Have you ever experienced sudden dizziness, as if the world around you were spinning, or found it difficult to maintain your balance while walking? These symptoms may be related to a disorder affecting the body’s balance system. One of the most notable conditions associated with these symptoms is vestibular neuritis.Vestibular neuritis is one of the causes of acute vertigo. It affects the vestibular nerve, which is responsible for transmitting balance signals from the inner ear to the brain. This can lead to severe vertigo, loss of balance, nausea, and sometimes vomiting.Although the symptoms can be uncomfortable and concerning, most cases gradually improve with appropriate treatment and vestibular rehabilitation.In this Dalili Medical guide, we will explore the causes of vestibular neuritis, its main symptoms and signs, how it is diagnosed, the available treatment options, and important tips that can support recovery and help restore balance.

1. What is vestibular neuritis?

Vestibular neuritis is a disorder that affects the vestibular nerve, which is responsible for transmitting balance signals from the inner ear to the brain. It commonly causes severe vertigo, impaired balance, nausea, and, in some cases, vomiting.

2. Is vestibular neuritis contagious?

No. Vestibular neuritis is not contagious and cannot be transmitted from one person to another, even in cases that may be associated with a previous viral infection or the reactivation of a virus that has remained dormant in the body.

3. What causes vestibular neuritis?

The exact cause of vestibular neuritis remains unknown in many cases. Some medical theories suggest that certain cases may be associated with a viral infection or the reactivation of a dormant virus. An inflammatory or immune response may also play a role in causing inflammation of the vestibular nerve and affecting its function.

4. Does vestibular neuritis cause hearing loss?

Vestibular neuritis usually does not cause hearing loss because it primarily affects the part of the nerve responsible for balance. Therefore, significant hearing loss occurring alongside vertigo may suggest another condition, such as labyrinthitis or Ménière’s disease, and should be medically evaluated.

5. Does vestibular neuritis cause tinnitus?

Tinnitus is not considered a typical or defining symptom of vestibular neuritis. If persistent or noticeable tinnitus occurs, particularly when accompanied by hearing loss, an ear examination and hearing test are recommended to determine the underlying cause.

6. How does vestibular neuritis begin?

Vestibular neuritis usually begins suddenly. Patients may experience severe, persistent vertigo accompanied by significant balance problems, nausea, vomiting, and difficulty standing or walking. Symptoms may become more intense with head movement, particularly during the first few days.

7. How long do the symptoms of vestibular neuritis last?

Symptoms are usually most severe during the first few days and then gradually improve. However, a feeling of imbalance or dizziness, particularly when moving the head or changing body position, may persist for several weeks. In some patients, these symptoms may last longer, depending on the body's recovery, the extent of nerve dysfunction, and the effectiveness of vestibular compensation.

8. Can vestibular neuritis go away completely?

Yes. Most patients experience significant improvement over time with appropriate treatment. Recovery depends largely on the brain's ability to undergo vestibular compensation, a process through which the brain adapts to the reduced balance signals coming from the affected ear. This gradually helps restore balance and reduce dizziness.

9. Can vestibular neuritis recur?

Symptoms can recur in some individuals, but recurrent episodes of vertigo are not typical of vestibular neuritis. Therefore, if episodes of vertigo occur repeatedly or intermittently, the doctor may need to investigate other possible causes, such as benign paroxysmal positional vertigo (BPPV) or Ménière’s disease, depending on the nature of the symptoms and the findings of the medical examination.

10. How is vestibular neuritis diagnosed?

The diagnosis of vestibular neuritis is primarily based on the patient's symptoms and a clinical examination. The evaluation may include:

• Assessing the nature of the vertigo, including when it started, how long it lasts, and how severe it is.

• Examining eye movements and checking for nystagmus.

• Performing head movement tests to assess vestibular function.

• Evaluating balance and the ability to walk.

• Conducting a hearing test when necessary.

• Performing specialized tests to assess vestibular system function.

• Using magnetic resonance imaging (MRI) in certain cases, particularly when symptoms are atypical or when there are signs that require other neurological causes to be ruled out.

11. Does vestibular neuritis require an MRI?

Not every patient with vestibular neuritis needs an MRI. The doctor determines whether imaging is necessary based on the symptoms and clinical examination findings.

An MRI may be recommended when symptoms are atypical or when neurological signs are present, in order to rule out other causes of vertigo, such as certain disorders affecting the brain, cerebellum, or brainstem, including stroke when clinically appropriate.

12. Does vestibular neuritis require antibiotics?

Vestibular neuritis usually does not require antibiotics because it is not typically caused by a bacterial infection.

Antiviral medications are also not routinely used in all cases, despite theories linking some cases to viral infections or the reactivation of dormant viruses. The need for any medication is determined by the doctor based on the diagnosis, clinical condition, and associated symptoms.

13. Does vestibular neuritis require antiviral medications?

Antiviral medications are not routinely used to treat all cases of vestibular neuritis, as there is insufficient evidence to clearly establish their effectiveness for all patients.

The decision to use antiviral treatment depends on the individual clinical situation and the suspected cause of the symptoms.

14. Are corticosteroids helpful in treating vestibular neuritis?

A doctor may prescribe corticosteroids, such as prednisone or prednisolone, in some cases, particularly during the early stages of the condition. However, their benefit has not been definitively established for all patients.

Therefore, the decision to use corticosteroids should be based on the severity of symptoms, the patient's overall health, and any other medical conditions or medications they may have or be taking.

15. Do medications for vertigo treat vestibular neuritis?

Medications used to control vertigo and nausea do not directly treat or repair the vestibular nerve. Instead, they primarily help relieve symptoms during the acute phase of the condition.

These medications are generally recommended for short-term use under medical supervision. Prolonged use of vestibular-suppressant medications may interfere with the vestibular compensation process through which the brain gradually adapts and restores balance.

16. How important is vestibular rehabilitation?

Vestibular rehabilitation is an important part of recovery, particularly for patients who continue to experience imbalance or dizziness with head movement.

The exercises typically include customized training for eye and head movements, balance, and walking. Their goal is to help the brain adapt to changes in the signals coming from the vestibular system and improve balance and stability.

17. Does vestibular neuritis require surgery?

In typical cases, vestibular neuritis does not require surgery. Treatment generally focuses on controlling symptoms during the acute phase, followed by vestibular rehabilitation and a gradual return to normal activities.

Surgical interventions are rare and may be considered for certain severe conditions that do not respond to standard treatments. They are not considered a routine treatment for vestibular neuritis.

18. Can I drive while I have vestibular neuritis?

It is advisable to avoid driving while experiencing severe vertigo or significant imbalance, as well as while taking medications that may cause drowsiness or affect concentration and reaction time.

Driving may be resumed once balance, mobility, and concentration have improved sufficiently for safe driving. If symptoms persist, it is preferable to discuss returning to driving with a healthcare professional.

19. Does movement make vestibular neuritis symptoms worse?

Head movement may temporarily increase dizziness, particularly during the acute phase of vestibular neuritis. However, prolonged avoidance of movement is generally not beneficial.

After the acute phase has passed, gradually returning to movement and daily activities, along with appropriate vestibular rehabilitation exercises, can help the brain undergo vestibular compensation and improve balance and stability.

What Causes Vestibular Neuritis?

Vestibular neuritis is a disorder affecting the vestibular nerve, which is responsible for transmitting balance-related information from the inner ear to the brain. It typically causes sudden, severe vertigo, impaired balance, nausea, and sometimes vomiting.

Vestibular neuritis usually does not cause hearing loss. Therefore, significant hearing loss occurring alongside vertigo may suggest another condition, such as labyrinthitis.

Main Possible Causes and Mechanisms

1. Viral infection — the most commonly proposed cause

Many cases of vestibular neuritis occur after or during a viral infection, particularly a respiratory infection.

The condition has been associated with several viruses, including herpes viruses, influenza viruses, and other respiratory viruses.

One proposed theory is that a dormant virus in the sensory nerve ganglia, particularly herpes simplex virus type 1 (HSV-1), may reactivate and affect the vestibular nerve. However, in many cases, a specific virus cannot be confirmed as the direct cause of the condition.

2. Post-infectious immune response

Symptoms of vestibular neuritis may sometimes develop several days or weeks after a viral infection has resolved.

In such cases, the dysfunction of the vestibular nerve may result from an inflammatory or immune response following the infection, rather than from an active virus directly affecting the nerve.

3. Reactivation of a dormant virus

Some viruses can remain dormant in the body for long periods and become reactivated under certain circumstances.

The reactivation of herpes simplex virus type 1 (HSV-1) has been proposed as a possible explanation for some cases of vestibular neuritis. However, this theory has not been established as the sole cause of all cases.

4. Inflammatory or autoimmune causes — less common

Certain autoimmune diseases or systemic inflammatory conditions may affect the vestibular nerves.

However, isolated vestibular neuritis is usually not the only manifestation of these conditions, and other symptoms or clinical findings related to the underlying disease are often present.

5. Reduced blood supply to the nerve — less common

Reduced blood flow to the vestibular nerve may cause sudden dysfunction of the nerve.

This possibility becomes more relevant in people with vascular risk factors, such as diabetes, high blood pressure, smoking, or vascular disease.

However, sudden vertigo should not automatically be assumed to be caused by vestibular neuritis. Serious conditions, including stroke affecting the cerebellum or brainstem, can produce similar symptoms.

Therefore, sudden and severe vertigo, particularly when accompanied by other neurological symptoms, requires urgent medical evaluation.

How Is Vestibular Neuritis Diagnosed?

The diagnosis of vestibular neuritis is based on an assessment of the patient's symptoms, a physical and neurological examination, and selected tests that help identify vestibular dysfunction and rule out other causes of vertigo.

Main Diagnostic Tests

1. Video Nystagmography (VNG)

Video nystagmography (VNG) records eye movements, particularly nystagmus, and helps assess the function of the vestibular system in the inner ear. It can help the doctor determine whether the balance disorder is related to dysfunction of the vestibular system.

2. Audiometry and Tympanometry

Hearing tests and tympanometry may be performed to assess cochlear and middle-ear function and to determine whether hearing loss or a middle-ear disorder could be contributing to the symptoms.

3. Physical and Neurological Examination and Follow-Up

The doctor evaluates eye movements, balance, walking ability, and certain neurological functions. The progression of symptoms may also be monitored over the following days.

In vestibular neuritis, severe vertigo typically begins to improve gradually. Nausea and vomiting also tend to decrease, while a feeling of imbalance may persist for a longer period before gradually resolving.

4. Brain Magnetic Resonance Imaging (MRI)

Not every patient with vestibular neuritis requires an MRI. However, brain imaging may be necessary when there are signs or symptoms suggesting that other neurological causes of vertigo need to be ruled out, such as stroke or other brain disorders.

MRI is particularly important when unusual symptoms or neurological signs are present, such as a severe or unusual headache, speech difficulties, weakness or numbness in a limb, significant changes in consciousness, or other new neurological symptoms.

Therefore, the diagnosis of vestibular neuritis does not rely on a single test. Instead, it is based on the patient's symptoms, clinical and vestibular examination, and appropriate investigations to exclude other potential causes of vertigo.

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What Are the Symptoms of Vestibular Neuritis?

Vestibular neuritis typically causes a sudden disturbance in the body's balance system due to dysfunction of the nerve responsible for transmitting balance signals from the inner ear to the brain.

The severity of symptoms varies from person to person, but the typical clinical presentation includes the following:

1. Sudden and Severe Vertigo

Vertigo is the main symptom of vestibular neuritis and may present as:

• A sensation that the surroundings are spinning or that the person is spinning.

• Sudden onset of symptoms, often developing over a short period.

• Vertigo that may be severe enough to make standing or walking difficult.

• Symptoms that typically worsen with head movement or changes in body position.

• Severe vertigo that usually lasts for several days before gradually improving.

2. Loss of Balance and Difficulty Walking

Patients may feel unsteady or feel as though their body is leaning to one side. Symptoms may include:

• A tendency to lean toward one particular side, often toward the affected ear.

• Unsteady walking, particularly during the first few days.

• Greater difficulty walking in the dark or on uneven surfaces because of reduced reliance on visual cues to maintain balance.

3. Nausea and Vomiting

Nausea and vomiting result from the sudden disruption of balance signals between the inner ear and the brain. These symptoms can be severe during the acute phase and may be accompanied by loss of appetite or increased sweating.

4. Nystagmus

Nystagmus refers to involuntary, repetitive eye movements that may be observed by the doctor during an examination. It occurs because of an imbalance between the vestibular signals transmitted from the two ears to the brain.

5. Worsening Symptoms with Head Movement

Rapid head movements or changes in body position may increase dizziness or feelings of unsteadiness. Patients may also temporarily experience difficulty maintaining visual fixation or focusing on moving objects.

6. Persistent Dizziness and Imbalance After the Vertigo Improves

After the acute phase has passed, not all symptoms necessarily disappear immediately. Some symptoms may persist for a period of time, including:

• A feeling of unsteadiness or imbalance.

• Reduced confidence while walking.

• Mild dizziness, particularly with movement.

• Fatigue or discomfort in visually busy environments, such as shopping malls.

• Temporary difficulty performing certain activities that require visual stability and good balance.

These symptoms may continue for several weeks and, in some cases, longer, particularly when vestibular compensation is slow.

7. Symptoms That May Precede the Onset of Vertigo

In some cases, acute symptoms may be preceded by signs associated with a viral infection, such as:

• A common cold or sore throat.

• Fatigue or a mild fever.

• Mild balance problems before the onset of severe vertigo.

Symptoms That Are Not Usually Typical of Vestibular Neuritis

An important characteristic of vestibular neuritis is that it generally does not cause significant hearing loss. Severe tinnitus and ear pain are also not considered typical features of the condition.

Therefore, significant hearing loss or severe tinnitus may lead the doctor to investigate other possible causes, such as labyrinthitis or Ménière’s disease, depending on the other symptoms and examination findings.

When Do Symptoms Require Urgent Medical Evaluation?

Urgent medical evaluation should be sought when severe and sudden vertigo is accompanied by any of the following:

• Weakness or numbness in the face, arm, or leg.

• Difficulty speaking or swallowing.

• Double vision.

• A severe or unusual headache.

• Loss of consciousness or fainting.

• Inability to stand or walk.

• Chest pain.

• Any new or unusual neurological symptoms.

Some of these symptoms may indicate serious neurological conditions, such as a stroke. Therefore, sudden vertigo should not automatically be assumed to be caused by vestibular neuritis without appropriate medical evaluation.

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Medical Treatment for Vestibular Neuritis

Medication for vestibular neuritis is primarily intended to relieve vertigo, nausea, and vomiting during the acute phase rather than directly repair the vestibular nerve.

In most cases, recovery occurs gradually over time. A significant part of the recovery process depends on the brain's ability to adapt to changes in balance signals through vestibular compensation and rehabilitation.

1. Medications for Vertigo — Short-Term Use

Doctors may prescribe medications to reduce the severity of vertigo and associated symptoms, such as:

• Betahistine, in some cases.

• Meclizine.

• Dimenhydrinate.

• Other antihistamines or vestibular-suppressant medications, depending on the patient's condition.

These medications are generally recommended for short-term use during the acute phase. Prolonged use of vestibular-suppressant medications may delay vestibular compensation, the process through which the brain gradually adapts and restores balance.

2. Medications for Nausea and Vomiting

When nausea or vomiting is severe, the doctor may prescribe antiemetic medications such as:

• Ondansetron.

• Metoclopramide.

• Other medications, depending on the patient's condition.

The choice of medication depends on the patient's age, overall health, underlying medical conditions, other medications being taken, and the severity of symptoms.

3. Corticosteroids

The use of corticosteroids, such as prednisolone or prednisone, in vestibular neuritis remains a subject of medical discussion.

Some studies suggest that corticosteroids may provide a benefit, particularly when administered early in the course of the condition. However, the evidence is not conclusive enough to consider corticosteroids necessary for all patients.

Therefore, corticosteroids should not be started without medical advice. A doctor should determine whether they are appropriate after evaluating the patient's condition, particularly in people with diabetes, high blood pressure, stomach ulcers, or certain infections.

4. Antiviral Medications

Although some cases of vestibular neuritis may be associated with viral infections, antiviral medications such as acyclovir or valacyclovir are not routinely used to treat vestibular neuritis.

Their benefit has not been convincingly established in most cases. Therefore, the decision to use antiviral treatment should be based on the individual clinical situation and the suspected cause.

5. Vestibular Rehabilitation — An Important Part of Recovery

After severe vertigo subsides, vestibular rehabilitation becomes an important component of recovery and can help restore balance.

Vestibular rehabilitation aims to help the brain adapt to reduced or altered signals from the affected vestibular nerve. It may include:

• Eye movement exercises.

• Head movement exercises.

• Balance exercises.

• Walking and mobility exercises.

• Exercises designed to improve visual fixation during head movement.

Vestibular rehabilitation becomes particularly important when imbalance or movement-related dizziness persists after the acute phase.

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Surgical Treatment for Vestibular Neuritis

Vestibular neuritis is generally not treated with surgery. Most cases improve gradually over time, with treatment focusing on controlling symptoms during the acute phase, followed by vestibular rehabilitation to help restore balance.

If vertigo persists or balance problems become chronic, the diagnosis should first be reassessed to confirm that the condition is actually vestibular neuritis. Other disorders that cause chronic dizziness may require different treatments.

Vestibular Neurectomy

Vestibular neurectomy is a specialized surgical procedure that may be discussed in the context of certain vestibular disorders, but it is not a routine treatment for vestibular neuritis.

The procedure involves cutting the nerve fibers responsible for transmitting balance signals from the inner ear to the brain while attempting to preserve the portion of the nerve responsible for hearing.

How Is the Procedure Performed?

The procedure is performed under general anesthesia. Several surgical approaches may be used to access the vestibular nerve, and the appropriate technique is selected according to the patient's condition and the purpose of the surgery.

In general, the procedure may involve:

• Surgically accessing the area around the ear or the skull base, depending on the surgical approach.

• Identifying the vestibular nerve, auditory nerve, and nearby nerves and blood vessels.

• Identifying the fibers responsible for vestibular function and separating them from the fibers associated with hearing as much as possible.

• Cutting the vestibular nerve fibers to prevent balance-related signals from traveling from the inner ear to the brain.

• Closing the surgical site and monitoring the patient's hearing and neurological function after surgery.

Is Surgery Used to Treat Vestibular Neuritis?

In typical cases, surgery is not part of the treatment for vestibular neuritis. Vestibular neurectomy is not performed simply because a patient has vestibular neuritis.

Most patients improve gradually with short-term medication when necessary, vestibular compensation, and vestibular rehabilitation.

Vestibular neurectomy is a major surgical procedure that may carry significant risks and complications. Therefore, it is reserved for carefully selected cases and requires evaluation by an otolaryngologist (ENT specialist) or a specialist in otology and skull-base surgery.

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Important Tips for Vestibular Neuritis

Several simple measures can help relieve symptoms and reduce the risk of falls. Gradually returning to movement can also support vestibular compensation and recovery of balance.

First: During the First Few Days

During the acute phase, the following measures are recommended:

• Rest when vertigo is severe, but avoid staying in bed all day if you are able to move safely.

• Get up slowly from a bed or chair and avoid sudden movements.

• Use a walking aid or ask someone to assist you when necessary, especially if your balance is significantly impaired, to reduce the risk of falling.

• Drink adequate fluids, particularly if vomiting is present, to prevent dehydration.

• Eat small, frequent meals if nausea is severe rather than consuming large meals.

• Avoid driving, cycling, working at heights, or working near dangerous machinery until your balance has sufficiently improved.

• Take medications for vertigo or nausea only as directed by your doctor, usually for a short period during the acute phase.

Second: After Severe Vertigo Begins to Improve

Once severe vertigo starts to subside, it is important not to avoid movement completely. Instead, gradually return to normal movement and activities:

• Gradually begin movement and balance exercises rather than completely avoiding head movement.

• Consider vestibular rehabilitation or specialized physical therapy if imbalance persists.

• Gradually move your head and eyes during daily activities. Gradual exposure to movement helps the brain adapt to changes in vestibular signals.

• Gradually return to daily activities according to your tolerance and level of balance.

• Increase physical activity progressively while maintaining safety and avoiding situations that increase the risk of falling.

Third: What Should Be Avoided?

• Prolonged or excessive use of vestibular-suppressant medications without medical supervision, as this may delay vestibular compensation.

• Alcohol, particularly while taking medications that may cause drowsiness or affect concentration and balance.

• Driving or operating machinery while vertigo or significant imbalance persists.

• Getting up suddenly or walking without assistance when the risk of falling is high.

• Remaining inactive for prolonged periods after the acute phase has improved, as gradual and safe movement supports the recovery of balance.