What is the treatment for vestibular neuritis?

Treatment for Vestibular Neuritis

The optimal treatment for vestibular neuritis involves short-term use of vestibular suppressants like meclizine for symptom management in the acute phase, followed by prompt discontinuation to facilitate vestibular compensation, combined with vestibular rehabilitation therapy. 1, 2

Acute Phase Management

• Vestibular suppressants should be used only as needed for severe vertigo, nausea, and vomiting rather than on a scheduled basis to avoid impeding central vestibular compensation 1
• Meclizine is FDA-approved for treating vertigo associated with vestibular system diseases and can be used for symptomatic relief 2
• Low-dose glucocorticoid therapy is recommended in the acute phase to accelerate recovery of vestibular function 3, 4
• Antiemetics can be used alongside vestibular suppressants to manage nausea and vomiting 4

Post-Acute Phase Management

• Vestibular suppressants should be withdrawn as soon as possible (preferably after the first several days) to avoid delaying central vestibular compensation 1, 4
• The American Academy of Otolaryngology-Head and Neck Surgery strongly advises against routine treatment with long-term vestibular suppressant medications such as antihistamines or benzodiazepines 1
• Vestibular rehabilitation therapy should be initiated early to promote vestibular adaptation and substitution 3, 5
• Key exercises for vestibular rehabilitation include:
  • Head-eye movements with various body postures 5
  • Balance exercises with reduced support base while performing various tasks 5
  • Gradual exposure to movements that provoke vertigo to promote habituation 5

Important Considerations

• Vestibular suppressants can cause significant side effects including drowsiness, cognitive deficits, and increased fall risk, especially in elderly patients 1
• Patients should be reassessed within 1 month after initial treatment to document resolution or persistence of symptoms 1
• When evaluating a patient 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 4, 6
• Early resumption of normal activity should be encouraged to promote compensation 4

Patient Education

• Patients should be informed about the natural course of vestibular neuritis and expected recovery timeline 1
• Education should emphasize that while medications provide symptomatic relief, they do not address the underlying cause and may delay recovery if used long-term 1
• Patients should understand the importance of compliance with vestibular exercises, as even brief periods of exercise performed several times daily are sufficient to facilitate vestibular recovery 1, 5
• Follow-up is essential to monitor recovery and adjust treatment as needed 1