Vestibular Neuritis vs Labyrinthitis: One Simple Test Tells Them Apart
Both cause severe vertigo, but only one affects your hearing. Learn how to tell the difference, what to expect, and how to recover faster.
Quick Facts
- 76% complete recovery with early steroids vs 27% without
- One question tells them apart: Can you hear normally?
- 95% of labyrinthitis cases are viral (single episode)
- HSV-1 found in 56-62% of vestibular ganglia
Feeling awful right now?
Your brain is incredibly good at adapting. Most people recover well, even if it takes a few weeks.
What to do right now:
- 1Find a safe spot — sit or lie down where you won't fall
- 2Fix your eyes on something that isn't moving
- 3Take slow breaths — panic makes the spinning feel worse
- 4Sip water if you can keep it down
- 5It WILL get better — acute vertigo peaks at 24-72 hours
This usually peaks within The worst spinning usually lasts 1-3 days, then starts to fade, then steadily improves.
Quick Summary
- Your inner ear or balance nerve is inflamed, usually from a virus
- The spinning is real and miserable — but not dangerous on its own
- Most people recover well, especially with the right treatment and exercises
With steroids started early, 76% make a complete recovery vs only 27% without.
Ready when you are
When you're feeling a bit steadier, specific exercises can help your brain adapt and reduce your symptoms. We'll guide you through them step by step — no experience needed.
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The room is spinning. You can’t walk straight. You’re maybe throwing up into a bowl while googling “am I having a stroke.” Take a breath. We’re going to sort this out. Vestibular neuritis and labyrinthitis are closely related — they feel almost identical. But there’s ONE simple difference that matters, and it determines how urgently you need treatment.
The One Question That Tells You Which One You Have
Can you hear normally?
That’s it. That’s the whole test.
- Hearing is fine? → Vestibular neuritis
- Hearing loss or ringing in one ear? → Labyrinthitis
Both cause the same brutal vertigo. Both are usually caused by viruses. Both are treated similarly. But labyrinthitis hits your hearing organ too — and that changes the urgency.
What’s Actually Happening In There
Your inner ear has two jobs: balance and hearing. They share the same tiny, fluid-filled space deep in your skull.
Vestibular neuritis is when the balance nerve gets inflamed. Think of it like a phone line getting damaged — the ear itself is fine, but the signals aren’t getting through properly. Your brain receives scrambled balance information from one side, normal information from the other, and interprets the mismatch as spinning.
Labyrinthitis is when the inflammation spreads to the whole inner ear — including the hearing parts. Now both your balance AND hearing signals are messed up on one side.
Here’s why the balance nerve gets hit so often: it travels through a ridiculously tight bony tunnel. When it swells from a virus, it gets squeezed like a garden hose kinked in a narrow pipe. That pressure damages the nerve and scrambles everything.
Is This What I Have?
The Telltale Signs (Both Conditions)
Classic Presentation
- •Severe spinning that lasts hours to days — not seconds
- •The spinning is CONSTANT, not triggered by specific positions
- •Nausea, often with vomiting
- •Feeling pulled to one side when you try to walk
- •Started suddenly, possibly 1-2 weeks after a cold
The Key Difference
| Vestibular Neuritis | Labyrinthitis |
|---|---|
| Vertigo ✓ | Vertigo ✓ |
| Nausea ✓ | Nausea ✓ |
| Hearing: NORMAL | Hearing: AFFECTED |
| Tinnitus: NO | Tinnitus: Often |
What You WON’T Have (If It’s Really This)
- Brief spinning triggered by rolling over or looking up (that’s BPPV — different condition)
- Episodes that come and go every few weeks (consider Ménière’s or vestibular migraine)
- Numbness, weakness, or slurred speech (see “When to Get Help NOW”)
- Headache with neck stiffness and fever (could be meningitis)
When to Get Help NOW
These Symptoms Need Emergency Evaluation
- ⚠Worst headache of your life + vertigo — could indicate bleeding in the brain
- ⚠Numbness or weakness on one side — stroke warning sign
- ⚠Trouble speaking or swallowing — stroke warning sign
- ⚠Sudden hearing loss + vertigo + you're over 50 with high blood pressure, diabetes, or you smoke — a specific type of stroke (AICA) can look exactly like labyrinthitis
- ⚠Fever + stiff neck + severe headache — could be meningitis
Call 911 or go to ER if: You have vertigo PLUS any stroke warning signs, OR vertigo with the worst headache of your life.
See a doctor within 24-48 hours if: You have sudden hearing loss with your vertigo. This needs urgent attention — both to protect your hearing AND to rule out the rare stroke that mimics labyrinthitis.
The good news: doctors can usually tell the difference between stroke and inner ear problems with a simple bedside exam. It’s called HINTS, and studies show it’s actually more accurate than an early MRI.
How We Fix This
Steroids — The Game-Changer
- •Steroids calm the inflammation squeezing your balance nerve
- •Within 24 hours = best results
- •Within 72 hours = still very helpful
- •After that = benefits drop significantly
- •Usually prednisone pills, tapering over 2-3 weeks
Vestibular Rehabilitation — Training Your Brain
- •Your brain is remarkably good at adapting
- •Gaze stabilization exercises (keeping eyes fixed while moving head)
- •Balance challenges that progressively get harder
- •Start when severe vertigo allows (days 3-7)
- •Continue 6-12 weeks — don't stop when you feel better
For Labyrinthitis: Protecting Your Hearing
- •Same steroids, more urgency — hearing damage can become permanent
- •Get your hearing formally tested (audiogram)
- •If oral steroids don't help: steroid injections through the eardrum
- •Hard truth: only about 7.5% get complete hearing recovery
- •This is why early treatment matters so much
What Doesn’t Work (Save Your Money)
- Antiviral medications — This seems like it should work (it’s caused by a virus!), but the same clinical trial that proved steroids work also tested antivirals. Zero benefit. Don’t bother.
- Taking meclizine or dramamine for more than 2-3 days — These help survive the acute phase, but long-term use actually prevents your brain from adapting. Counterintuitive, but important.
- Strict bed rest — Staying still feels safer, but it slows recovery. Movement is medicine.
- Betahistine — Widely prescribed outside the US, but high-quality evidence that it helps is basically nonexistent.
What Recovery Actually Looks Like
Days 1-3: The Storm
Severe vertigo, can't function normally, lots of nausea. This is the peak. It will pass.
- •May be bed-bound
- •Vomiting common
- •Anti-dizziness meds are okay NOW
- •Stay hydrated if you can
Days 4-7: The Fog Lifts
Spinning eases but you still feel 'off.' Head movements trigger symptoms.
- •STOP anti-dizziness meds
- •Start gentle vestibular exercises
- •Move a little more each day
- •Extreme fatigue is normal
Weeks 1-4: Finding Your Feet
Steady improvement. Some days better than others.
- •Keep up vestibular exercises
- •Return to normal activities gradually
- •Don't push through if truly miserable
- •Recovery isn't linear — expect setbacks
Months 1-3: The New Normal
Most people feel mostly recovered. Brain has learned to compensate.
- •50-70% fully recover
- •May notice subtle issues in challenging situations
- •Continue exercises if symptoms persist
- •Watch for secondary BPPV developing
Important Statistics
Still Feeling Stuck? Here’s Why (And What to Do)
Common Reasons Recovery Stalls
Check these first
- •Still taking anti-dizziness meds (stop them!)
- •Avoiding movement — bed rest delays recovery
- •Anxiety has taken the wheel (affects 20-50%)
- •BPPV developed as complication (10-15%)
- •Not doing vestibular exercises consistently
The Fixes
Evidence-based solutions
- •Stop meclizine completely after day 3
- •Start or intensify vestibular rehab
- •Address anxiety — CBT works well
- •Get checked for secondary BPPV
- •See a specialist if 4-6 weeks with no progress
Surprising fact: Psychological factors predict recovery better than vestibular test results. Your test results only explain about 12% of how well you’ll do. Your mental state matters more.
Keeping This From Coming Back
The Recurrence Reality
True recurrence is uncommon: only 2-11% of people get this again. If you’re having repeated episodes of vertigo, it’s probably not vestibular neuritis/labyrinthitis returning — it’s likely something different that needs a different approach.
About 10-15% of people develop BPPV (benign positional vertigo) weeks to months after vestibular neuritis. That’s the “rolling over and the room spins for 30 seconds” type. Good news: it’s easily treated with a repositioning maneuver.
Who Can Help
Primary Care or Urgent Care
Areas of Expertise:
- •Getting steroids started within 72 hours
- •HINTS exam to rule out stroke
- •Initial evaluation
Vestibular Physical Therapist
Areas of Expertise:
- •Guided rehabilitation
- •Customized exercise programs
- •Troubleshooting slow recovery
Audiologist
Areas of Expertise:
- •Formal hearing testing
- •Tracking hearing changes
- •Hearing aids if needed
ENT or Neurotologist
Areas of Expertise:
- •Hearing not improving
- •Steroid injections consideration
- •Complex or uncertain cases
Vestibular Neuritis vs Labyrinthitis: The Summary
| Vestibular Neuritis | Labyrinthitis | |
|---|---|---|
| Hearing | Normal | Affected |
| Cause | Usually viral | Usually viral (sometimes bacterial) |
| Vertigo | Severe, 24-72 hrs peak | Same |
| Treatment | Steroids + vestibular rehab | Same, but more urgency for hearing |
| Complete recovery | 50-70% | ~11% (vestibular); 7.5% (hearing) |
| Long-term symptoms | 30-50% have some | 72.5% at 5 years |
The distinction matters most for urgency. If you have hearing loss, you need treatment faster — both to protect hearing and to rule out the rare stroke that can look identical.
The Bottom Line
Here’s what I want you to remember at 2am when the room won’t stop spinning:
This is almost certainly not dangerous. It’s a viral inflammation in your inner ear. It’s miserable and scary, but your brain is already working on adapting.
Getting steroids early matters. If you can see a doctor within 72 hours (ideally 24), ask about them. The difference in outcomes is significant — 76% complete recovery vs 27%.
Movement is medicine. After the first few days, start vestibular exercises even though they make you dizzy. Stop the anti-dizziness meds. Your brain needs the challenge to recalibrate.
Most people recover well. Even if tests show permanent inner ear damage, your brain compensates remarkably well. The majority of people return to normal life.
And if you have hearing loss with your vertigo? Get seen urgently. Your hearing is worth protecting, and there’s a small chance it’s something that needs immediate attention.
You’re going to get through this.
Common Questions
Questions we hear from people just like you
This is the first thing everyone worries about. Here's the good news: doctors can tell the difference with a simple bedside exam that's actually MORE accurate than an early MRI (96-100% accurate). If you can see a doctor and they do this test, you can trust the results. That said, if you have sudden hearing loss WITH vertigo AND risk factors like high blood pressure or diabetes — get checked urgently. That combo needs attention.