Vestibular Neuronitis

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	Symptoms
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What is vestibular neuronitis?

Vestibular neuronitis happens when the vestibular nerve in your inner ear becomes swollen and painful. This nerve carries balance signals from the inner ear to the brain. When the nerve is inflamed, it can make you feel that the room is spinning or that you have lost your balance. This is called vertigo.

Vestibular neuronitis usually happens in only one ear.

What causes vestibular neuronitis?

Vestibular neuronitis happens most often after a cold or the flu. So experts believe it may be caused by a virus. It may also be caused by conditions that affect blood flow and the brain and central nervous system. For example, experts have linked Lyme disease, which can affect the central nervous system, to some cases of vestibular neuronitis.

The infection inflames the nerve, causing it to send incorrect signals to the brain that the body is moving. But your other senses (such as vision) do not detect the same movement. The confusion in signals can make you feel that the room is spinning or that you have lost your balance (vertigo).

What are the symptoms?

The main symptom is vertigo, which appears suddenly. It often occurs with nausea and vomiting. The vertigo usually lasts for several days or weeks. In rare cases it can take months to go away entirely.

Vestibular neuronitis does not affect your hearing.¹

How is vestibular neuronitis diagnosed?

A doctor can usually diagnose this problem based on your symptoms of sudden vertigo, nausea, and vomiting with no hearing loss.

If the cause of your symptoms is not clear, your doctor may test your eye movements and hearing or may order an MRI scan of your head.

How is it treated?

The good news is that this problem usually goes away on its own. Until the sense of motion goes away, there are things you can do to feel better.

Many people find that it helps to stay in bed for the first 2 or 3 days and keep their head still. Your doctor also may suggest balance exercises to help control your symptoms.

Sometimes you can control severe symptoms with medicines, such as antihistamines (for example, Benadryl). One study suggests that corticosteroids, such as methylprednisolone, may help.²

Antibiotics do not work on conditions that are caused by a virus. Because doctors suspect that vestibular neuronitis is caused by a virus, they don't use antibiotics to treat it.

Frequently Asked Questions

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	Balance exercises for vertigo

The main symptom of vestibular neuronitis is vertigo, a feeling that you or your surroundings are moving when there is no actual movement. Vertigo caused by vestibular neuronitis:³

• Begins suddenly, usually without warning.
• Is severe enough that it often causes nausea and sometimes vomiting.
• Gradually gets better over a period of a few days to weeks.

After the first symptoms of vertigo go away, there may be a period lasting a month or more when any sudden head movement can trigger vertigo.

Vestibular neuronitis does not cause hearing loss. However, it is similar to a condition called labyrinthitis, which often—but not always—causes temporary or permanent hearing loss or a roaring sound in the ears (tinnitus). The difference between vestibular neuronitis and labyrinthitis is where the inflammation occurs. Vestibular neuronitis affects the vestibular nerve whereas labyrinthitis affects the inner ear canal. For more information, see the topic Labyrinthitis.

Vestibular neuronitis is usually diagnosed from your symptoms of sudden vertigo, nausea, and vomiting with no hearing loss.

It is common for people to use the terms vertigo, dizziness, and lightheadedness to mean the same thing. However, they are not the same, and it is important to be able to tell the doctor which one you are experiencing.

Your doctor will ask questions about your medical history and perform a physical exam to learn the cause of vertigo. The physical exam usually includes the Dix-Hallpike test, which will help your doctor find out whether your vertigo is triggered by certain head movements.

Additional tests may be done if the cause of vertigo is not clear. These tests may include:

• Electronystagmography, which involves attaching wires (electrodes) to the face to detect involuntary eye movements that occur when a person has vertigo.
• Imaging tests, such as an MRI.
• Hearing tests such as pure tone audiometry or auditory brain stem evoked tests.

Vestibular neuronitis usually gets better on its own within days or weeks. The goal of treatment is to keep you comfortable until the symptoms pass.

Drugs that may be used to control symptoms of vertigo include:

• Antihistamines (such as Dramamine, Antivert, or Benadryl).
• Scopolamine (such as Transderm-Scop).
• Sedatives (such as Valium or Klonopin).

These drugs should only be taken for 1 to 2 weeks to control severe symptoms of vertigo. They usually do not stop vertigo completely but they may help reduce nausea and vomiting. If the vertigo is severe, antiemetic drugs may be used to control nausea and vomiting.

In addition, recent research suggests that corticosteroids, such as methylprednisolone, may help you recover from vestibular neuronitis.²

For the first 2 to 3 days of vestibular neuronitis when vertigo symptoms are most intense, bed rest and keeping your head still may make the vertigo easier to cope with.

If the vertigo symptoms last more than a few days, you may want to try the Brandt-Daroff exercise for vertigo (moving your head and body slowly from side to side). Activity may help the brain ignore false signals of motion more quickly. It is especially important to move your head as you normally would and to avoid holding it completely still so that your body can adjust. Bed rest may help prevent attacks of vertigo, but it usually increases the time it takes for the body to adjust.

There are also balance exercises you can do at home to help control your vertigo. For more information, see:

Balance exercises for vertigo

Organization

• Dizziness: Lightheadedness and Vertigo
• Labyrinthitis

Citations

1. Ruckenstein MJ (2003). Vertigo. In RW Evans, ed., Saunders Manual of Neurologic Practice, chap. 4, pp. 339–342. Philadelphia: Saunders.

2. Strupp M, et al. (2004). Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. New England Journal of Medicine, 351(4): 354–361.

3. Johnson J, Lalwani AK (2003). Ménière's disease, vestibular neuronitis, paroxysmal positional vertigo, and cerebellopontine angle tumors. In JB Snow et al., eds., Ballenger's Otorhinolaryngology Head and Neck Surgery, 16th ed., chap. 20, pp. 408–419. Lewiston, NY: BC Decker.

Other Works Consulted

• Baloh RW (2003). Vestibular neuritis. New England Journal of Medicine, 348(11): 1027–1032.

• Solomon D, Frohman EM (2005). The dizzy patient. In DC Dale, DD Federman, eds., Scientific American Medicine, section 11, chap. 1. New York: WebMD.

Author:	Merrill Hayden Ralph Poore	Last Updated September 12, 2005
Medical Review:	Patrice Burgess, MD - Family Medicine Kathleen Romito, MD - Family Medicine Colin Chalk, MD, CM, FRCPC - Neurology
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