Treatment of vestibular neuritis

Mark F. Walker

Vestibular neuritis is an acute peripheral vestibulopathy. It is thought to result from a reactivation of herpes simplex virus that affects the vestibular ganglion, vestibular nerve, labyrinth, or a combination of these. The symptoms are prolonged continuous vertigo, nausea and vomiting, and imbalance. In evaluating a patient with an acute vestibular syndrome, it is important not to miss a central cause, such as a brainstem or cerebellar stroke or hemorrhage, which could be life-threatening. Definitive central signs are not always present. Thus, any patient thought to have vestibular neuritis who has significant vascular risk factors should be evaluated for possible stroke. Most patients recover well from vestibular neuritis, even without treatment. Nonetheless, studies suggest that a course of oral steroids accelerates the recovery of vestibular function; whether steroids influence long-term outcome is less certain. Thus, until more data become available, it is reasonable to treat otherwise healthy individuals who present within 3 days of onset and to withhold steroids from those who are at higher risk of complications. Antiemetics and vestibular suppressants are useful acutely but should be withdrawn as soon as possible (preferably after the first several days), because their prolonged use may impede the process of central vestibular compensation. Early resumption of normal activity should be encouraged, to promote compensation. Directed vestibular rehabilitation therapy can further promote this process.