Vestibular neuritis is what doctors call a dysfunction of the balance organ. Those affected suffer from dizziness.
What is vestibular neuritis?
In medicine, vestibular neuritis is also known as vestibular neuropathy. What is meant by this is an acute or chronic disturbance of the function of the organ of balance, which is located in the inner ear. Other names for the disease are vestibulopathy, vestibular neuropathy and vestibular neuronitis. See percomputer for Leschke Syndrome Explanation.
Neuronitis means “nerve inflammation”. Sometimes the condition is also called “hearing loss of the vestibular system”. The incidence of vestibular neuritis is 3.5 in 100,000 per year. The proportion of diagnoses in special clinics for dizziness is around seven percent.
Vestibular neuropathy is one of the three most common forms of vertigo. In most cases, vertigo occurs between the ages of 30 and 60. In addition, vestibulopathy often appears in spring or early summer.
Causes
The possible causes of vestibular neuritis are still unclear. It is assumed that viruses are responsible for the development of the disease. It is not uncommon for viral infections to appear before the onset of vestibular neuropathy. But circulatory disorders can also be the trigger of dizziness.
These cause functional disorders or even a functional failure of the balance organ on the side of the body affected by the disease. While the brain of the affected person still receives normal signals on the healthy side, there is no signal at all or only a disturbed signal on the diseased side. Due to this imbalance, the patient suffers from strong dizzy spells in the early stages. Herpes infections, Lyme borreliosis and autoimmune diseases are suspected to be other rare causes.
Symptoms, Ailments & Signs
A typical symptom of vestibular neuritis is severe rotary vertigo. This is usually accompanied by nausea and vomiting. The general condition of the patient also suffers from the disease. It is not uncommon for the dizziness to be so severe that those affected are unable to walk without assistance.
In some cases, the symptoms improve when the patient lies quietly on their back and closes their eyes. However, if even slight movements are performed, the condition worsens again. Symptoms of vestibular neuritis usually last for a few days. However, as you progress, they gradually get better.
Another side effect of vestibular neuropathy is nystagmus, which causes jerky eye movements. The eyes move in the direction of the vestibular nerves that are not affected by the disease. A tendency to fall to the affected side while standing or sitting is also typical. The patient’s hearing is usually not affected by vestibular neuritis.
Diagnosis & course of disease
If vestibular neuritis is suspected, a doctor should be consulted. This first deals with the anamnesis (medical history) of the patient and has him describe the symptoms. Possible pre-existing conditions are also of interest.
The nystagmus of the eyes also plays an important role. To check it, the patient puts on special Frenzel glasses. Next step is to do a vestibular exam to check balance. The ear canal is exposed to a warm rinse. The eyes are also checked during this procedure. People suffering from vestibular neuritis do not show any changes in the direction of the nystagmus.
Special examinations of ear, nose and throat medicine or imaging diagnostic procedures can also be useful. These include sonography (ultrasound examination), computed tomography (CT) or magnetic resonance imaging (MRI). The ear, nose and throat specialist ensures the diagnosis by means of a caloric test of the inner ear.
This leads to thermal underexcitability in the organ of balance, which is caused by warm or cold water or air. Since dizzy spells can also have numerous other causes, it is particularly important to differentiate them from vestibular neuritis if it is suspected. The possible diseases can be Meniere’s disease or benign positional vertigo.
Vestibular neuritis usually takes a positive course. In most patients, the sense of balance is restored or at least improved after a period of around twelve weeks. However, about 15 percent of all those affected also suffer from benign positional vertigo.
When should you go to the doctor?
Unsteady gait and an increased occurrence of accidents or falls are signs of an existing irregularity. You must be presented to a doctor so that serious damage can be avoided. In case of dizziness, nausea and vomiting, a doctor is required. A so-called rotary vertigo, which causes the impossibility of walking straight, is characteristic. A doctor should be consulted if the body becomes crooked when moving, if you are unsure of your movements or if you appear very unstable overall. If bystanders notice unusual eye movements of the person concerned, this should be discussed with a doctor.
Characteristic of vestibular neuritis is a temporary spontaneous healing. This occurs as soon as the affected person allows himself a rest phase lying on his back and closes his eyes. At the same time, the symptoms increase in intensity as soon as slight movements are performed. See a doctor if you need help getting around, if you can no longer carry out daily activities on your own, or if your hearing is impaired.
There is often a feeling of pressure in the ear, ringing in the ears or certain frequencies can no longer be heard as usual. A tendency for the affected person to fall while sitting or standing is considered unusual. It should be examined by a doctor so that the cause of the symptoms can be diagnosed and treatment can be initiated.
Treatment & Therapy
In the case of vestibular neuritis, it may sometimes be necessary to treat the affected person as an inpatient in a hospital. Patients are required to remain in bed for a period of time. They are given medication to treat symptoms such as dizziness, vomiting and nausea.
In order to improve blood circulation, several infusions take place. These are also helpful to replace fluid lost through vomiting. The glucocorticoid methylprednisolone is a proven drug. The treatment with the substance lasts about a week. Over the course of therapy, the dose is gradually reduced to restore the vestibular nerve.
If the disorder does not improve after a short time, training measures take place in which the patient learns how to deal with his symptoms. The focus is on intensive balance training. It serves to speed up the healing process. To do this, the doctor, under controlled conditions, exposes the vestibular system to situations that cause dizziness. The stimulus can promote recovery.
Complications
As a rule, the prognosis for vestibular neuritis is favorable. Serious complications only occur occasionally. The dizziness is usually over after about three months. In rare cases, however, recurrences can occur, which then affect the other ear. Furthermore, about 15 percent of all patients experience benign positional vertigo in the same ear.
This can also be treated well and is only a temporary phenomenon. However, it becomes more complicated for those affected who experience the rotary vertigo caused by the illness as a traumatic event. In these cases, a phobic postural vertigo can also develop. Since this cannot be traced back to organic causes, but exclusively to psychological causes, the therapy here must concentrate on eliminating the anxiety disorder.
A potentially serious complication of vertigo can be triggered by a dangerous fall, which is often associated with serious injuries and broken bones. This risk particularly affects older people whose bone stability is already additionally reduced by osteoporosis. Very rarely, vestibular neuritis leads to chronic bilateral labyrinth failure.
Here the standing and walking motor skills are disturbed in the dark or with closed eyes. In the long term, this double strain on both ears often leads to complete disorientation in space. It is then no longer possible to practice dangerous professions or high-risk sports.
Outlook & Forecast
The course and prognosis of vestibular neuritis are favorable. Spontaneous healing usually occurs within two to three weeks. In the majority of those affected, the sense of balance returns to normal completely or at least partially after 12 weeks at the latest. However, some of those affected still have dizziness even after several months.
Only in rare cases does the dizziness progress to other forms of dizziness or balance disorders. Up to 15 percent of those affected also show what is known as benign paroxysmal positional vertigo (benign positional vertigo) in the affected ear. This is characterized by brief attacks of rotary vertigo when the head moves or changes position (looking down or up, turning the head) or when lying down. The persistent rotary vertigo can also traumatize the affected person in such a way that a fearful expectation of a possible vertigo attack develops into a phobic postural vertigo.
The individual prognosis depends above all on the affected person being physically active again as quickly as possible. The general condition is also important for the prognosis. Older people affected often suffer longer from the existing symptoms due to their comparatively poorer general condition. Recurrences (recurrence of dizziness) only occur in very rare cases and then usually affect the previously unaffected ear.
Prevention
Preventive measures against vestibular neuritis are not known. The causes of dizziness are still in the dark.
Aftercare
In most cases, patients with vestibular neuritis have very few and limited options for direct follow-up care. The person concerned should therefore ideally consult a doctor at an early stage and also initiate treatment in order to prevent the occurrence of further complications and symptoms. It cannot heal on its own, so medical treatment is always necessary.
Most patients are usually dependent on taking various medications. The person concerned should follow all the doctor’s instructions and take the medication regularly and in the correct dosage. If you have any questions or are unclear, you should always consult a doctor first.
Furthermore, in many cases the support of those affected by their own family is necessary. Those affected should drink a lot to relieve the symptoms. The medication itself can be gradually discontinued after consultation with a doctor. Contact with other people affected by vestibular neuritis can often be very useful, as this leads to an exchange of information, which can make the patient’s everyday life much easier.
You can do that yourself
After a clear diagnosis of vestibular neuritis, measures of everyday and self-help can improve the handling of the disease and shorten the healing process. Regardless of whether the disease is due to circulatory disorders in the vestibular organs or other causal factors, practical exercises are useful in addition to drug treatment. They also serve to directly encounter and relieve dizzy attacks and feelings of nausea.
To overcome nystagmus, the jerky involuntary eye movement. For example, it helps to sit upright on a chair and move your hand to the right and left in front of your eyes at a distance of 30 cm to 50 cm with your fingers stretched out. The eyes should follow the hand or finger without turning the head. Through the exercise, the involuntary eye movement (nystagmus) is superimposed by a voluntary eye movement and weakens the nystagmus.
Other exercises done regularly, which usually serve to strengthen the vestibular organs, also help to overcome nausea caused by vestibular neuritis. Specifically, these are exercises such as “standing on one leg”, “walking in a line” or “walking sideways and backwards”. Physical activity promotes blood circulation. Combinations of exercise and balance training, such as dancing, are particularly effective.
