Vestibular neuritis: what are the different treatments?

Vestibular neuritis: what are we talking about exactly?

First thing to know: in our inner ear (which is behind the eardrum and ossicles) is one of the “centers” of our balance – the vestibular system. Its role: to inform the brain of the movements of the head in space (up, down, left, right) so that we can keep balance in all circumstances. The vestibular system (in cooperation with the other “balance systems”) thus helps us to walk on two legs and to remain upright … without falling!

We are talking about vestibular neuritis when the vestibule (which transmits information between the vestibule and the brain, therefore) is the site of inflammation. In medical terms, this pathology is defined as a “sudden unilateral peripheral vestibular deficit without associated hearing impairment, of undetermined origin”. It should be noted that the vestibular nerve mixes with the auditory nerve – which contributes to the mechanism of hearing.

What are the causes of vestibular neuritis? To date, the exact causes of vestibular neuritis have not been clearly identified – specialists consider it to be a viral pathology, possibly related to the herpes virus (Herpes simplex). Moreover, according to the university hospitals of Marseille *, vestibular neuritis is preceded by an infection of the airways in 53% of cases – angina, rhinosinusitis, laryngitis, otitis …

What are the symptoms of vestibular neuritis?

To know. Vestibular neuritis (also known as vestibular neuronitis) is a disease that can affect anyone – both men and women, at all ages. It can even reach the child.

The symptoms of vestibular neuritis are very disabling on a daily basis. We can in particular observe:

  • Violent dizziness: we have a “head spinning”, we have the impression that the world “revolves” around us, and this feeling gets worse when we move our head,
  • Vomitings : they are linked to dizziness, we cannot swallow anything, we cannot eat or drink,
  • A disorder : when you stand up, you fall on the side with the nerve inflammation (if vestibular neuritis has appeared in the right ear, you fall on the right side),
  • A nystagmus : the eyes move involuntarily and jerky.

Attention ! In the event of vestibular neuritis, there is no hearing loss (we hear correctly, no deafness) or tinnitus (whistling, buzzing … in the ear). Indeed: there is no damage to the auditory system.

Diagnosis and treatment: what treatment for vestibular neuritis?

To know. Although bothersome and disabling, vestibular neuritis is usually not serious. However, this pathology often requires emergency hospitalization because the affected person can no longer get up, eat, drink or simply turn their head …

Vestibular neuritis: the diagnosis. The diagnosis of vestibular neuritis is essentially clinical with a list of criteria to be evaluated by the doctor – ENT (otolaryngologist) or neurologist.

In an elderly person and / or with cardiovascular risk factors (arterial hypertension, diabetes, obesity, overweight, etc.), additional examinations may be performed to verify that it is not a matter of a cerebrovascular accident (AVC) – it will notably be a question of an MRI examination, often practiced in urgency.

Vestibular neuritis: the treatment. Treatment of vestibular neuritis is primarily symptomatic. During the first hours / days in the hospital, drugs are administered intravenously – indeed: due to vomiting, oral route is not possible. These are mainly anti-vertiginous drugs (acetylleucine: Tanganil® against vertigo) and anti-emetic drugs (metoclopramide: Primperan® against vomiting).

Symptoms of vestibular neuritis may start to subside after 24 hours, but it can also last for several days.

When the person is able to stand / move again, the drug treatment is lightened and physiotherapy sessions are prescribed. The objective: to re-educate the vestibular system using specific techniques to restore lasting balance to the body. We are talking about vestibular physiotherapy.

Thanks to Dr. Jean-Pierre Balagué, neurologist at the Pont de Chaume clinic (Montauban – ELSAN group).

*Source : AP-HM

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