Vestibular neuritis (also called vestibular neurononitis) is caused by viral infection of the vestibular nerve, which is the nerve that conveys balance information from the inner ear to the brain. The most common virus that causes vestibular neuritis is Herpes Simplex Virus type 1 (HSV-1), which is the same virus that causes cold sores. It is uncommon in children, and make up about 6% of adults going to the emergency department for vertigo [Tarnutzer, 2011].

Diagnosis

Typically, people with vestibular neuritis will experience symptoms of an upper-respiratory illness (cough, fever, runny nose, etc) a few days before, or at the onset of vertigo or severe imbalance. The vertigo usually lasts for about 2-3 days, before it subsides and is followed by a period of feeling off balance, and disoriented which can last for several weeks.

When someone presents with vertigo to the emergency department, a vertebrobasilar stroke is an important consideration, even though vestibular neuritis is the most likely cause. A bedside physical examination that evaluates the vestibulo-ocular reflex, nystagmus, and alignment of the eyes can help distinguish both conditions. If there is doubt, a brain MRI should be checked.

Differentiating vestibular neuritis from stroke is essential – if stroke is suspected, the patient will need to be admitted to the hospital for further monitoring and evaluation. If the diagnosis is vestibular neuritis, a patient can often be discharged with medications and a referral to vestibular therapy.

Treatment

  • Medications for vestibular neuritis include a corticosteroid taper, anti-emetics for nausea, and a short course of vestibular suppressants (benzodiazepines or meclizine).
  • There is no current evidence to support the use of anti-viral medications.
  • It is important to only use a short course of vestibular suppressants – prolonged usage will impair central compensation, the process by which the brain learns to adapt to the damaged vestibular nerve.
  • Vestibular therapy is very important to enhance central compensation.

The term labyrinthitis is used when a patient experiences hearing involvement with vertigo.


References

Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 2011 Jun 14;183(9):E571-92