Vestibular Neuritis
Complete guide to understanding and treating vestibular neuritis
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Vestibular neuritis is the third most common cause of peripheral vertigo, affecting approximately 6% of patients who present to emergency departments with dizziness. It’s a self-limiting condition that typically resolves within days to weeks with proper treatment.
Key Symptoms & Signs
Primary Symptoms
- •Sudden severe vertigo lasting days
- •Constant dizziness worsened by movement
- •Nausea and vomiting
- •Difficulty maintaining balance
- •Horizontal nystagmus
Associated Features
- •No hearing loss (unlike labyrinthitis)
- •Symptoms worsen with head movement
- •Tendency to fall toward affected side
- •Normal neurological exam
- •May follow viral illness
Clinical Presentation
Typical Features
Presents with sudden onset of continuous vertigo lasting several days.
- •Develops over several hours
- •Peaks within 24-48 hours
- •Continuous (not episodic)
- •No hearing symptoms
Distinguishing Signs
Key examination findings help differentiate from central causes.
- •Positive head impulse test
- •Unidirectional nystagmus
- •No skew deviation
- •Normal neurological exam
Treatment Phases
Acute Phase (First 3 Days)
Focuses on symptom management
- •Vestibular suppressant medications
- •Antiemetics for nausea
- •Short-term activity modification
- •Begin gentle head movements when tolerated
Early Recovery (Days 4-14)
Initiating rehabilitation
- •Start vestibular rehabilitation
- •Gaze stabilization exercises
- •Gradual increase in activity
- •Balance training introduction
Recovery Phase (2-8 weeks)
Progressive rehabilitation
- •Advanced balance exercises
- •Return to normal activities
- •Continuing vestibular exercises
- •Monitoring for complications
Recovery Timeline
Days 1-3
Acute phase with severe symptoms
- •Severe vertigo
- •Need for medication support
- •Limited activity
- •Begin gentle movements
Week 1-2
Initial improvement phase
- •Decreasing vertigo intensity
- •Starting exercises
- •Improved balance
- •Reduced medication needs
Weeks 2-8
Recovery phase
- •Progressive improvement
- •Increasing activity levels
- •Continuing exercises
- •Return to normal activities
2-6 months
Long-term recovery
- •Complete resolution in most cases
- •Possible residual symptoms
- •Monitoring for BPPV
- •Prevention strategies
Important Statistics
6%
of ER dizziness cases
85%
resolve within one year
15%
risk of developing BPPV
Prevention and Management
Early Treatment
Starting appropriate treatment promptly improves outcomes
Action: Seek medical care at first signs of severe vertigo
Exercise Compliance
Regular vestibular exercises aid recovery
Action: Follow prescribed exercise program consistently
Activity Modification
Gradual return to activities helps prevent complications
Action: Follow activity progression guidelines
Monitoring
Watch for signs of complications
Action: Regular follow-up with healthcare team
Care Team
Primary Care Physician
Areas of Expertise:
- •Initial evaluation
- •Diagnosis
- •Treatment coordination
When to see: First point of contact for symptoms
Vestibular Therapist
Areas of Expertise:
- •Specialized exercises
- •Balance training
- •Recovery monitoring
When to see: After initial diagnosis for rehabilitation
ENT Specialist
Areas of Expertise:
- •Detailed vestibular testing
- •Complex cases
- •Treatment resistant cases
When to see: For persistent or complex symptoms