Sometimes vestibular neuronitis is used synonymously with viral labyrinthitis. However vestibular neuronitis only presents with vertigo, while viral labyrinthitis is also accompanied by tinnitus, hearing loss, or both.
Although etiology is unclear, a viral cause is suspected. Vestibular neuronitis is usually unilateral.
Symptoms and Signs of Vestibular Neuronitis
Symptoms of vestibular neuronitis include a single attack of severe vertigo Dizziness and Vertigo Dizziness is an imprecise term patients often use to describe various related sensations, including Faintness (a feeling of impending syncope) Light-headedness Feeling of imbalance or unsteadiness... read more , with nausea and vomiting and persistent nystagmus Nystagmus Nystagmus is a rhythmic movement of the eyes that can have various causes. Vestibular disorders can result in nystagmus because the vestibular system and the oculomotor nuclei are interconnected... read more toward the affected side, which lasts 7 to 10 days. The nystagmus is unidirectional, horizontal, and spontaneous, with fast-beat oscillations in the direction of the unaffected ear. The absence of concomitant tinnitus or hearing loss is a hallmark of vestibular neuronitis and helps distinguish it from Meniere disease Meniere Disease Meniere disease is an inner ear disorder that causes vertigo, fluctuating sensorineural hearing loss, and tinnitus. There is no reliable diagnostic test. Vertigo and nausea are treated symptomatically... read more as well as labyrinthitis Purulent Labyrinthitis Purulent (suppurative) labyrinthitis is bacterial infection of the inner ear, often causing deafness and loss of vestibular function. Purulent labyrinthitis usually occurs when bacteria spread... read more .
The condition slowly subsides over days to weeks after the initial episode. Some patients have residual dysequilibrium, especially with rapid head movements, probably due to permanent vestibular injury.
Diagnosis of Vestibular Neuronitis
Audiology, electronystagmography, and MRI
Patients suspected of having vestibular neuronitis undergo an audiologic assessment Testing Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss ( 1). More than 10% of people in the US have some degree of hearing loss that compromises their... read more , electronystagmography Testing Earache, hearing loss, otorrhea, tinnitus, and vertigo are the principal symptoms of ear problems. In addition to the ears, nose, nasopharynx, and paranasal sinuses, the teeth, tongue, tonsils... read more with caloric testing, and gadolinium-enhanced MRI of the head, with attention to the internal auditory canals to exclude other diagnoses, such as cerebellopontine angle tumor Overview of Intracranial Tumors Intracranial tumors may involve the brain or other structures (eg, cranial nerves, meninges). The tumors usually develop during early or middle adulthood but may develop at any age; they are... read more , brain stem hemorrhage Intracerebral Hemorrhage Intracerebral hemorrhage is focal bleeding from a blood vessel in the brain parenchyma. The cause is usually hypertension. Typical symptoms include focal neurologic deficits, often with abrupt... read more , or infarction. MRI may show enhancement of the vestibular nerves, consistent with inflammatory neuritis.
Treatment of Vestibular Neuronitis
Symptom relief with antiemetics, antihistamines, or benzodiazepines
Symptoms of vestibular neuronitis are symptomatically addressed over the short term as in Meniere disease Treatment Meniere disease is an inner ear disorder that causes vertigo, fluctuating sensorineural hearing loss, and tinnitus. There is no reliable diagnostic test. Vertigo and nausea are treated symptomatically... read more , ie, with anticholinergics, antiemetics (eg, prochlorperazine or promethazine 25 mg rectally or 10 mg orally every 6 to 8 hours), antihistamines or benzodiazepines, and a corticosteroid burst with rapid taper. If vomiting is prolonged, IV fluids and electrolytes may be required. Long-term use (ie, for more than several weeks) of vestibular suppressants is highly discouraged because these drugs delay vestibular compensation, particularly in older patients. Vestibular rehabilitation (usually given by a physical therapist) helps compensate for any residual vestibular deficit.
Patients have severe, constant vertigo with nausea and vomiting and nystagmus towards the affected side lasting days to weeks.
There is no hearing loss or tinnitus.
Testing is done to exclude other disorders.
Treatment is directed at symptoms and includes antiemetics and antihistamines or benzodiazepines; corticosteroids may also be helpful.
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