function recovery (100% normal caloric test results) compared to treatment between 25-72 hours (58% normal results) 1
• Recommended regimen: Oral prednisolone 50 mg/day for 5 days with tapering of doses for the next 5 days 1
• For patients with severe nausea: Consider combined therapy with initial intravenous betamethasone 8 mg for the first 1-2 days 1
• Corticosteroids accelerate recovery of vestibular function by reducing inflammation of the vestibular nerve 2

Symptomatic Management

• Vestibular suppressants and antiemetics for acute vertigo control:
  • Meclizine 25-100 mg daily in divided doses 3
  • Benzodiazepines such as diazepam 5 mg for acute peripheral vertigo 4
  • Prochlorperazine 25 mg oral or suppository for managing associated nausea 4
• Important caution: Limit vestibular suppressant use to the first several days only, as prolonged use impedes central vestibular compensation 2
• Monitor for drowsiness with meclizine and advise patients about operating machinery or driving 3

Recovery Phase Management

Vestibular Rehabilitation Therapy

• Begin as soon as acute severe vertigo subsides (typically after 2-3 days)
• Includes:
  • Visual fixation exercises while patient is still bed-ridden to accelerate recovery 5
  • Gradual progression to more challenging balance and gait exercises
  • Customized vestibular exercises based on specific deficits 6
• Vestibular rehabilitation promotes central compensation and improves long-term outcomes 4, 2

Activity Recommendations

• Early resumption of normal activity should be encouraged to promote central compensation 2
• Avoid prolonged bed rest as it delays recovery
• Gradually increase activity levels as tolerated

Follow-up and Monitoring

• Reassess patients within 1 month after treatment to:
  • Confirm symptom resolution
  • Evaluate for persistent symptoms that may indicate treatment failure
  • Rule out coexisting vestibular conditions or CNS disorders 4
• Consider vestibular function testing (caloric testing) at 3 months to assess recovery 1

Patient Education

• Explain the nature of vestibular neuritis and expected recovery timeline
• Discuss potential for disease recurrence and importance of follow-up 4
• Advise about safety concerns, especially regarding fall risk during recovery
• Provide information about vestibular rehabilitation exercises for home practice

Special Considerations

• Patients with significant vascular risk factors presenting with acute vestibular syndrome should be evaluated for possible stroke, as central causes can mimic vestibular neuritis 2
• Elderly patients are at higher risk of falls and may require more intensive monitoring and support during recovery 4
• Consider withholding steroids in patients at higher risk of steroid complications 2

This treatment approach aims to reduce inflammation of the vestibular nerve, manage acute symptoms, and promote central compensation, ultimately improving quality of life and reducing the risk of falls and other complications associated with persistent vestibular dysfunction.