Vestibular Neuritis Therapy

Vestibular neuritis is a condition that results from inflammation of the vestibular nerve in the inner ear and leads to symptoms such as dizziness, imbalance, and nausea. The treatment process is designed to alleviate these symptoms and help the patient regain balance. In the initial phase, medication is administered to reduce dizziness and nausea. Corticosteroids and antiviral drugs may be used to control the inflammation. In addition, vestibular rehabilitation therapy (VRT) involves exercises that strengthen balance. VRT contributes to the recovery process by accelerating the brain’s compensation for the loss, and early intervention enhances the effectiveness of treatment, significantly improving the patient’s quality of life.

What is Vestibular Neuritis and How Does It Affect Balance?

Vestibular neuritis is a condition caused by an infection (inflammation) of the vestibular nerve in the inner ear. This condition prevents the proper transmission of signals required for balance and spatial perception to the brain. As a result, patients experience sudden dizziness (vertigo), imbalance, vomiting, and difficulty walking. Vestibular neuritis is not associated with hearing loss, which distinguishes it from labyrinthitis:

• Sudden dizziness
• Nausea
• Vomiting
• Imbalance while walking
• Nystagmus (uncontrolled eye movements)

Vestibular neuritis is generally associated with viral infections. In particular, the herpes virus is one of the common causes of this condition, and it has been observed to occur after upper respiratory tract infections. The brain gradually compensates for the loss of balance and initiates the recovery process.

This disease, due to its sudden and severe symptoms, can significantly affect patients’ daily lives. Although the recovery process varies from person to person, early diagnosis and treatment can help control the symptoms. The brain uses neural adaptation mechanisms to compensate for the damage, and this process can be supported by vestibular rehabilitation therapy.

What Are the Common Symptoms of Vestibular Neuritis?

Vestibular neuritis typically presents with sudden onset dizziness and imbalance, which can make it difficult for a person to carry out daily activities. The symptoms of the disease are characterized by severe and disturbing manifestations. The most common symptoms include:

• Severe dizziness
• Nausea and vomiting
• Loss of balance
• Difficulty walking
• Visual disturbances
• A feeling of fullness in the ear (rarely)

The disease usually occurs without symptoms such as hearing loss or tinnitus because only the balance-related nerve is affected. Visual disturbances may manifest as blurred images or difficulty focusing on a fixed point, depending on head movement.

Vestibular neuritis can also cause systemic symptoms such as general malaise, fatigue, and anxiety due to the continuous discomfort of the symptoms. If left untreated, the condition may last from a few days to several weeks, though it generally improves over time.

The discomfort caused by vestibular neuritis is alleviated as the brain’s balance center adapts to the condition. However, during this process, it is very important for the patient to receive professional support to prevent recurrent episodes of dizziness and to strengthen the balance system.

How Do Health Professionals Diagnose Vestibular Neuritis?

The diagnosis of vestibular neuritis begins with a detailed patient history and clinical examination. To confirm the diagnosis and rule out other possibilities, specialized tests and imaging techniques may also be used.

• v-HIT: Evaluates the response of the eyes during rapid head movements. It is a differential diagnostic test that is short and easily tolerated.
• VNG Test: Monitors vestibular functions by observing eye movements. A comprehensive battery of tests is used to rule out possible central conditions, which may extend the test duration up to 30 minutes.
• Caloric Test: Measures the function of the semicircular canals in the ear.
• VEMP: Assesses the condition of the otolithic organs and nerve pathways.
• Postural tests such as the Romberg and Unterberger tests analyze the patient’s balance and posture.
• Hearing Test (Audiometry): Essential for differentiating between vestibular neuritis and labyrinthitis, as hearing is a complex sense and any pre-existing hearing loss might not be noticed by the patient. Therefore, it must be thoroughly documented.

• MRI: Used to rule out central nervous system-related problems.

During the physical examination, it is confirmed that the patient’s complaints of dizziness and imbalance originate from the vestibular system. The absence of hearing loss is an important clue in differentiating vestibular neuritis from other conditions. The direction of the nystagmus and the eye responses during head movements are carefully evaluated.

Past viral infections, such as a history of upper respiratory tract infection, are also taken into consideration during the diagnostic process. Early and accurate diagnosis is critical for the prompt initiation of treatment and for preserving the patient’s quality of life.

How Does Vestibular Rehabilitation Therapy Help in Recovery from Vestibular Neuritis?

Vestibular rehabilitation therapy (VRT) is an effective treatment method used to support the weakened balance system caused by vestibular neuritis and to alleviate symptoms such as dizziness. This therapy, which aims to enhance the brain’s capacity to adapt, improves balance and visual stabilization functions through personalized exercises:

• Enhances the brain’s adaptation to the balance system
• Improves visual focus
• Helps habituate the patient to movements that trigger dizziness
• Strengthens postural balance

One of the key advantages of VRT is that it promotes the brain’s ability to reorganize weakened vestibular signals. In particular, visual stabilization exercises help develop the vestibulo-ocular reflex, making it easier to see clearly during head movements. This process enables patients to carry out daily activities more safely.

The principle of habituation involves repeatedly exposing the patient to situations that trigger dizziness. Through this method, the brain gradually learns to respond appropriately to such stimuli and to control the condition, thereby reducing the severity of the symptoms.

Additionally, balance exercises significantly contribute to improving postural control, especially in patients who are at a high risk of falling.

The success of VRT is supported by clinical research, and the therapy is administered according to a personalized plan. The level of exercises is regularly adjusted by the therapist based on the patient’s condition, needs, and rate of progress, ensuring that the treatment proceeds both safely and effectively.

Which Medications Are Commonly Used in the Treatment of Vestibular Neuritis?

Medications used in the treatment of vestibular neuritis focus on alleviating symptoms and controlling the underlying causes. Drugs targeting dizziness, nausea, and inflammation are preferred to ease the patient’s daily life.

Vestibular Suppressants:

• Meclizine
• Dimenhydrinate

Antiemetics:

• Ondansetron
• Promethazine
• Metoclopramide

Corticosteroids:

• Prednisone

Antiviral Drugs:

• Acyclovir

In using these medications, the patient’s clinical condition and the severity of symptoms are taken into account. Vestibular suppressants help alleviate dizziness and imbalance, while antiemetics reduce nausea. Although corticosteroids control inflammation, their contribution to long-term recovery has been observed to be limited. Antiviral drugs are used when the disease is of viral origin, although their efficacy has not been fully proven.

In addition to medication, vestibular rehabilitation therapy (VRT) is of great importance. This therapy includes exercises that help regain balance and cope with dizziness. Moreover, in some patients, dietary changes and lifestyle adjustments may also support the treatment. The effectiveness of the treatment process can be enhanced by the correct selection of medications and early intervention.

What Is the Typical Prognosis for Individuals Receiving Treatment for Vestibular Neuritis?

The prognosis for individuals undergoing treatment for vestibular neuritis is generally positive. Although most patients experience severe dizziness and imbalance during the acute phase, significant improvement is usually seen within a few weeks. However, in some cases, symptoms may persist for an extended period, and mild balance problems may become permanent:

• The recovery process may be longer in older individuals.
• The severity of the initial symptoms may prolong the recovery process.
• Early initiation of rehabilitation accelerates recovery.
• Chronic symptom development is possible, though rare.

Some patients may continue to experience mild dizziness or a sense of imbalance—especially in visually stimulating environments—even after the acute phase has passed. Vestibular rehabilitation therapy (VRT) is an effective method to strengthen balance and reduce dizziness; however, its success depends on the timely initiation of treatment. Rehabilitation exercises accelerate the adaptation between the brain and the balance system, thereby increasing the chance of complete recovery.

In the long term, patients with persistent symptoms may develop certain adaptations to continue their daily activities. Factors such as advanced age or chronic illnesses may adversely affect the prognosis. Nevertheless, appropriate treatment and regular rehabilitation programs make a significant difference in the recovery process and help keep the symptoms under control.

Dr. Ody. Emel Uğur

Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. She worked for 15 years at Istanbul Training and Research Hospital, specializing in Pediatric Audiology, Otologic Diseases, and Vestibular System Disorders. In 2015, she joined the Acıbadem Healthcare Group. She currently works as a Dr. Audiologist at Acıbadem Altunizade Hospital and also serves as a faculty member and program director of the Audiometry Department at Acıbadem University Vocational School of Health Services.