Vestibular Neuritis

Explained in simple words

1Vestibular neuritis is a sudden inflammation of the balance nerve that carries signals from the inner ear to the brain.

2It usually follows a viral infection, such as a cold, cough, fever or throat infection, often one to two weeks earlier.

3The virus causes swelling of the nerve. The swollen nerve stops sending correct signals from that ear.

4The brain then receives a strong signal from the healthy ear and almost nothing from the affected one.

5This large mismatch is felt as sudden, severe and continuous spinning.

6The attack usually begins abruptly, often on waking in the morning, and is much more severe than most people have ever experienced.

7Unlike BPPV, the spinning does not stop after a minute. It continues for many hours, and often for one to three days.

8There is usually severe nausea and repeated vomiting, and the patient cannot stand or walk without support.

9Even small movements of the head make it worse, so the patient lies completely still, often with eyes closed.

10An important point is that hearing remains normal. There is no significant hearing loss and no ringing in the ear.

11That is what separates it from labyrinthitis, where hearing is also affected.

12There should also be no double vision, no slurred speech, no weakness of the face, arm or leg, and no severe headache.

13If any of those are present, it is an emergency, because it may be a stroke rather than an ear problem. Go to hospital at once.

14This is exactly why a proper examination is so important in the first attack. Bedside tests and the vHIT test can distinguish the two reliably.

15Diagnosis is made by examination of the eye movements, along with tests such as vHIT, caloric testing and VNG.

16Treatment in the first few days is aimed at controlling the spinning and vomiting so that the patient can rest and take fluids.

17A short course of steroid medicines may be advised early, to reduce the swelling of the nerve.

18Anti-giddiness tablets are useful in the first two or three days, but they should not be continued for long.

19This is very important — taking them for weeks actually delays recovery, because they stop the brain from learning to adjust.

20The real treatment is vestibular rehabilitation, which means specific balance exercises started as early as possible.

21The affected nerve may never fully recover, but the brain learns to work with the good ear. This process is called compensation.

22Because of compensation, most patients become completely normal again even if the nerve remains weak.

23Move about as soon as you can bear to, with support. Staying in bed longer than necessary slows down recovery.

24Full recovery usually takes a few weeks. Elderly patients and those who avoid movement take longer.

25If unsteadiness continues beyond a few weeks, structured exercises under guidance will almost always bring further improvement.