Merck Manual

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Vestibular Neuronitis

(Viral Labyrinthitis)


Mickie Hamiter

, MD, New York Presbyterian Columbia

Reviewed/Revised May 2023

Vestibular neuronitis causes a self-limited episode of vertigo, presumably due to inflammation of the vestibular division of the 8th cranial nerve; some vestibular dysfunction may persist.

Sometimes vestibular neuronitis is used synonymously with viral labyrinthitis. However vestibular neuronitis manifests only with vertigo, whereas in viral labyrinthitis, tinnitus, hearing loss, or both are also present.

Although etiology is unclear, a viral cause is suspected. Vestibular neuronitis is usually unilateral.

Symptoms and Signs of Vestibular Neuronitis

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

Treatment of Vestibular Neuronitis

  • Symptom relief with antiemetics, antihistamines, or benzodiazepines

Symptoms of vestibular neuronitis are symptomatically managed over the short term as in Meniere disease Treatment Meniere disease is an inner ear disorder that causes vertigo, nausea, fluctuating sensorineural hearing loss, and tinnitus. There is no reliable diagnostic test. Vertigo and nausea are treated... 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 medications delay vestibular compensation, particularly in older patients.

Vestibular rehabilitation (usually given by a physical therapist) helps compensate for any residual vestibular deficit.

Key Points

  • Patients have severe, constant vertigo with nausea and vomiting and nystagmus toward the unaffected side; it lasts days to weeks.

  • Vestibular neuronitis does not cause hearing loss or tinnitus.

  • Do tests to exclude other disorders.

  • Treatment is directed at symptoms and includes antiemetics and antihistamines or benzodiazepines; corticosteroids may also be helpful.

Drugs Mentioned In This Article

Drug Name Select Trade
Compazine, Compazine Rectal, Compazine Solution, Compazine Syrup, Compro
Anergan-50, Pentazine , Phenadoz , Phenergan, Phenergan Fortis, Prometh Plain, Promethegan
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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