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Vestibular Neuritis

An infection of the vestibular nerve in the inner ear

Vestibular neuritis refers to an infection that affects a nerve within the inner ear, leading to the inflammation of the vestibular nerve. This inflammation can lead to a disruption in an individual's sense of balance, causing a feeling of imbalance.

What is vestibular neuritis?

The vestibular system, found in the inner ear, is a sensory organ responsible for perceiving movement and maintaining balance in most mammals. Vestibular neuritis occurs when the vestibular system is damaged, resulting in clinical symptoms. However, what are the underlying causes of this condition?

Causes of vestibular neuritis

Peripheral vestibular syndrome typically arises from dysfunctions in the semicircular canals, vestibule, or vestibular nerve. It can occur after a head injury, as well as in conditions like Meniere's disease or benign paroxysmal positional vertigo (BPPV).

On the other hand, central vestibular syndrome results from dysfunctions within the central nervous system (CNS) responsible for balance control. Several potential causes include damage to the brainstem or cerebellum due to multiple sclerosis, the presence of a brain tumour, Arnold-Chiari malformation, or Wallenberg syndrome.

Symptoms of vestibular neuritis

The symptoms associated to this condition include:

  • Sudden and severe dizziness, often accompanied by a spinning or rocking sensation.
  • Dizziness, generally persisting throughout the episode.
  • Difficulty with balance, making it challenging to maintain stability.
  • Nausea, a common symptom experienced during episodes.
  • Difficulty concentrating, which can be attributed to the disruptive effects on balance.

Vestibular neuritis and labyrinthitis are closely related diseases. Vestibular neuritis involves the inflammation of a branch of the vestibulocochlear nerve responsible for balance. Labyrinthitis, on the other hand, involves inflammation of both branches of the vestibulocochlear nerve, affecting both balance and hearing. The symptoms of labyrinthitis are similar to those of vestibular neuritis, with the addition of tinnitus (ringing in the ears) and/or hearing loss.

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Vestibular neuritis and recovery times

Generally, the most severe symptoms, such as vertigo and severe light-headedness, tend to subside within a couple of days. However, these symptoms can significantly impede the performance of everyday tasks. After the severe symptoms subside, most patients undergo a gradual and complete recovery, which typically takes several weeks, generally around three weeks. When recovering from vestibular neuritis, it is important to note that a subset of patients may continue to experience balance issues and dizziness, which can persist for several months.

Vestibular neuritis diagnosis

Vestibular neuritis is diagnosed by a specialist, like an otologist or neurotologist, during an office visit. An audiologist may also be involved in conducting tests to assess hearing and vestibular damage.

To help confirm the diagnosis, specialists will run tests, including hearing tests, balance tests and assessments for vestibulocochlear nerve damage. The presence of nystagmus, characterized by rapid and uncontrollable eye movement, serves as an indication of vestibular neuritis. 

If symptoms persist or worsen, further tests may be conducted to explore other potential causes like stroke, head injury, brain tumour, or migraine. An MRI with contrast may be ordered to rule out certain brain disorders.

Vestibular neuritis treatment

The treatment for vestibular syndrome is divided into three main phases:

  1. Alleviating dizziness by prescribing antivertigo medications, sedatives, and/or antiemetics.
  2. Undergoing vestibular rehabilitation conducted by a vestibular physiotherapist.
  3. In more severe cases, surgical intervention may be considered, involving the severing of the vestibular nerve or removal of the vestibular receptors.

What is vestibular rehabilitation?

If symptoms persist for more than a few weeks, it is best to undergo a vestibular rehabilitation program. The primary objective of this program is to retrain the brain to adapt to the changes in balance experienced by the patient. The program start with a thorough evaluation conducted by a vestibular physical therapist, focusing on various areas that influence balance, including:

  • Legs: Assessing the leg's ability to perceive balance sensations while standing or walking.
  • Eyes: Evaluating how effectively the sense of sight interprets the body's position in relation to its surroundings.
  • Ears: Gauging the inner ear's functionality in maintaining balance.
  • Body as a whole: Analysing how well the body comprehends its centre of gravity, such as detecting swaying or unstable posture.

Based on the assessment outcomes, a customized exercise regimen is devised specifically for the patient.

Vestibular rehabilitation exercises

Here are a few examples of balance exercises:

  • Weight Shifting: Shift your body weight from side to side and back and forth while maintaining a standing position.
  • Head-Turn Exercise: Focus your eyes on a stationary object while slowly turning your head from side to side.
  • Quick Head Turns: Maintain steady vision while rapidly turning your head from the side to the centre.
  • Distant Object Focus: Choose a distant object and fix your gaze on it, periodically glancing at the floor, and continue walking towards the object.

Remember, these vestibular rehabilitation exercises can be beneficial for improving balance and should be performed under the guidance of a vestibular physical therapist or healthcare professional.

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