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.
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?
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.
The symptoms associated to this condition include:
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.
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 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.
The treatment for vestibular syndrome is divided into three main phases:
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:
Based on the assessment outcomes, a customized exercise regimen is devised specifically for the patient.
Here are a few examples of balance exercises:
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.