This topic provides information about vestibular neuritis.
What is vestibular neuritis?
Vestibular neuritis is an infection of the vestibular branch of the vestibulocochlear nerve (the eighth cranial nerve) which connects the balance organ within the inner ear to the brainstem. The infection causes an inflammation of the nerve, resulting in a miscommunication between the vestibular system of the inner ear (balance system) and the brain. This is not the same as the common childhood middle ear infection.
What causes vestibular neuritis?
Vestibular neuritis is usually a viral infection, but can be bacterial.
Bacterial neuritis is rare. It can be caused by an infected middle ear spreading to the inner ear through the round or oval window and infecting the nerve. It is likely, however, that the infection will also invade the labyrinth before reaching the nerve, resulting in labyrinthitis.
Another rare bacterial neuritis can be the result of an infection from bacterial meningitis spreading to the vestibulocochlear nerve.
Although not much is known about viral vestibular neuritis, it is more common than bacterial. The viral infection of the nerve may be the result of a systemic (total body) viral illness such as the herpes virus, or a viral infection that is localized only to the inner ear. In most cases, the type of viral infection is impossible to identify because there is no way of sampling it from the nerve.
What are the symptoms?
Symptoms of vestibular neuritis include:
- Loss of balance
- Nausea and vomitting
Symptoms can range from mild to severe.
Symptoms usually come on suddenly and are the worst in the first few days. During the first few days, symptoms are usually constant. After a few days to a few weeks, symptoms may only occur following sudden movements. In the majority of cases reported, vestibular neuritis is a one-time occurrence.
Because vestibular neuritis is confined to the vestibular portion of the vestibulocochlear nerve, hearing is unaffected. This is different from labyrinthitis in which similar symptoms of dizziness exist, with the addition of tinnitus and/or hearing loss in the affected ear.
How is vestibular neurtitis diagnosed?
There are no specific tests used to diagnose vestibular neuritis. Tests will first be recommended to rule out other causes of dizziness, such as stroke, head injury, cardiovascular disease, allergies, neurological disorder, or Meniere’s disease.
When other conditions have been ruled out, specific tests such as an audiogram, a vestibulonystagmography (VNG) test, vestibular evoked myogenic potential (VEMP) test, and imaging tests may be recommended to determine whether a different vestibular condition is occurring, or to localize where in the vestibular system the problem is.
How is it treated?
During the first several days of symptoms, vestibular neuritis is often treated with medications to reduce the symptoms of nausea and vertigo.
Other medications may be prescribed to treat the infection and/or inflammation such as antiviral medications, antibiotics, or steroids. It is critical that medical treatment is given promptly after sympmtoms start to reduce the likelihood of damage to the nerve and chronic dizziness.
Does vestibular neuritis cause lasting problems?
In cases where the vestibular nerve was damaged as a result of the infection, chronic dizziness can occur. This can cause difficulty with daily activities or movements. In this case, more intensive treatment for the dizziness, called Vestibular Rehabliation Therapy(VRT), may be necessary to “retrain” the brain to compensate for the difference in signals coming from the ears. Improvement in dizziness can occur quickly for some, while others may need the therapy for years.