For Healthcare Professionals:
The Vestibular neuritis is one of the most common causes of acute peripheral vestibular syndromes. In most cases, only the uperior branch of the vestibular nerve is affected (sUVP). However, a new study by Best et al. (2025) demonstrated that in about one-third of patients the inferior branch is also involved (s+iUVP)—with significant impact on severity and long-term prognosis.
Key findings:
- 36 % of 96 UVP patients showed combined lesions (s+iUVP).
- This group demonstrated:
- Greater deviation of subjective visual vertical (SVV)
- Increased ocular torsion (OT)
- Higher rate of pathological head impulse tests (HIT)
- Significantly reduced cVEMP amplitudes on the affected side
- In long-term follow-up (~4 years) , s+iUVP patients had higher scores for Angst und psychische Belastung (The Symptom Checklist-90 R and the Vertigo Symptom Scale).
Clinical implications:
Early identification of s+iUVP patients using SVV, HIT, and cVEMP is essential to:
- better predict prognosis
- initiate targeted vestibular rehabilitation einzuleiten
- recognize psychosomatic sequelae at an early stage
👉 Interested in deepening your knowledge of vestibular neuritis?
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For Patients – Easy to Understand
Vestibular neuritis – when the whole balance nerve is affected
Sudden vertigo, nausea, sweating, and unsteadiness when walking — this can be Vestibular neuritis , an inflammation of the balance nerve in the inner ear. Many people recover well — but not everyone.
Researchers have found: when the entire nerve is affected (not just one part), symptoms are usually stronger and recovery takes longer.
How can you recognize it?
- Stronger vertigo at the beginning
- More severe balance problems, especially in the dark or on uneven ground
- Longer-lasting unsteadiness while walking
- Higher risk of anxiety or a “foggy” feeling even weeks or months later
What helps?
- A thorough specialist examinationto determine how much of the nerve is affected
- Targeted vestibular rehabilitation with specially trained therapists
- If needed: psychological supportif anxiety or insecurity persists
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Conclusion:
Additional involvement of the inferior branch of the vestibular nerve in acute unilateral vestibulopathy leads to greater vestibular impairment and may trigger prolonged symptoms. Early identification of these patients could improve clinical outcomes, accelerate recovery, and prevent secondary psychosomatic complications.