Relationship Between Upper Respiratory Infections and Vestibular Neuritis
Yes, people with colds or upper respiratory infections can develop vestibular neuritis, as viral infections are considered the most likely cause of this condition.
Pathophysiology and Causal Relationship
Vestibular neuritis is characterized by sudden, severe vertigo lasting several days, without associated hearing loss or other neurological symptoms 1. The condition is believed to be caused primarily by viral infections, particularly the reactivation of latent herpes simplex virus type 1 (HSV-1) 2.
The relationship between upper respiratory infections and vestibular neuritis is supported by several key findings:
- Histopathological studies have demonstrated degeneration of the superior vestibular nerve in affected patients 3
- There is often evidence of a recent or concurrent upper respiratory tract infection in patients diagnosed with vestibular neuritis 4
- The condition sometimes occurs in epidemics, suggesting an infectious etiology 4
- COVID-19 has also been reported to cause vestibular symptoms through similar mechanisms as other viral infections 5
Clinical Presentation
Vestibular neuritis typically presents with:
- Sudden onset of severe rotatory vertigo lasting several days
- Horizontal spontaneous nystagmus toward the unaffected ear
- Pathologic head-impulse test toward the affected ear
- Postural imbalance with falls toward the affected ear
- Nausea and vomiting
- Absence of hearing loss or tinnitus (key differentiating feature from other causes) 2
Diagnostic Approach
When evaluating a patient with suspected vestibular neuritis following a cold or URI:
- Focus on timing, triggers, and associated symptoms rather than quality of dizziness 6
- Perform a thorough vestibular examination including HINTS (Head Impulse, Nystagmus, Test of Skew) 6
- Look for characteristic signs:
- Unidirectional horizontal nystagmus
- Positive head impulse test
- Normal hearing 6
- Rule out central causes (stroke) with proper HINTS examination, which is more sensitive than early MRI (100% versus 46%) for detecting stroke 6
Differential Diagnosis
Important conditions to distinguish from vestibular neuritis include:
| Condition | Differentiating Features |
|---|---|
| Vestibular Neuritis | No hearing loss, unidirectional nystagmus, positive head impulse test |
| Labyrinthitis | Presents with both vertigo AND hearing loss [1] |
| Stroke/TIA | Abnormal HINTS exam, additional neurological deficits [6] |
| Vestibular Migraine | History of migraine, photophobia, variable duration [6] |
| Menière's Disease | Fluctuating hearing loss, tinnitus, aural fullness [1] |
Treatment Approach
For patients with vestibular neuritis following a cold or URI:
Early corticosteroid therapy is strongly recommended:
- Improves recovery rate to 62% within 12 months 2
- Promotes peripheral restoration of labyrinthine function
Symptomatic treatment with antivertiginous drugs for acute symptoms 3
Vestibular rehabilitation exercises to improve central compensation 2
Antiviral agents have not shown benefit in clinical studies 3, though one case report suggests potential benefit of prophylactic valacyclovir in recurrent cases 7
Prognosis and Follow-up
- Recovery typically occurs over days to weeks, but mild transitory episodes of dizziness may recur over 12-18 months 4
- Recovery depends on:
- Peripheral restoration of labyrinthine function (often incomplete)
- Somatosensory and visual substitution
- Central compensation 2
- Reassessment within 1 month after initial treatment is recommended to evaluate treatment response 6
Key Considerations
- Vestibular neuritis is the third most common cause of peripheral vestibular vertigo with an annual incidence of 3.5 per 100,000 population 2
- It accounts for 7% of patients at specialized vertigo clinics 2
- The condition is a diagnosis of exclusion - careful evaluation is needed to rule out central causes of vertigo 2
- Early recognition and treatment with corticosteroids improves outcomes 2