What is the treatment for Vestibular Neuritis?

Treatment for Vestibular Neuritis

The optimal treatment for vestibular neuritis includes a short course of oral corticosteroids in the acute phase, followed by vestibular rehabilitation therapy, while avoiding prolonged use of vestibular suppressant medications. 1

Acute Phase Management (First 1-3 Days)

Pharmacological Treatment

• Corticosteroids:

  • A short course of oral corticosteroids (prednisone or methylprednisolone) for 7-14 days with tapering dose is recommended 1
  • Corticosteroids accelerate recovery of vestibular function when started within the first 3 days 2
  • Early treatment with corticosteroids can improve recovery rate to 62% within 12 months 3

• Symptomatic Relief:

  • Vestibular suppressants: Use only short-term (first few days) to manage acute symptoms 1, 2

    • Meclizine 25-100 mg daily in divided doses 4
    • Caution: May cause drowsiness; avoid driving or operating machinery 4

  • Antiemetics: For nausea and vomiting

    • Prokinetic antiemetics (domperidone, metoclopramide) may be used without significantly interfering with vestibular compensation 1

Important Cautions

• Limit vestibular suppressant use: Prolonged use may impede central vestibular compensation 2
• Avoid complete bed rest: Early mobilization promotes compensation 2

Recovery Phase Management

Vestibular Rehabilitation Therapy (VRT)

• Initiate early: Begin as soon as acute severe vertigo subsides 5

• Key exercises include:

  1. Head-eye movements in various body positions 5
  2. Balance exercises with reduced support base 5
  3. Gradual exposure to movements that provoke vertigo 5
  4. Habituation exercises 1, 5

• Effectiveness: Vestibular rehabilitation combined with medical management shows significantly higher effectiveness (95.83%) compared to routine treatment alone (79.17%) 6

Monitoring and Follow-up

• Reassess within 1 month after initial treatment to confirm symptom resolution 1
• Educate patients about the natural course of recovery and potential for residual symptoms 1

Outcome Measures

Successful treatment should result in improvements in:

• Dizziness Handicap Inventory (DHI) scores 6
• Vestibular Symptom Index (VSI) 6
• Performance-oriented mobility assessment (POMA) 6
• Functional independence measure (FIM) 6

Recovery Mechanisms

Recovery from vestibular neuritis occurs through:

1. Peripheral restoration of labyrinthine function (improved by corticosteroids) 3
2. Sensory substitution (visual and somatosensory) 3
3. Central vestibular compensation (improved by vestibular exercises) 3

Differential Diagnosis Considerations

• Rule out central causes of vertigo (stroke, cerebellar hemorrhage) before confirming diagnosis 2
• Consider HINTS examination (Head-Impulse, Nystagmus, Test of Skew) to distinguish peripheral from central causes 1
• Other conditions to rule out: vestibular migraine, beginning Ménière's disease 3

Factors That May Impede Recovery

• Prolonged use of vestibular suppressants 2
• Visual and somatosensory deprivation 5
• Immobilization 5
• Advanced age 5
• Concurrent central lesions 5

While most patients recover well from vestibular neuritis even without treatment, the combination of early corticosteroid therapy and vestibular rehabilitation significantly improves outcomes and accelerates the recovery process.