From the Guidelines
Vestibular neuritis is characterized by a continuous episode of severe vertigo lasting several days, and treatment should focus on managing acute symptoms and promoting central compensation through vestibular rehabilitation exercises. The condition typically presents with sudden, severe vertigo, nausea, vomiting, and imbalance without hearing loss or other neurological symptoms, as outlined in the clinical practice guideline for Ménière's disease 1. Key features of vestibular neuritis include:
- Sudden onset of severe vertigo
- Duration of vertigo lasting 12 to 36 hours with decreasing disequilibrium for the next 4 to 5 days
- Absence of hearing loss, tinnitus, or aural fullness
- Severe rotational vertigo and prolonged nausea and vomiting Treatment should begin with vestibular suppressants like meclizine 25mg every 6-8 hours or diazepam 2-5mg every 6-8 hours for the first 1-3 days only to manage acute symptoms, as these medications can help alleviate the severe vertigo and nausea associated with vestibular neuritis 1. Additionally, corticosteroids such as prednisone 60mg daily for 5 days followed by a 5-day taper may speed recovery by reducing inflammation of the vestibular nerve, as suggested by the guideline 1. Most importantly, vestibular rehabilitation exercises should be started as soon as the acute phase subsides, typically within 3-7 days, to promote central compensation and optimal outcomes. Patients should understand that while the acute severe vertigo typically resolves within days, residual dizziness and imbalance may persist for weeks to months, and that recovery depends on central nervous system compensation for the asymmetry created by the vestibular nerve inflammation 1.
From the Research
Vestibular Neuritis Continuous Presentation
- Vestibular neuritis is an acute peripheral vestibulopathy characterized by prolonged continuous vertigo, nausea and vomiting, and imbalance 2.
- The symptoms are thought to result from a reactivation of herpes simplex virus that affects the vestibular ganglion, vestibular nerve, labyrinth, or a combination of these 2.
- The condition can be treated with oral steroids, which may accelerate the recovery of vestibular function, although the influence on long-term outcome is less certain 2, 3, 4.
- Antiemetics and vestibular suppressants can be useful in the acute phase, but their prolonged use may impede the process of central vestibular compensation 2.
- Early resumption of normal activity and directed vestibular rehabilitation therapy can promote the recovery process 2, 3, 5.
Treatment Options
- Corticosteroids have been shown to have long-term beneficial effects for the recovery of vestibular function and allow for better vestibular compensation 3, 4.
- Symptomatic therapies, such as generalized supportive care and administration of vestibular suppressants and antiemetics, can be used to manage the condition 5.
- Specific drug therapies, including steroid therapy, antiviral therapy, and vasodilator therapy, have been reported to be effective in treating vestibular neuritis 5, 6.
- Vestibular rehabilitation therapies, including generalized vestibular and customized vestibular exercises, can be used to promote recovery 3, 5.
Diagnosis and Prognosis
- The diagnosis of vestibular neuritis is based on the characteristic clinical features of abrupt true-whirling vertigo lasting for more than 24 hours, and no presence of cochlear symptoms and other neurological symptoms and signs 5.
- Various diagnostic tests, such as the head impulse test, bithermal caloric test, and vestibular-evoked myogenic potential test, can be conducted to accurately diagnose vestibular neuritis 5.
- The prognosis for vestibular neuritis is generally good, with most patients recovering well from the condition, even without treatment 2.