From the Guidelines
Vestibular neuritis is an inner ear disorder that requires prompt treatment to manage symptoms and improve quality of life, and the most effective treatment approach involves a combination of vestibular suppressants, antiemetics, corticosteroids, and vestibular rehabilitation exercises. The condition is characterized by sudden, severe vertigo, nausea, vomiting, and balance problems due to inflammation of the vestibular nerve. Treatment focuses on symptom management with vestibular suppressants like meclizine (25mg every 4-6 hours as needed) or diazepam (2-5mg every 6-8 hours) for 3-5 days to control vertigo and nausea, as recommended by 1. Antiemetics such as ondansetron (4-8mg every 8 hours) can help with vomiting. Corticosteroids like prednisone (60mg daily for 5 days, then tapered over 5 more days) may reduce inflammation and speed recovery if started within 3 days of symptom onset, as suggested by 1.
Key Considerations
- Patients with vestibular neuritis should avoid driving or hazardous activities during acute episodes and ensure adequate hydration when experiencing nausea and vomiting.
- Vestibular rehabilitation exercises are crucial for long-term recovery and should begin as soon as acute symptoms subside, typically within 1-2 weeks, as recommended by 1.
- These exercises help the brain compensate for the vestibular deficit, and most patients recover significantly within 6-8 weeks, though some may have residual symptoms for months.
- The condition is believed to result from viral inflammation of the vestibular nerve, often following an upper respiratory infection.
Treatment Approach
- A comprehensive treatment plan should include a combination of vestibular suppressants, antiemetics, corticosteroids, and vestibular rehabilitation exercises, as supported by 1 and 1.
- Clinicians should reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms, as recommended by 1.
- Patients with persistent symptoms should be evaluated for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders, as suggested by 1.
Patient Education
- Patients should be educated regarding the impact of vestibular neuritis on their safety, the potential for disease recurrence, and the importance of follow-up, as emphasized by 1 and 1.
- Patient education should include a discussion of factors that might predispose to vestibular neuritis, diagnosis and treatment options, and risk for recurrence, as recommended by 1.
From the FDA Drug Label
MECLIZINE HYDROCHLORIDE tablets, for oral use Initial U. S. Approval: 1957 INDICATIONS AND USAGE Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1).
The answer to vestibular neuritis is that meclizine may be used for the treatment of vertigo associated with diseases affecting the vestibular system, which includes vestibular neuritis.
- Key points:
- Meclizine is indicated for vertigo associated with vestibular system diseases.
- Vestibular neuritis is a disease affecting the vestibular system. 2
From the Research
Definition and Causes of Vestibular Neuritis
- Vestibular neuritis, also known as vestibular neuronitis, is the third most common peripheral vestibular disorder after benign paroxysmal positional vertigo and Ménière disease 3.
- The cause of vestibular neuritis remains unclear, but it is known to be caused by a viral infection of the vestibular nerve or ischemia of the anterior vestibular artery 3.
- Recent studies have also reported immune-mediated mechanisms as a possible cause of vestibular neuritis 3.
Clinical Features and Diagnosis
- The characteristic clinical features of vestibular neuritis are abrupt true-whirling vertigo lasting for more than 24 hours, with no presence of cochlear symptoms and other neurological symptoms and signs 3.
- Various diagnostic tests such as the head impulse test, bithermal caloric test, and vestibular-evoked myogenic potential test are conducted to accurately diagnose vestibular neuritis 3.
Treatment Options
- Various treatments for vestibular neuritis have been reported, which are largely divided into symptomatic therapy, specific drug therapy, and vestibular rehabilitation therapy 3.
- Symptomatic therapies include generalized supportive care and administration of vestibular suppressants and antiemetics 3.
- Specific drug therapies include steroid therapy, antiviral therapy, and vasodilator therapy 3.
- Vestibular rehabilitation therapies include generalized vestibular and customized vestibular exercises 3.
- A study found that early treatment with ondansetron associated with corticosteroids and antiviral treatment reduced vestibular deficit in acute-phase vestibular neuritis 4.
- Another study suggested that steroid treatment within 24 hours of onset of vestibular neuronitis results in better restitution of vestibular function than treatment between 25 and 72 hours 5.
Prognosis and Recovery
- The evaluation of the vestibulo-ocular reflex has long remained the main element for the evaluation of the state of health of vestibular neuritis, but it is not sufficient to assess the state of health 6.
- Posturography and symptomatic scales should also be used to assess the state of health, as the neuritis considered to be compensated with the VOR will not always be symptomatically compensated 6.
- A study found that patients with the most important physical activity feel better from a symptomatic point of view, over a long period after the episode, and that physical activity is probably more necessary than any type of rehabilitation 6.