Vestibular neuronitis

In most patients, a diagnosis of vestibular neuritis can be made with an office visit to a vestibular specialist. These specialists include an otologist (ear doctor) or neurotologist (doctor who specializes in the nervous system related to the ear). Referral to an audiologist (hearing and vestibular [balance] clinician) may be made to perform tests to further evaluate hearing and vestibular damage. Tests to help determine if symptoms might be caused by vestibular neuritis include hearing tests, vestibular (balance) tests and a test to determine if a portion of the vestibulocochlear nerve has been damaged. Another specific test, called a head impulse test, examines how difficult it is to maintain focus on objects during rapid head movements. The presence of nystagmus, which is uncontrollable rapid eye movement, is a sign of vestibular neuritis.

If symptoms continue beyond a few weeks or become worse, other tests are performed to determine if other illnesses or diseases are causing the same symptoms. Some of these other possible health conditions include stroke, head injury, brain tumor, and migraine headache. To rule out some of the disorders of the brain, an MRI with dye (called a contrast agent) may be ordered.

Treatment consists of managing the symptoms of vestibular neuritis, treating a virus (if suspected), and participating in a balance rehabilitation program.

Managing symptoms. When vestibular neuritis first develops, the focus of treatment is to reduce symptoms. Drugs to reduce nausea include ondansetron (Zofran®) and metoclopramide (Reglan®). If nausea and vomiting are severe and not able to be controlled with drugs, patients may be admitted to the hospital and given IV fluids to treat dehydration.

To reduce dizziness, drugs such as meclizine (Antivert®), diazepam (valium), compazine and lorazepam (Ativan®) are prescribed. The different types of drugs used to reduce dizziness are group together and called by the general name, vestibular suppressants. Vestibular suppressants should be used no longer than three days. They are not recommended for long-term use and may make recovery more difficult.

Sometimes steroids are also used.

Treating a virus. If a herpes virus is thought to be the cause of the vestibular neuritis, antiviral medicine such as acyclovir is used. (Antibiotics are not used to treat vestibular neuritis because this disorder is not caused by bacteria.)