Treatment for Vestibular Neuritis
The optimal treatment for vestibular neuritis consists of short-term corticosteroid therapy in the acute phase, followed by vestibular rehabilitation therapy, while avoiding prolonged use of vestibular suppressant medications. 1, 2
Acute Phase Management
- Corticosteroids should be administered early (within 3 days of symptom onset) to accelerate recovery of vestibular function in otherwise healthy individuals 1
- Short-term use of vestibular suppressant medications (such as meclizine) and antiemetics is appropriate only for the first few days to manage severe vertigo, nausea, and vomiting 1, 3
- Vestibular suppressants should be withdrawn as soon as possible (preferably after the first several days) as prolonged use may impede central vestibular compensation 1, 4
- Meclizine (25-100 mg daily in divided doses) can be used as needed rather than scheduled to avoid interfering with vestibular compensation 5, 3
Post-Acute Phase Management
- Vestibular rehabilitation therapy (VRT) is the cornerstone of treatment after the acute phase and promotes recovery through vestibular adaptation and substitution 6, 7
- Early resumption of normal activity should be encouraged to promote central vestibular compensation 1, 6
- Key VRT exercises include:
- Head-eye movements with various body postures and activities 6
- Balance exercises with reduced support base and various head/trunk orientations 6
- Gradual exposure to movements that provoke vertigo to promote habituation 6
- Exercises should be performed several times daily, even brief periods are beneficial 6
Important Considerations
- Clinicians should not routinely treat vestibular disorders with long-term vestibular suppressant medications such as antihistamines or benzodiazepines 4
- Vestibular suppressants can cause significant side effects including drowsiness, cognitive deficits, and increased fall risk, especially in elderly patients 4, 5
- Patients should be reassessed within 1 month after initial treatment to document resolution or persistence of symptoms 4, 5
- When evaluating patients with acute vestibular syndrome, it's crucial to rule out central causes such as brainstem or cerebellar stroke, especially in patients with vascular risk factors 1, 8
Expected Outcomes
- Most patients recover well from vestibular neuritis, even without treatment, though recovery may be accelerated with appropriate interventions 1, 8
- Recovery occurs through a combination of peripheral restoration of labyrinthine function, sensory substitution, and central compensation 8
- Early corticosteroid treatment can improve recovery rate to approximately 62% within 12 months 8
- Vestibular rehabilitation combined with medical management shows significantly higher effectiveness rates (95.83%) compared to routine treatment alone (79.17%) 7
Patient Education
- Patients should be educated about the natural course of vestibular neuritis, expected recovery timeline, and importance of compliance with vestibular exercises 5
- Patients should understand that while medications may provide symptomatic relief, they do not address the underlying cause and may delay recovery if used long-term 4
- Education should emphasize the importance of follow-up to monitor recovery and adjust treatment as needed 4