Vestibular Neuritis

What is Vestibular Neuritis?

Vestibular Neuritis is also referred to as otitis interna and vestibular neuronitis; where the person can have feelings of sudden vertigo, possible hearing loss or a ringing sensation in the ears.  It is a disorder that affects the vestibulocochlear nerve of the inner ear. This nerve plays a very important function in sending information pertaining to balance and head position from the inner ear, where impulses are interpreted in the brain once it reach there. It can become a concern when the nerve becomes inflamed for the reason that, it cannot be accurate anymore in interpreting messages reaching an affected person’s brain.

vestibular neuritis picture



 

Vestibular neuritis and labyrinthitis are disorders closely related with each other in terms of how it originated and which part of the internal ear is specifically damaged, except that there is preservation of auditory functioning in vestibular neuritis. Vestibular neuritis involves swelling of only a branch of the vestibulocohlear nerve which is responsible for maintaining balance, while labyrinthitis affects both branches of the same nerve which is necessary for balance and hearing.  The two problems are having similar symptoms; only that in labyrinthitis, there might be hearing loss or tinnitus.

Vestibular Neuritis Symptoms

The main characteristic of Vestibular Neuritis is a sudden, severe attack of vertigo. The first attack may last for 7 to 10 days, usually accompanied with nausea, vomiting and nystagmus. Some may have additional mild vertigo attacks that may be noted for several weeks and this can only happen when the head is changed from one position to another. This syndrome is observed mostly among middle aged adults, though it can occur with children after having a common cold.

Common signs and symptoms

  • Sudden, severe vertigo that increases with head movement
  • Dizziness
  • Anxiety
  • General ill feeling
  • Nausea and vomiting
  • Problems in concentration
  • Rapid and undesired eye motion (Nystagmus)
  • Common side effect
  • Chronic anxiety often leads to heart palpitations, tremors, panic attacks, derealization and feelings of depression.

Vestibular Neuritis Causes

The specific causative mechanism of Vestibular Neuritis remains unknown until today. There are causes which are thought to be the possible reasons; however, there are some who manifest the condition and who does not have any of the signs listed earlier.

Common causes

Some research findings enumerated common causes of Vestibular Neuritis which are as follows:

  • Viral infection of the inner ear
  • Swelling around the vestibulocochlear nerve which is caused by a virus
  • Viral infections occurring in other parts of the body

Examples of infections leading to Vestibular Neuritis

  • Herpes Simplex type 1 virus
  • Measles
  • Polio
  • Mumps
  • Hepatitis
  • Common cold or Flu
  • Acute localized ischemia

Vestibular Neuritis Diagnosis

There is no specific test available to diagnose Vestibular Neuritis. Attending physicians utilize a method of elimination to be able to diagnose the health problem. Some signs of an inner ear viral infection are similar to those of medical problems; so that a careful examination is done to rule out other possible causes of dizziness which are related to a stroke, cardiovascular disease, head injury, allergies, neurological disorders, side effects of prescription and nonprescription drugs and anxiety.


Diagnostic procedures are done to evaluate the hearing acuity of the person and the presence of other symptoms. Those who have chief complaints of the manifestations mentioned earlier are best advised to visit an attending physician or specialists who can perform complete and thorough history taking before final evaluation is done to confirm the diagnosis. These specialists include an otologist, who specializes in ear problems; or a neurologist, who has specialty in checking for nervous system problems related to the ears.  The diagnostic tests performed are:

  • Hearing tests (Audiogram)
  • Vestibular balance tests
  • Vestibulocochlear damage tests, such as Vestibular evoked myogenic potentials
  • Head thrust test to determine for presence of nystagmus
  • Magnetic resonance imaging with dye, to rule out some disorders of the brain

Vestibular Neuritis Treatment

The main goal of treatment is directed at relieving the symptoms that it causes the patient.

Symptoms management

  • Medications to control nausea and vomiting such as, Ondansetron (Zofran) and Metoclopramide (Reglan)
  • Suppositories containing prochlorperazine for nausea and vomiting
  • An intravenous line for rehydration purposes in instances when vomiting is severe and making the patient weak
  • Parenteral medications are given as necessary
  • Drugs used for dizziness are Meclizine (Antevert), Diazepam (Valium), Compazine and Lorazepam (Ativan)
  • Some steroids are also used (Prednisone)
  • For a herpes simplex viral infection, an antiviral such as Acyclovir is used

Physical Therapy Rehabilitation programs

  • Head and eye movements
  • Postural changes
  • Walking exercises
  • Rehabilitation strategies used are gaze stability exercises, habituation exercises and functional retraining

Others

It is necessary to treat an anxiety disorder and/or depression since anxiety affects the balance of the person.

Vestibular Neuritis Prevention and Complications

Vestibular neuritis is usually experienced once. Most individuals with the disorder recover fully from the condition with clinical consultation and with proper management done. Recovery usually takes from one to six weeks; although for those who have the residual symptoms, it may last for many months and even years. Referral for rapid follow-up care is needed to visit again primary care physicians, a neurologist, an EENT (eye ear nose throat) specialist for consultation and evaluation of signs and symptoms and to check for the effects of management done to patients.

The basic prevention of Vestibular Neuritis to recur is to follow the entire recommended treatment regimen, regardless of the causative factors. These have to be religiously done so that the patient won’t suffer the symptom-related complications such as fluid-electrolyte imbalance and some physical weakness due to prolonged immobility.


References:

  • http://www.merckmanuals.com/home/ear-nose-and-throat-disorders/inner-ear-disorders/vestibular-neuronitis
  • http://my.clevelandclinic.org/services/head-neck/diseases-conditions/vestibular-neuritis
  • http://emedicine.medscape.com/article/794489-medication
  • Neal Cherian, MD. Cleveland Clinic Disease Management Program. Dizziness. Accessed 5/23/2013.
  • Timothy Hain, MD. American Hearing Research Foundation. Vestibular neuritis and labyrinthitis. Accessed 5/23/2013.
  • Charlotte Shupert, PhD. with contributions from Bridget Kulick, PT. Vestibular Disorders Association. Vestibular neuritis and labyrinthitis: Infections of the inner ear. Accessed 5/23/2013.

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