What Is Vestibular Neuritis? Symptoms, Causes, Diagnosis, and Treatment

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Vestibular neuritis is a condition in the inner ear caused by infection or swelling (inflammation) of a nerve. The vestibular nerve sends your brain messages about your balance and movement. Your brain uses this information from both ears to stay balanced while your body moves or changes position. Vestibular neuritis interferes with that signal, so your brain can’t match the signals correctly. You can feel dizzy, or a spinning feeling called vertigo when that happens. Vestibular neuritis can affect anyone, but it’s most common in middle-aged adults.

Symptoms

Vestibular neuritis symptoms can happen suddenly, making it hard to stand up or walk. You might feel like you aren’t balanced or spinning, especially when moving your head. These symptoms usually come about over a few hours. They can sometimes come after a viral infection, like an upper respiratory infection.

Symptoms of vestibular neuritis include:

  • Dizziness
  • Vertigo
  • Nausea and vomiting
  • Balance problems, unsteady feeling

Symptoms usually improve on their own after a few days, but you can feel dizzy and unsteady for several weeks. In most cases, the symptoms of vestibular neuritis will go away without medicine or treatment. However, if you have any of the following symptoms, it could be a sign of something more serious. If you have any of the following symptoms with your vertigo, you should make an appointment to see your doctor:

  • Headaches
  • Vision changes
  • Changes in sensation
  • Muscle weakness
  • Difficulty speaking
  • Uncoordinated or unable to walk

What Is Vertigo And How Does it Feel?

Have you ever spun or twirled your body around quickly, several times? If your answer is yes, you probably felt like you were still spinning or swaying and dizzy after you stopped moving. That feeling of the room spinning around you is called vertigo. 

Vertigo isn’t a diagnosis or disease – it’s a symptom, but your doctor can’t measure or test it. You could feel like your body is moving while standing or sitting still. Or, it could seem like the room or things around you are moving when they aren’t.

Vertigo is the most common vestibular neuritis symptom, but other conditions can also cause vertigo. Some of the most common causes of vertigo include Meniere’s disease.

What Causes Vestibular Neuritis?

Vestibular neuritis is caused by swelling and irritation of a nerve in the inner ear, often during or after an infection from a virus. The nerves in the inner ear are important to your feeling of balance and dizziness. When this area is irritated, your brain has a hard time controlling your body’s ability to stay in the correct position when you are sitting, standing, or walking.

Vestibular Neuritis Diagnosis

Vestibular neuritis diagnosis can be difficult because there are no specific tests available. Your doctor will take your medical history and physical exam to evaluate if you have vestibular neuritis.

Physical exam and tests to diagnose vestibular neuritis:

  • Turning your head to check your ability to keep your eyes focused on a target
  • Watching you walk to see if you lean to one side or sway while you walk

If your symptoms are concerning for something more serious than vestibular neuritis, other tests might be helpful, such as:

  • Electronystagmography: tests eye reflexes with air or water in the inner ear
  • Head Magnetic resonance imaging (MRI)
  • electroencephalogram (EEG): tests electrical brain activity

Vestibular Neuritis Treatment

Each person’s treatment for vestibular neuritis differs depending on symptoms and ability to do normal activities. There is no surgery for vestibular neuritis, but you can use medications and therapy to help symptoms. 

Medications

These medications are usually prescribed for only a few days to make you feel better while the inflammation of vestibular neuritis resolves. The type of medicines used to treat symptoms of vestibular neuritis include:

  • Antihistamines: used to reduce dizziness. They include diphenhydramine (Benadryl®) and meclizine (Antivert®)
  • Antiemetics:  used to control nausea and vomiting. They include promethazine and metoclopramide
  • Sedatives: used to help vertigo symptoms. They include diazepam and lorazepam

Medication Side Effects

There are some side effects of the medicines used to treat vestibular neuritis.

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Antihistamines and sedatives symptoms can cause:

  • sleepiness
  • dry mouth
  • blurry vision

You should not take these medications while driving, working with machinery, or operating dangerous equipment. Be careful walking and moving around to prevent falling while taking these medications.

Benzodiazepine sedative medications, like alprazolam, diazepam, or lorazepam, can cause withdrawal symptoms if you suddenly stop taking them. Vertigo symptoms can get worse and increase your risk of falling. Benzodiazepines can be habit-forming when they are taken for long periods of time. They should only be used exactly as directed by your doctor and pharmacist.

Vestibular Rehabilitation

Vestibular rehabilitation (VR) can help people with vestibular neuritis. This involves gentle exercises to train the brain to use other senses (seeing or touching) instead of the inner ear to adjust to balance changes. 

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Physical therapists can teach you how to do these exercises at home a few times a day. There are 3 types of VR therapies:

  • Balance training exercises teach you how to improve balance during everyday activities.
  • Habituation exercise therapy involves moving your head up, down, and to the side. It teaches your brain how to control the feeling of imbalance.
  • Gaze stabilization can help control eye movements in people with vision problems caused by vertigo and dizziness. 

Next Steps

Vestibular neuritis is not very common, but it can cause quite concerning symptoms. Other health problems can cause vertigo, dizziness, and blurry vision, too, so it’s important to speak with your doctor to get the right diagnosis.

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Living with health conditions that affect balance and dizziness is uncomfortable and possibly dangerous because of the risk of falling. If you or a family member have vertigo and dizziness, keep hallways and pathways clear of things that could make you trip and fall. Wear shoes that aren’t slippery and move rugs that might slide. 

Some organizations and websites have more information and tips for dealing with dizziness, vertigo, and other common problems that affect people with vestibular neuritis: