Vestibular Neuritis : Causes, Symptoms, Treatment, Balance Rehabilitation Program, How Long Does It Last?

Vestibular neuritis is a medical condition where the vestibulocochlear nerve, which is the inner ear nerve, gets affected with inflammation and swelling. The function of the vestibulocochlear nerve is to send information regarding a person’s balance and position of the head from the inner ear to the brain. When this nerve gets affected, then the interpretation by the brain, of the information which is transmitted, gets disrupted. Vestibular neuritis can affect anyone; however, it is rarely seen in children.

Vestibular neuritis is closely related with labyrinthitis. In Vestibular Neuritis, a branch of the vestibulocochlear nerve, which is the vestibular part, gets inflamed which affects the patient’s balance. In Labyrinthitis, there is swelling or inflammation of both the branches of the vestibulocochlear nerve i.e., the vestibular as well as the cochlear part, and this affects the balance as well as hearing. In labyrinthitis, patient presents with the same symptoms that of vestibular neuritis with the additional symptom being tinnitus or ringing in the ears with hearing loss.

Treatment of Vestibular Neuritis comprises of managing the symptoms and treating the cause which is mostly viral.

The most common cause of Vestibular Neuritis is thought to be a viral infection of the inner ear, which can cause swelling around the vestibulocochlear nerve. Vestibular Neuritis can also occur from viral infection in other part of body, such as shingles, cold sores, chickenpox, flu, measles, mumps, polio and hepatitis. Genital herpes does not cause vestibular neuritis.

• Abrupt and severe vertigo comprising of swaying or spinning sensation.
• People suffering from vestibular neuritis experience the symptoms of dizziness and balance difficulties.
• Patient has difficulties with concentration.
• Nausea and vomiting also occur.
• Nystagmus is also a sign of vestibular neuritis.

A vestibular specialist can easily diagnose vestibular neuritis. A vestibular specialist includes an otologist or a neurotologist. Tests which are done to confirm the diagnosis of vestibular neuritis include: Vestibular or balance tests, hearing tests and a test to assess if a part of the vestibulocochlear nerve is damaged. There is one more specific test done known as the head thrust test. This test helps in determining the difficultly in maintaining focus on objects during rapid movements of the head. Nystagmus (uncontrollable rapid eye movement), is also another sign of vestibular neuritis.

If the patient continues to experience symptoms of vestibular Neuritis after a few weeks or if there is worsening of the symptoms, then other tests are done to determine what disease or illness is causing the symptoms. Some of the medical conditions, which can cause the symptoms of vestibular neuritis are head injury, stroke, brain tumor and migraines. These medical conditions can be ruled out by investigations, such as contrast MRI.

Treatment for Vestibular Neuritis comprises of treating the virus, if it’s the cause, and managing the symptoms. Patient should also enroll in a balance rehabilitation program. Symptoms of Vestibular Neuritis are managed by:

• Medications to reduce nausea, such as metoclopramide (Reglan) and ondansetron (Zofran).
• Hospital admission and IV fluids are given if the patient has severe nausea and vomiting due to Vestibular Neuritis.
• Vestibular suppressants are given for dizziness, such as meclizine, diazepam, compazine and lorazepam. These medications should not be used longer than three days and long-term use is not recommended as it can make the recovery difficult.
• In some cases, steroids can also be used for treating Vestibular Neuritis.
• For treatment of a virus/viral infections, such as if herpes virus is the cause of vestibular neuritis, then antiviral medications, such as acyclovir are used.

If the balance and dizziness problems persist for more than a few weeks, then patient should participate in a vestibular physical therapy program. The aim of this program is retraining the brain so that it can adapt to the balance changes which the patient experiences.

In this program, the vestibular physical therapist assesses the parts of the body which affect balance and these include:

• Examination of Legs to see how well they are able to sense balance when standing or walking.
• Examination of Eyes to assess how well they interpret what they see (surroundings) in relation to the body’s position.
• Examination of Ears to check how well the inner ear is functioning for maintaining the balance.
• The Complete Body as a whole to assess the quality of interpretation of the body in relation to the center of gravity, such as if the body sways or has an unsteady posture.

Depending upon the results of the evaluation, the vestibular physical therapist specifically designs an exercise program for the patient.

Some balance exercises for vestibular neuritis which can be done are:

Exercises which shift the body weight forwards, backwards and side-to-side when standing are:

• Turn the head from side to side while keeping your eyes focused on an object.
• Another exercise for Vestibular Neuritis is keeping your vision steady when making rapid side-to-center head turns.
• Focus your eyes on a faraway object with brief glances towards the floor and all the while continue to walk towards that object.

A successful balance rehabilitation program for Vestibular Neuritis can be achieved by repeating the set of personalized exercises around two to three times a day. In this manner, the brain can learn methods to adjust the movements which cause dizziness and imbalance. Majority of the exercises for Vestibular Neuritis can be done at home which will help in accelerating the recovery process of Vestibular Neuritis. Vestibular rehabilitation specialists will also provide instructions on how to do these exercises, which exercises can be done at home and what home safety measures can be undertaken to prevent or avoid falls.

The severe symptoms, such as dizziness and severe vertigo, often last for a couple of days; however, as long as they are present, they greatly affect the patient’s quality of life and make it very difficult for the patient to perform daily activities of living. After reduction of the severe symptoms many patients make a gradual, but complete recovery from Vestibular Neuritis in around 3 to 4 weeks; however, there are some patients who can continue to have balance and dizziness problems for some months.

In more than 90% of the patients, the vestibular neuritis does not recur and is a one-time occurrence and most of the patients completely recover.

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