by Joon Nah
updated July 18, 2020
Vestibular neuritis (sometimes called Vestibular Neuronitis) it the second most common cause of vestibular dizziness. It is a condition of the inner ear where inflammation of the vestibular nerves produces dizziness, nausea and imbalance and can significantly limit movement and ability to perform normal daily activity.
Sign and Symptoms of Vestibular Neuritis
- Dizziness, vertigo, lightheaded-ness, imbalance, nausea/vomiting, fullness in the ear, visual motion sensitivity,
- Symptoms do NOT include hearing loss, or ringing (and other noises) in the ear. However sensations of ear fullness has been reported.
- Symptoms are usually most severe at onset and gradually decrease over days.
- Symptoms can vary significantly depending upon which parts of the vestibular nerve are affected and with individual differences with patients
Causes of Vestibular Neuritis
Vestibular neuritis was long thought to be primarily caused by an infection (viral more often than bacterial). However current research indicates additional and possibly more likely relationships with local blood clots (a thrombosis), and auto-immune deficiencies.
The primary process involves inflammation of Vestibular Nerve which is the nerve from the vestibular organ to the brain. This nerve communicates information about movement and position from the sensor (the vestibular apparatus) to the processor (your brain). The inflammation and resulting damage to the vestibular nerve interferes with these signals which trigger the sensations of dizziness and nausea.
Who Gets It?
- Usually between the ages of 30-60 with most between 40 and 50.
- Affects males and females at the same rate
- 30% have common colds just prior to their dizziness symptoms
How Vestibular Neuritis is Diagnosed
There is no single test which indicates you have vestibular neuritis, rather it is diagnosed by excluding other causes. In the acute phase (1st week), diagnoses are generally made with thorough history-taking and an objective exam. An experienced physician, vestibular physiotherapist, or E.N.T. will typically exclude other causes of dizziness and be able to confirm the problem as a peripheral vestibular one.
Chronic cases may continue with additional procedures such as caloric testing, VEMPs, ENG, vHIT (among others) to help further confirm the vestibular disorder.
MRIs and CT scans cannot rule out or rule in vestibular neuritis.
Treatment for Vestibular Neuritis
Vestibular Suppressant Medications
These are often prescribed with the most common in Canada being Serc (betahistine dihydrochloride) and Gravol (dimenhydrinate). These drugs do not actually “cure” the disease, rather can reduce symptoms related to it. However, while some patients report significant symptom changes with these medications others do not. It is recommended that these drugs only be used in the acute/severe phase of the attack (first week), as continued use can actually interfere with the body’s ability to compensate and can result in long term problems.
Steroid based medications such as methylprednisolone and glucocorticoids have been shown to help with reducing the length of the neuritis by increasing the speed of compensation. These steroids work to reduce inflammation of the vestibular nerve and decrease direct damage to the nerve itself.
Recent studies have shown excellent results related to physiotherapy treatment for vestibular neuritis (Vestibular Rehabilitation Therapy – VRT). Physiotherapy identifies specific deficits related to the loss of function from the affected vestibular apparatus then uses exercise based treatment to improve compensation gradually reducing the symptoms. Exercises typically involve components of gaze stabilization, balance, desensitizing head/body movements, and substitution exercises.
Prognosis and Outcomes
Patients experience the most severe symptoms in the first few days with significant improvement usually within 7-10 days. Average cases of vestibular neuritis last 9 weeks however can be often be 12 weeks or longer. There have been only a few noted cases where an original vestibular neuritis has re-occurred. If your dizziness attacks repeatedly occur, get better, then re-occur, it is likely that your diagnosis in not a neuritis.
Unfortunately many patient’s vestibular systems only partially compensate following a vestibular neuritis and can be left with residual symptoms of dizziness and imbalance for months to years. Earlier intervention can provide faster and more complete resolution. We encourage you to find high quality VRT clinics such as Cornerstone Physiotherapy in Toronto to assess and treat these disorders.
Joon Nah BScPT
Certified Vestibular Physiotherapist
Joon is the co-founder of the well-known Cornerstone Dizziness Clinics located in Burlington, North York and Toronto. He received his certificate in Vestibular Rehabilitation from the Emory School of Medicine and is both a clinician and educator in his specialized field.
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