OVERVIEW

What is vestibular neuritis?

Vestibular neuritis, also known as vestibular neuronitis, labyrinthitis, neurolabyrinthitis, or acute peripheral vestibulopathy, is a benign condition. As the name suggests, it is caused by inflammatory changes in the vestibular nerve, typically believed to result from viral infection leading to nerve swelling and dysfunction.

It often manifests as sudden-onset vertigo accompanied by nausea, vomiting, and unsteady walking. Without treatment, symptoms may gradually improve within 1–2 days for some individuals, with balance slowly recovering, indicating spontaneous resolution.

However, a small percentage may experience prolonged dizziness or imbalance lasting several months. During episodes, vestibular neuritis can also lead to accidental injuries, such as falls. In the acute phase, corticosteroids and antiviral medications, along with symptomatic treatments like anti-vertigo and antiemetic drugs, often alleviate symptoms.

Is vestibular neuritis common in daily life?

Vestibular neuritis is not particularly common in daily life. Statistics show it accounts for about 7% of cases in vertigo clinics.

SYMPTOMS

What are the common manifestations of vestibular neuritis?

• Sudden acute onset of vertigo (feeling like you're spinning, swaying, tilting, or that the space around you is moving), which worsens when turning your head, changing body position, coughing, sneezing, or opening your eyes. There is no tinnitus or hearing loss.

• Digestive discomfort such as nausea and vomiting may occur.

• Some may experience unsteady walking, though most can still walk. Certain individuals may have difficulty walking or even fall, but symptoms gradually improve over time.

What serious consequences can vestibular neuritis cause?

• Unsteady walking may lead to accidental falls and injuries.

• Severe nausea and vomiting can cause dehydration and electrolyte imbalances.

• Benign paroxysmal positional vertigo or panic disorder may develop.

Which department should you visit for vestibular neuritis?

Otolaryngology (ENT), Neurology, or Emergency Department.

CAUSES

What are the common causes of vestibular neuritis?

• The most common cause is viral infection of the vestibular nerve: Viruses such as measles, influenza, rubella, mumps, herpes zoster, and chickenpox can infect the vestibular nerve.

• Acute local ischemia of the vestibular nerve.

• Bacterial infection of the vestibular nerve, such as factors like head injury or inner ear infection, which allow bacteria to enter the inner ear and cause nerve infection. This is a less common cause.

Who is most commonly affected by vestibular neuritis?

It can occur at any age but is most common in people aged 40–50. It is rare in children.

Is vestibular neuritis contagious?

It is not an infectious disease and cannot be transmitted.

Is vestibular neuritis hereditary?

It is not hereditary.

DIAGNOSIS

How is vestibular neuritis diagnosed?

• Symptoms: Sudden onset of vertigo accompanied by nausea, vomiting, and unsteady gait, with normal hearing and no tinnitus.

• Physical examination findings: Consistent with acute vestibular imbalance (including spontaneous vestibular nystagmus, positive head impulse test, caloric testing, gait instability, and otolith-ocular reflex imbalance).

• No signs of ear inflammation or infection are found on examination, and there are no other neurological signs or symptoms, such as dysarthria (a motor speech disorder affecting articulation, voice quality, speech rate, or rhythm), dysphagia, muscle weakness, sensory loss, facial drooping, or limb dysmetria (impaired control of muscle contraction, resulting in movements that are either too large or too small).

• MRI and angiography rule out other intracranial lesions.

What tests are needed for vestibular neuritis? Why are these tests performed?

The diagnosis of vestibular neuritis is primarily based on clinical information, as there are no specific diagnostic tests. The purpose of these tests is to rule out acute vascular lesions in the central nervous system to prevent complications and death.

For younger individuals with acute persistent vertigo, no other neurological signs or symptoms, nystagmus, and findings consistent with vestibular neuritis, imaging may not be necessary if symptoms improve within 48 hours.

• Preferred diagnostic methods: MRI and magnetic resonance angiography to exclude acute vascular lesions in the central nervous system.

• If MRI is unavailable or contraindicated (e.g., due to metal implants), thin-slice CT scanning may be used.

How are the head impulse test and caloric test performed?

• Head impulse test: The examiner rapidly turns the patient's head toward the affected side. If the eyes cannot maintain fixation, the test is positive.

• Caloric test: The patient's head is tilted back 30°. Warm (44°C) or cool (30°C) water is irrigated into the ear. Normally, warm water induces nystagmus with the fast phase toward the irrigated ear, while cool water induces nystagmus with the fast phase away from the irrigated ear. Lack of response suggests vestibular dysfunction on that side.

What are the manifestations of an abnormal otolith-ocular reflex?

Otolith-ocular reflex imbalance: A red lens is placed over one eye, and a white light is shone at the patient. The patient observes the position of the red dot relative to the white light. If imbalance is present, vertical diplopia or skew deviation may occur when the light is moved.

What conditions should vestibular neuritis be differentiated from?

• Cerebellar hemorrhage or infarction: Typically occurs in older individuals with atherosclerotic risk factors (hypertension, diabetes, smoking). Signs include nystagmus not suppressed by fixation, inability to stand or walk without support, dysmetria, dysarthria, or headache. The head impulse test is usually normal. Symptoms may persist for 72 hours or longer. Imaging aids in differentiation.

• Brainstem infarction: Neurological signs may include ipsilateral Horner syndrome, ipsilateral facial and contralateral limb/trunk loss of pain/temperature sensation, abnormal eye movements, absent corneal reflex, hoarseness, dysphagia, or ipsilateral limb ataxia. More common in older individuals with small-vessel disease related to hypertension or diabetes. MRI is diagnostic.

• Herpes zoster oticus: Acute vertigo may be accompanied by hearing loss, facial paralysis, ear pain, and vesicular eruptions in the ear canal or auricle.

• Ménière’s disease: Episodic vertigo with tinnitus, hearing loss, and ear fullness, recurring over months or days.

TREATMENT

What are the treatment methods for vestibular neuritis?

• Treatment with corticosteroids and antiviral drugs: During the acute phase of vestibular neuritis, hormone therapy is generally chosen, such as prednisone or methylprednisolone, to improve vestibular function. When a viral infection is considered the cause of vestibular neuritis, antiviral medications may be administered.

• Symptomatic treatment: Symptomatic treatment is often used to alleviate dizziness, nausea, and vomiting. This includes antiemetics, antihistamines, anticholinergics, and benzodiazepines.

• Vestibular rehabilitation therapy (physical therapy): After acute symptoms subside, a vestibular rehabilitation plan should be initiated early. Vestibular training (such as gaze stabilization exercises, static and dynamic balance training, and functional activity training) can help patients with permanent vestibular damage recover faster and improve balance.

Can vestibular neuritis resolve on its own?

Yes, it can self-resolve.

Can vestibular neuritis be completely cured?

With timely and standardized treatment, vestibular neuritis can be completely cured.

Is follow-up necessary for vestibular neuritis? How should it be done?

Some residual balance dysfunction or dizziness from vestibular neuritis may persist for months, so regular follow-up is necessary. Patients who have not fully recovered may need check-ups every two weeks (e.g., through head impulse tests or caloric tests to assess balance function recovery). Follow-up should be scheduled according to the doctor's advice until full recovery.

Can vestibular neuritis recur after treatment? What should be done if it recurs?

In most cases, patients experience vestibular neuritis only once. A very small number of people may have a recurrence years later. If it recurs, seek medical attention promptly for symptomatic treatment.

DIET & LIFESTYLE

What should patients with vestibular neuritis pay attention to in daily life?

• During episodes of vertigo or dizziness, try to rest in bed to avoid falls and injuries due to impaired balance.

• Avoid smoking and alcohol.

• Avoid strong light, loud noises, and stressful environments, as these may worsen dizziness.

• Refrain from driving or working at heights while experiencing vertigo.

• After symptoms ease, gradually increase activity at home, and go for walks with someone accompanying you.

• Start vestibular rehabilitation exercises and moderate physical activity as soon as acute symptoms subside.

PREVENTION

Can vestibular neuritis be prevented? How to prevent it?

Currently, there is no effective method to prevent vestibular neuritis, but you can try to avoid factors such as catching a cold or staying up late, which may weaken immunity and increase the risk of viral infection or local ischemia of the vestibular nerve.