Merck Manual

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Vestibular Neuronitis


Mickie Hamiter

, MD, New York Presbyterian Columbia

Reviewed/Revised May 2023
Topic Resources

Vestibular neuronitis is a disorder characterized by a sudden severe attack of vertigo (a false sensation of moving or spinning) caused by inflammation of the vestibular nerve, the branch of the 8th cranial nerve that helps control balance.

The Ears

The vestibule is a part of the inner ear. It contains organs that control balance (see also Overview of the Inner Ear Overview of the Inner Ear The fluid-filled inner ear (labyrinth) is a complex structure consisting of two major parts: The organ of hearing (cochlea) The organ of balance (vestibular system) The cochlea and the vestibular... read more ). It is connected to the brain by the vestibular nerve. Vestibular neuronitis is probably caused by a virus.

Symptoms of Vestibular Neuronitis

Vestibular neuronitis may occur as a single, isolated attack of severe vertigo Dizziness and Vertigo Dizziness is an inexact term people often use to describe various related sensations, including Faintness (feeling about to pass out) Light-headedness Dysequilibrium (feeling off balance or... read more lasting 7 to 10 days, but many people have additional attacks of milder vertigo for several weeks thereafter. The first attack of vertigo is usually the most severe. Vertigo is a false sensation that people, their surroundings, or both are moving or spinning. Most people describe this unpleasant feeling as "dizziness," although people often also use the word "dizzy" for other sensations, such as being light-headed.

The attack of vertigo is accompanied by nausea, vomiting, and nystagmus (a rapid jerking movement of the eyes in one direction alternating with a slower drift back to the original position). The vertigo is severe at first, and gradually subsides over the course of several days, with residual imbalance lasting up to several months. People do not have tinnitus (ringing in the ears), and hearing is usually not affected.

Diagnosis of Vestibular Neuronitis

Treatment of Vestibular Neuronitis

  • Medications such as meclizine or lorazepam to relieve vertigo

  • Medications such as prochlorperazine to relieve vomiting

  • Sometimes corticosteroids such as prednisone

  • Intravenous fluids if vomiting persists

  • Physical therapy

In people with vestibular neuronitis, treatment of vertigo is done only to relieve the symptoms it causes and consists of medications such as meclizine or lorazepam. Nausea and vomiting may be relieved by pills or suppositories containing medications that relieve nausea (such as prochlorperazine). These medications should be used only for a short amount of time because prolonged use may lengthen the duration of symptoms, particularly in older people. Additionally, corticosteroids are used briefly. If vomiting continues for a long time, a person may need to be given fluids and electrolytes by vein (intravenously).

Although the vertigo often subsides relatively quickly (over several days), a feeling of dizziness may last for up to several weeks to months. During this time, doctors encourage people to stay active. A specialized form of physical therapy, called vestibular therapy, may be helpful.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Antivert, Bonine, Dramamine Less Drowsy, Dramamine-N, Medivert, Meni-D , Travel Sickness
Ativan, Loreev XR
Compazine, Compazine Rectal, Compazine Solution, Compazine Syrup, Compro
Deltasone, Predone, RAYOS, Sterapred, Sterapred DS
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