Vestibular Neuritis

Vestibular neuritis which is caused by vestibular nerve dysfunction shows symptoms such as isolated and acute vertigo. Dix and Hallpike in 1952 explained vestibular neuronitis and differentiated it from Meniere’s disease[1]. The most likely etiology that is considered for vestibular neuritis is a viral cause[2]. Vestibular neuritis is seen in 3/2-9% of patients in dizziness centers. The usual onset age of the disease is 30 to 60 years old [3]. There is no significant difference between females and males in the incidence of the disease. Specific signs of vestibular neuritis include vertigo, nausea/vomiting, oscillopsia (motion of surroundings and blurred vision), gait abnormality, unsteadiness and postural imbalance[4]. These symptoms may appear suddenly or within several hours.

Diagnosis

In order to detect Vestibular neuritis, initially, neurological disorders, especially those resulting from the brain stem or cerebellum, as well as other hearing impairments, should be ruled out[4]. This would be done by an accurate history taking and appropriate diagnostic tests.

In the early stages of Vestibular neuritis, in addition to the mentioned symptoms, horizontal nystagmus with beating far from the lesion side is seen. Moreover, patients are deviating toward the lesion side especially when walking. Assessments such as the Fukuda stepping test, which are usually performed as a screening of vestibular disorders, are designed based on this fact. In vestibular neuritis, vestibular symptoms are seen in isolation, that is, there are not any symptoms such as hearing loss and tinnitus. It is not a dangerous disease, but it is important because in some central vestibular diseases, which need urgent intervention, similar symptoms are seen. Basic assessments which are routinely performed for diagnosis of vestibular neuritis include hearing evaluation for ruling out other diseases related to vertigo such as Meniere’s disease, videonystagmography and video head impulse test (vHIT). If the patient has other symptoms, the otolaryngologists will also propose further examinations.

Treatment

Vestibular neuritis treatments are focused on reducing symptoms of nausea, vomiting, nystagmus, and vertigo in the initial stage, the first one to three days after the onset of symptoms, which patient’s symptoms are more severe. In this stage, vestibular suppressants are used. Moreover, corticosteroids are also used to accelerate the improvement of peripheral vestibular function. In the next stages, based on the patient’s symptoms, vestibular rehabilitation would be recommended and performed by an audiologist. The aim of vestibular rehabilitation exercises is to accelerate central vestibular compensation[5]. The required time for vestibular rehabilitation in unilateral vestibular dysfunction is 1-3 months.

  1. Dix, M.R. and C.S. Hallpike, The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol, 1952. 61(4): p. 987-1016.
  2. Baloh, R.W., Clinical practice. Vestibular neuritis. N Engl J Med, 2003. 348(11): p. 1027-32.
  3. Depondt, M., [Vestibular neuronitis. Vestibular paralysis with special characteristics]. Acta Otorhinolaryngol Belg, 1973. 27(3): p. 323-59.
  4. Strupp, M. and T. Brandt, Vestibular neuritis. Semin Neurol, 2009. 29(5): p. 509-19.
  5. Walker, M.F., Treatment of vestibular neuritis. Curr Treat Options Neurol, 2009. 11(1): p. 41-5.