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Vestibular Neuritis

Summary:


Vestibular neuritis/neuronitis is the infection of the vestibular nerve. It is the second most common condition affecting the inner ear that causes dizziness and imbalance.




Contents

What is Vestibular Neuritis?

The vestibular system is a system of postural balance and is located in the inner ear. Vestibular neuritis/neuronitis is the inflammation of the vestibular nerve, usually as a result of an infection. It is the second most common cause of dizziness and vertigo (sensation of movement of self or environment) related to the inner ear.


What are the common causes?

  • Viral infection, usually related to the upper respiratory tract or the gastrointestinal tract
  • Less commonly, bacteria infection of the inner ear

What are the signs and symptoms?

  • Dizziness/vertigo lasting minutes to hours
  • Nausea
  • Oscillopsia if both ears are affected (blurred vision with upon head movement and/or environment)
  • Imbalance while doing usual activities, especially during fast changes in posture (eg. lying to sit, turning in bed)
  • Sensitive to movement of surrounding (walking against the flow of crowd, sitting in a car with other vehicles passing by)

What are the risk factors?

  • Previous episodes of upper respiratory tract or gastrointestinal tract infection
  • While vestibular neuritis can occur at any age, it is common among men and women aged 30 to 60 years old. This is because:
    • The number of nerve cells in the vestibular system decreases at about 55 years old
    • Blood flow to the inner ear also decreases with age

What type of treatments are available?

Medication

  • Vestibular suppressants such as antihistamines and anticholinergic drugs (eg. meclizine, promethiazine, cinnarizine)
  • Antiemetic drugs to reduce vertigo and nausea (eg. prochlorperazine)

Physiotherapy (Vestibular Rehabilitation)

  • Exercises to improve head-eye coordination (vestibulo-ocular reflex)
  • Balance exercises to improve head-body coordination (vestibulospinal reflex) and reduce risk of falls
  • Gaze Stabilization Exercise for Vestibular Dysfunction to reduce the intensity of vertigo during movements that provoke symptoms

What is the prognosis?

  • Excellent with compensation
  • Symptoms usually abate after 48 to 72 hours and gradual return of balance occurs over approximately 6-weeks period
  • Benign Paroxysmal Positional Vertigo (BPPV) may occur as a squealer in 15% of those diagnosed with vestibular neuritis

What can I do to help myself?

Consult your general practitioner to ascertain if the cause of your giddiness is truly of vestibular origin. You may be referred to an Ear-Nose-Throat (ENT) specialist and a physiotherapist for vestibular rehabilitation.


If you have not seek medical attention

  • Avoid fast movements that provoke symptoms
  • Avoid operating machinery or driving if you feel dizzy

After seeking medical attention

  • Consume your medications as prescribed
  • Do the exercises prescribed by your physiotherapist

References

  • Herdman, S. J. (2007). Vestibular Rehabilitation. Philadelphia, US: EA Davis.
  • Strupp. M. & Brandt. T. (2009). Vestibular Neuritis. Seminars in Neurology. 29, 5.
  • Baloh. R. W., Honrubia. V. & Jacobson. K. (1987). Benign Positional Vertigo: Clinical and Oculographic Features in 240 cases. Neurology 37(3): 371-278
- Last updated 24 May 2017,12:42 pm




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