Vestibular Neuritis
Also known as: Vestibular neuronitis, Balance nerve inflammation
Vestibular neuritis is inflammation of the vestibular nerve, which carries balance information from the inner ear to the brain. It causes a sudden, intense, constant spinning sensation (vertigo) that comes on over hours, peaks within the first day, and typically lasts for one to several days, accompanied by nausea, vomiting, and unsteadiness. Unlike labyrinthitis, hearing is not affected. It is usually attributed to a viral infection or reactivation of a dormant virus in the nerve, and often follows a cold or flu. Although the first days are frightening and disabling, vestibular neuritis is not dangerous and almost always improves as the brain compensates, especially with early movement and balance exercises.
At a Glance
- Common symptoms
- Sudden, severe, constant vertigo lasting a day or more, Nausea and vomiting, Unsteadiness and a tendency to veer to one side when walking
- Main treatments
- Short course (no more than a few days) of vertigo-suppressant and anti-nausea medication, Corticosteroids, if started early, which may speed nerve recovery in some people, Vestibular rehabilitation exercises to retrain balance, started as soon as the acute vomiting settles
- Category
- Eye & Ear · Fairly common; one of the leading causes of sudden prolonged vertigo seen in emergency and primary care
- See a doctor if
- Sudden severe vertigo lasting more than a few hours
Symptoms
Causes
- Viral inflammation of the vestibular nerve, often following an upper respiratory infection
- Reactivation of herpes simplex virus lying dormant in the nerve
- Reduced blood supply to the nerve in some cases
- Rarely, autoimmune inflammation
Risk Factors
- Recent viral illness such as a cold or flu
- Middle age, when it is most common
- History of cold sores or other herpes virus infections
- Stress and lack of sleep
Diagnosis
- Clinical history of sudden prolonged vertigo without hearing loss
- Examination of eye movements, including the head impulse test, to confirm a peripheral (inner ear) cause
- Hearing test to confirm hearing is normal and distinguish from labyrinthitis
- MRI if there are features suggesting stroke, such as inability to walk, severe headache, or other neurological signs
- Vestibular function testing in persistent cases
Treatment
- Short course (no more than a few days) of vertigo-suppressant and anti-nausea medication
- Corticosteroids, if started early, which may speed nerve recovery in some people
- Vestibular rehabilitation exercises to retrain balance, started as soon as the acute vomiting settles
- Intravenous fluids if vomiting causes dehydration
- Supportive: getting up and moving as early as tolerated, since bed rest delays compensation
- Supportive: sleeping with the head slightly raised and avoiding sudden head movements in the first days
- Supportive: good sleep and stress management, which support the brain's adaptation
Prevention
- Reduce viral infections through hand hygiene and vaccination
- Manage stress and prioritize sleep
- Avoid smoking, which impairs blood flow to the inner ear
- Start balance exercises promptly after an episode to reduce lasting dizziness
When to See a Doctor
- Sudden severe vertigo lasting more than a few hours
- Vertigo with headache, weakness, numbness, double vision, difficulty speaking, or inability to stand (call emergency services)
- Hearing loss or ear pain with the dizziness
- Persistent vomiting and inability to keep down fluids
- Dizziness that has not improved after several weeks
Frequently Asked Questions
Related Conditions
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