Vestibular disease
Vestibular neuritis
This information is intended as a general introduction to this topic. As everyone is affected differently by balance and dizziness problems, you should speak to your doctor for individual advice.
For reasons of better readability, the generic masculine is used and the simultaneous use of the language forms male, female and diverse (m/f/d) is dispensed with. Unless otherwise indicated, the personal designations used in this patient information refer to all genders.
What is vestibular neuritis?
Vestibular neuritis is a condition that causes a sudden, severe attack of vertigo, usually accompanied by nausea and vomiting. This attack can last for days. Vestibular neuritis does not come and go; it is a one-off, serious event. But for weeks or months after the attack, sufferers may have balance problems and be unsteady.
Vestibular neuritis is also known as neuropathia vestibularis, neuronitis vestibularis, acute unilateral vestibulopathy or acute vestibular syndrome. Vestibular neuritis is sometimes confused with another condition, labyrinthitis, but they are not the same disease.
Vestibular neuritis is most common in people between the ages of 30 and 50, but can occur at any age.
Summary
- A sudden, severe attack of vertigo, usually associated with nausea and vomiting.
- Hearing loss is not a symptom.
- Occurs when the balance nerve is disturbed. Signals that control balance cannot reach the brain.
- A single major event, it does not occur episodically (coming and going).
- Most common in 30 to 50-year-olds, but can occur at any age.
- In the acute phase (usually in the first 2 or 3 days), supportive treatment is given.
- Balance problems and gait instability can last for several weeks or months.
- Vestibular rehabilitation can help with recovery.
- More than one attack is rare, and most people make a full recovery.
What causes vestibular neuritis?
Vestibular neuritis occurs when a part of the vestibular system on one side suddenly fails.
The vestibular system includes the semicircular canals and the macular organs (otolith organs) in the inner ear. These structures detect head movements, for example when your head tilts, turns or changes speed. The information from these structures is transmitted to the brain via the vestibular nerve (also known as the 8th cranial nerve or vestibulocochlear nerve). Your brain uses these signals from the vestibular system in the inner ear together with signals from your eyes, bones, muscles and joints to keep you balanced while you are standing or moving.
In vestibular neuritis, the structures of the inner ear are in order. However, part of the vestibular nerve is impaired. This means that the signals from the vestibular system in the inner ear do not reach the brain. As a result, part of your vestibular system suddenly fails, causing you to experience severe dizziness and nausea.
Where do the faults come from?
Researchers are not sure what causes the vestibular nerve disorder. There are several theories:
- The nerve could be infected by a dormant (inactive) virus that is reactivated for some reason. Some viruses cause an infection and then hide in the body instead of leaving it. They go into a 'dormant' state in the nerve cells. They can be reactivated months or years later by chronic stress. Some examples are chickenpox, which can reactivate as shingles, and the herpes simplex virus.
- Inflammation caused by a viral infection can lead to tiny blood clots in the blood vessels around the vestibular nerve and damage it.
- An imbalance of the immune system can lead to the immune system attacking the vestibular nerve, similar to multiple sclerosis.
All these possibilities are still being investigated.
The first signs of neuritis vestibularis, known as the acute phase, usually include the following symptoms:
- a sudden, severe attack of vertigo (the feeling that you or your surroundings are spinning)
- Severe balance problems
- Nausea and vomiting
The acute phase usually lasts 2 or 3 days, but can also last a week or longer. It is often severe and restrictive in everyday life. People who are in the acute phase of neuritis vestibularis are often unable to stand up or walk and usually vomit uncontrollably.
After the acute phase, people with vestibular neuritis may still have balance problems and be unsteady. Movement exacerbates these symptoms. Some people are sensitive to visually stimulating environments (visually induced vertigo). Some people have a feeling of fullness in the ear or tinnitus. This is known as the chronic phase. It can last for weeks or months.
Hearing loss is not a symptom of neuritis vestibularis.
Diagnosis of vestibular neuritis
Vestibular neuritis is usually diagnosed in the acute phase by a neurologist in a hospital emergency room.
The doctor will ask you about your symptoms and medical history, e.g. any infections, headaches or migraines you have had in the past.
Your doctor will also carry out a thorough physical and neurological examination and observe the eye movements. In the acute phase, the eyes beat spontaneously (without a stimulus) in the direction of the healthy ear. This is also known as spontaneous nystagmus.
Once the acute phase is over, some of the following diagnostic tests can be performed:
- Hearing tests
- Otoscopic examination
- Imaging (CT or MRI scans)
- Vestibular functional examination
Vestibular neuritis causes symptoms of a stroke, so the doctor must carefully rule out such more dangerous conditions.
Treatment of vestibular neuritis
The acute phase of neuritis vestibularis usually subsides on its own. Treatment in this phase is aimed at alleviating the symptoms and making you as comfortable as possible.
Supportive treatment during the acute phase may include the following:
- Medication to reduce dizziness, either by mouth or via an intravenous (IV) line, such as dimenhydrinate or ondansetron
- IV fluids to replace fluid loss through vomiting
- Steroids to reduce inflammation of the vestibular nerve
The administration of antiviral drugs does not appear to have any effect.
Once the acute phase is over, further treatment aims to help you get back to normal. Between 40-60% of people affected by vestibular neuritis can regain some or all of their nerve function in the first 4 to 6 weeks.
The first recommendation after the acute phase has subsided is to move your head and body as naturally as possible. You can find 'starter exercises' on our website that you can start with on your own. Through these exercises, the brain learns to compensate for your vestibular system.
Compensation means that the brain gets used to not receiving any input from the damaged vestibular system of the inner ear. The brain learns to maintain balance with only the healthy side as a reliable source of information.
For many people, compensation occurs on its own over time. However, for people whose symptoms do not diminish and who continue to have difficulty performing their daily activities, vestibular rehabilitation can contribute to recovery by promoting compensation.
In some people, vestibular neuritis can lead to a complication known as persistent postural-perceptual dizziness (PPPD). One aim of treatment is to prevent the development of PPPD.
Therapy option
Vestibular rehabilitation
Vestibular rehabilitation is an exercise therapy. It is designed to help your brain relearn balance control and respond to signals from the vestibular and visual systems. A certified IVRT® Dizziness and Vestibular Therapist can help you create treatment goals and an appropriate exercise program.
Ideally, you should start vestibular rehabilitation as soon as the acute phase is over. The sooner you start, the sooner you will feel better. It is important to start slowly and then do more and more.
Remember that vestibular rehabilitation takes time and effort. Your therapist will show you the exercises you need to do, but you are the one who has to do them according to plan.
Medication for dizziness can impair recovery during this phase, so you should avoid taking it if possible.
Therapy option
Other treatments
In rare cases, vestibular rehabilitation does not help. If you are still suffering from severe symptoms after several months of therapy, it should be clarified whether you are suffering from another (possibly neurological) disease or persistent postural-perceptive dizziness (PPPD).
What happens next?
What you can expect in the future.
In some patients, the damaged vestibular nerve returns to its normal function within four to six weeks. In others, gait instability can last for several months.
It is very rare for someone to have more than one attack of neuritis vestibularis, and most people make a full recovery.
However, some studies suggest that around 25% of those affected by vestibular neuritis go on to develop persistent postural-perceptual dizziness (PPPD). The right treatment and rehabilitation are very important to ensure that you have no long-term restrictions in your everyday life.
In order to keep this patient information as short as possible, we have not included a detailed list of references. However, this can be requested at any time at info@ivrt.de.
