In vestibular neuritis, the vestibular nerve (Nervus vestibularis) is inflamed. This results in attacks of vertigo, which are often accompanied by nausea, vomiting and nystagmus. Below you will find further information on the symptoms, diagnosis and treatment of vestibular neuritis as well as specialists for the treatment of this inflammation of the vestibular nerve.
Vestibular neuritis can cause persistent or intermittent severe rotatory vertigo. This is an inflammation of the vestibular nerve (Nervus vestibularis). As a result, this nerve can no longer correctly transmit the impulses from the vestibular organ in the inner ear to the movement center in the brain.
This results in completely uncontrollable sensations of movement, which usually include severe and persistent spinning dizziness.
Our vestibular system consists of three semicircular canals , each about 6 millimeters in size, which are filled with a special lymph fluid.
The three semicircular canals are perpendicular to each other. Each individual semicircular canal embodies one of the three directions of rotation around the vertical, transverse and longitudinal axes in three-dimensional space. The three semicircular canals report real rotational accelerations to the vestibular nerve.
A small ampoule at the bottom of the semicircular canals detects and measures the linear accelerations. Just as we feel in a car, for example, when accelerating and braking.
The organ of balance is one of the sensory organs @ Henrie /AdobeStock
The attack of vertigo is usually very unpleasant for those affected and can last up to seven days or longer. The attacks of vertigo are often accompanied by severe nausea, vomiting and nystagmus.
Rotational vertigo is a special form of vertigo in which the sensation of rotation is counterclockwise @ dragonstock /AdobeStock
Affected people usually develop a stronger feeling of illness. In addition, there is usually a tendency to fall to the affected side. If the sense of balance of the left inner ear is affected, there is a tendency to fall to the left side.
Nystagmus is the term used by doctors to describe a particular form of uncontrollable eye movement (eye tremor). The surroundings become blurred during a rapid rotation around the vertical axis. The eyes reflexively try to follow the rotation and jerk back again (vestibulo-ocular reflex, VOR).
This allows us to better focus on our surroundings when we turn quickly. Nystagmus usually goes completely unnoticed. Rotational vertigo can also trigger nystagmus, although this can also be very pronounced, depending on the severity of the vertigo attack.
In these cases, the movement center in our brain does not know that the strong spinning sensation is not real. It therefore reacts by initiating a "real" nystagmus (as in the case of real rotational acceleration).
Doctors suspect that the cause is a viral infection or a reactivation of herpes simplex type 1 viruses. This assumption can be substantiated by the detection of genetic material (DNA) from this type of virus in degenerative inflammation of the vestibular nerve. Statistically, there is a noticeable accumulation of the disease in people between the ages of 50 and 60.
Of all patients who seek medical treatment for vertigo, only 7 percent suffer from vestibular neuritis. In the remaining patients, their attacks of vertigo have other causes. Risk factors that favor vestibular neuritis are not known.
The typical, usually prolonged attacks of torsional vertigo are not sufficient for a reliable diagnosis of the disease. There are too many other causes of vertigo attacks, so that further diagnostic procedures are necessary.
Even modern imaging procedures such as CT and MRI do not provide a reliable diagnosis.
Simple tests (head impulse test) and a rotational and thermal test of the vestibular apparatus, as well as a few exclusion criteria, allow a reliable diagnosis to be made.
The head impulse test is very easy to perform without any external aids. The doctor asks the patient to fixate a distant point with their eyes.
The doctor takes the patient's head in both hands and turns it jerkily to the right and left. Based on the reflex eye movements, the doctor can make a reliable statement as to whether and which of the two balance organs is not functioning.
An important indication is that vestibular neuritis never occurs together with tinnitus. And if an audiogram is performed, there are no abnormalities. A disorder of the vestibular apparatus does not impair hearing. The disorder also does not trigger tinnitus.
The head impulse test checks whether the patient can fixate a point with the eyes when the head is turned @ Halfpoint /AdobeStock
Accompanying symptoms of vestibular neuritis, such as frequent vomiting, initially require treatment of the symptoms and accompanying symptoms. This means that in most cases, the treating physician will first administer medication to prevent further vomiting (antiemetics) .
If the vomiting leads to a severe loss of fluids and electrolytes, an intravenous infusion is used.
Anticholinergics, antihistamines and benzodiazepines are available to dampen the rotary vertigo. These drugs dampen the transmission of nervous stimuli, although this is not limited to the affected vestibular nerve.
Corticosteroid shock therapy is also an option. This is a short-term treatment with cortisone or cortisone-like drugs (corticoids). Patients should take these over a period of around three days. Cortisone has an anti-inflammatory effect.
Patients should accompany all forms of therapy with movement and balance exercises (physiotherapy). The recommended physiotherapy also includes eye training such as gaze stabilization and training of the vestibulo-ocular effect.
With medical treatment as described above, the acute phase subsides after 3 to 4 days. Patients can then walk again without assistance.
It can take up to 7 weeks for the symptoms to disappear completely and for fitness to be restored. In principle, the prognosis is good.
If the organ of balance or the vestibular nerve does not fully regenerate, the brain can compensate. Therefore, there is usually no residual impairment of the sense of balance.
Vestibular neuritis is an inflammatory disease of the vestibular nerve or vestibular organ in the inner ear. Certain herpes viruses are very likely to trigger the disease.
The main symptom is severe spinning vertigo, which can last up to seven weeks.
Accompanying symptoms are usually
Hearing is not affected by the disease.
Drug treatment in combination with physiotherapy is a suitable therapy . The prognosis is generally favorable.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
