What are the symptoms of vestibular neuritis (inflammation of the vestibular nerve)?

From the Guidelines

Vestibular neuritis is characterized by acute prolonged vertigo with prolonged nausea, vomiting, and severe rotational vertigo lasting 12 to 36 hours, without hearing loss, tinnitus, or aural fullness, as noted in the clinical practice guideline for Ménière's disease 1.

Key Symptoms

• Sudden, severe vertigo (spinning sensation) that develops over hours and can last for days
• Nausea and vomiting
• Difficulty walking and imbalance
• Symptoms worsen with head movements
• Nystagmus (involuntary eye movements) may be present

Differentiating Features

• Unlike other vestibular disorders, vestibular neuritis does not cause hearing loss or tinnitus
• Symptoms are most intense during the first 1-3 days and gradually improve over weeks

Treatment

• Vestibular suppressants like meclizine or diazepam for symptom relief during the acute phase
• Anti-nausea medications such as ondansetron
• Corticosteroids like prednisone may be prescribed if started within 3 days of symptom onset
• Vestibular rehabilitation exercises are crucial for recovery and should begin as soon as the acute vertigo improves, as suggested by the clinical practice guideline 1.

Pathophysiology

• Believed to result from viral inflammation of the vestibular nerve, disrupting balance signals from the inner ear to the brain, which explains the vertigo and imbalance symptoms, consistent with the description in the clinical practice guideline for Ménière's disease 1.

From the Research

Symptoms of Vestibular Neuritis

The symptoms of vestibular neuritis include:

• Spontaneous horizontal-torsional nystagmus beating away from the lesion side 2
• Abnormal head impulse test for the involved semicircular canals 2
• Ipsilesional caloric paresis 2
• Decreased responses of vestibular-evoked myogenic potentials during stimulation of the affected ear 2
• Unsteadiness with a falling tendency toward the lesion side 2
• Vertigo and nausea/vomiting 3, 2
• Dizziness and dizziness disability 4, 5

Diagnostic Hallmarks

The diagnostic hallmarks of vestibular neuritis are:

• Spontaneous nystagmus 2
• Abnormal head impulse test 2
• Caloric paresis 2
• Decreased responses of vestibular-evoked myogenic potentials 2

Treatment and Rehabilitation

Treatment and rehabilitation options for vestibular neuritis include:

• Symptomatic medication to relieve vertigo and nausea/vomiting 3, 2
• Corticosteroids to reduce inflammation and promote recovery 3, 2, 6, 4, 5
• Vestibular rehabilitation therapy (VRT) to improve balance and reduce dizziness 5
• Combination of corticosteroids and VRT for better recovery 5