Vestibular Neuritis

What Is Vestibular Neuritis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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Vestibular neuritis occurs when the nerve in the inner ear becomes inflamed, causing sudden, severe vertigo (a feeling of spinning or motion). It's usually caused by a viral infection, which then triggers swelling in the vestibulocochlear nerve — the same nerve that's responsible for relaying information about balance and head movement to the brain.

When the vestibulocochlear nerve becomes inflamed, the brain can't interpret these signals correctly, which then leads to symptoms such as vertigo, according to the Cleveland Clinic.

Signs and Symptoms of Vestibular Neuritis

The symptoms of vestibular neuritis often come on so suddenly that people are alarmed and see their doctor — or even go the emergency room — soon after. The symptoms can appear when you first wake up, or they can develop later in the day. They include:

  • Sudden, severe vertigo
  • Difficulty balancing or walking
  • Dizziness
  • Nausea and vomiting
The symptoms of vestibular neuritis are very similar to those of another, closely related disorder called labyrinthitis. People who develop labyrinthitis can also experience symptoms such as sudden, severe vertigo or nausea, but the difference is that they will experience tinnitus (a ringing or noise in the ear) or hearing loss. Vestibular neuritis does not trigger tinnitus or hearing loss, notes the Vestibular Disorders Association (VeDA).

Causes and Risk Factors of Vestibular Neuritis

Vestibular neuritis is thought to develop when a person catches a viral infection such as measles, mumps, or hepatitis. (The herpes virus, which causes cold sores or chickenpox and shingles, has also been associated with vestibular neuritis.)

In other instances, it may be caused by a virus that just affects the vestibulocochlear nerve or the fluid-filled tubes and sacs of the inner ear. Usually, people only develop vestibular neuritis in one ear.

How Is Vestibular Neuritis Diagnosed?

There's no specific test that can diagnose vestibular neuritis, but a specialist such as an otologist (a doctor who specializes in ear concerns) or neurotologist (a doctor who specializes in neurological-related inner ear concerns) can arrive at a diagnosis after ruling out other causes of dizziness such as stroke, head injuries, and other neurological disorders.

Doctors can also look for symptoms of horizontal nystagmus, or rapid eye movements, in the direction of the unaffected ear. (This is especially the case if a person isn't experiencing any other vision changes, weaknesses, or impaired sensations.)

Prognosis of Vestibular Neuritis

Luckily, the majority of people will fully recover from vestibular neuritis, and an estimated 95 percent of them will never develop it again.



But because the condition can be caused by a virus, it's possible for the infection to go dormant, then flare up again in the future. It's not possible to predict who will develop vestibular neuritis again.

Recurrence is infrequent, though, with studies showing it affects between 2 and 11 percent of patients, according to Stat Pearls.

Duration of Vestibular Neuritis

The most severe symptoms of vestibular neuritis — like intense vertigo and dizziness — only last a few days. But for many people, the recovery process is gradual, and it can take about three weeks for the symptoms to fully fade away.

Some people also report having dizziness and balance problems that last for months.

Treatment and Medication Options for Vestibular Neuritis

If you've been diagnosed with vestibular neuritis, your doctor may be able to treat the underlying infection with antiviral drugs such as Zovirax (acyclovir), which can treat herpes simplex and herpes zoster viruses. Doctors can also treat the immediate symptoms of vestibular neuritis, such as nausea and dizziness, with over-the-counter or prescription medications. Oftentimes, inner ear infections don't cause any permanent damage if they're treated in time.

Medication Options

There are several medications available that can treat the acute symptoms of nausea and dizziness, including:

Dehydration, from vomiting, can be treated with intravenous fluids.

Vestibular Physical Therapy

If you've been experiencing symptoms like dizziness for longer than a few weeks, your doctor may recommend that you start a balance rehabilitation program. These exercises can help your brain adjust to any lingering changes in balance.

Some examples of exercises may include:

  • Shifting your body weight from side to side or front to back while standing
  • Focusing your eyes on an object while turning your head from side to side
  • Focusing your eyes on a distant target while walking toward it and taking occasional glances at the floor
Vestibular physical therapy exercises can usually be done at home, ideally two or three times a day.

Prevention of Vestibular Neuritis

It's unclear whether vestibular neuritis can be prevented. Researchers believe that the disorder is caused by viruses, but viral infections of the inner ear can be trickier to study than bacterial infections. It can also be difficult to study the labyrinth — the fluid-filled tubes and sacs that make up the inner ear — because it's susceptible to being damaged.

Complications of Vestibular Neuritis

The onset of vestibular neuritis can bring about sudden, severe symptoms that often send people to the emergency room and make it extremely difficult for people to go about their day. The symptoms start to subside over the next few weeks, but some people can experience trouble with balance or dizziness, and have trouble walking, standing, or even turning their head.

Difficulty balancing can also be dangerous, as it could cause a fall.

Research and Statistics: How Many People Have Vestibular Neuritis?

Exact numbers are not available, but some research has estimated that vestibular neuritis occurs in 7 out of 200,000 people. It may also account for about 7 percent of all patients who seek help at outpatient clinics that specialize in vertigo treatment.

Related Conditions and Causes of Vestibular Neuritis

Labyrinthitis is another disorder that's caused by an infection, which can then trigger inflammation in the inner ear. Labyrinthitis can be caused by both viral and bacterial infections. Serous labyrinthitis can caused by bacteria that have infected the middle ear or the bone surrounding the inner ear, usually from a chronic, untreated middle ear infection (chronic otitis media). Another type of labyrinthitis, called suppurative labyrinthitis, is caused by bacteria that have infected the inner ear itself.

Labyrinthitis causes symptoms such as vertigo and dizziness, but can also trigger tinnitus (ringing in the ears) or hearing loss.

Resources We Love

VeDA (Vestibular Disorders Association)

VeDA is a nonprofit organization that seeks to educate the public about vestibular disorders and connect patients with doctors who can diagnose and treat the conditions.

Additional reporting by Ingrid Strauch.

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