What is the management of vestibular (vestibular) neuritis?

From the Guidelines

Vestibular neuritis should be managed with symptomatic treatment using vestibular suppressants and early vestibular rehabilitation, prioritizing patient education and counseling on the risk of falls and recurrence. The management of vestibular neuritis involves a multifaceted approach, focusing on alleviating acute symptoms and promoting long-term recovery. Initially, medications like diazepam (2-5mg every 6-8 hours), meclizine (25mg every 6-8 hours), or promethazine (25mg every 6 hours) can be used for 3-5 days to control acute vertigo and associated nausea 1.

Key Considerations

• Corticosteroids such as prednisone (60mg daily for 5 days followed by a 5-day taper) may be beneficial if started within the first 3 days, as they can reduce inflammation of the vestibular nerve and potentially improve recovery.
• Antivirals like acyclovir have not shown significant benefit and are not routinely recommended.
• Vestibular rehabilitation exercises should be initiated as soon as the acute symptoms begin to subside, typically within a week of onset, to promote central compensation and faster recovery.
• These exercises include gaze stabilization, habituation exercises, and balance training.

Patient Education and Counseling

• Patients should be counseled on the risk of falls associated with vestibular neuritis, particularly in the elderly and frail, who may be more susceptible to serious injury as a result of falling 1.
• Counseling should include assessment of home safety, activity restrictions, and the need for home supervision until vestibular neuritis is resolved.
• Patients should also be educated on the importance of follow-up after the diagnosis of vestibular neuritis and the potential for recurrence, with a reported rate of 5% to 13.5% at 6-month follow-up 1.

Outcome

• Most patients recover completely within 6-8 weeks, though some may have residual symptoms requiring longer rehabilitation.
• The condition is believed to result from viral inflammation of the vestibular nerve, which explains why anti-inflammatory treatments and rehabilitation focusing on neural adaptation are the cornerstones of management.

From the FDA Drug Label

Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. The management of vestibular neuritis may include the use of meclizine for the treatment of vertigo associated with the condition.

• The drug is specifically indicated for diseases affecting the vestibular system. The use of meclizine for vestibular neuritis is based on its approval for related conditions, but the label does not directly address vestibular neuritis management 2.

From the Research

Management of Vestibular Neuritis

The management of vestibular neuritis involves several approaches, including:

• Symptomatic treatment during the acute phase, with a variety of drugs available 3
• Use of corticosteroids, which may accelerate the recovery of vestibular function and allow for better vestibular compensation 3, 4, 5
• Vestibular rehabilitation therapy, which can promote the process of central vestibular compensation and improve functional outcomes 4, 5, 6
• Antiemetics and vestibular suppressants, which can be useful in the acute phase but should be withdrawn as soon as possible to avoid impeding the process of central vestibular compensation 4
• Early resumption of normal activity, which can promote compensation 4

Treatment Options

The treatment options for vestibular neuritis include:

• Corticosteroids, which may be effective in reducing the severity of the attack and promoting recovery 3, 4, 5
• Vestibular rehabilitation therapy, which can be effective in promoting functional recovery and improving quality of life 5, 6
• Combination of corticosteroids and vestibular rehabilitation therapy, which may be equally effective as either treatment alone 5
• Ondansetron, which may have a functional vestibuloprotective effect in the treatment of vestibular neuritis 7

Rehabilitation

Vestibular rehabilitation therapy can be an effective treatment for vestibular neuritis, and may include:

• Exercises of visual fixation while the patient is still bed-ridden, which can accelerate the recovery process 3
• Supervised exercise therapy, which can be individually tailored and supported by home exercises 6
• Group format rehabilitation, which can be effective in promoting functional recovery and improving quality of life 6