Vestibular neuronitis, also called Vestibular neuritis, can be a paroxysmal, single attack of vertigo

Vertigo (medical)

Vertigo is a type of dizziness, where there is a feeling of motion when one is stationary. The symptoms are due to a dysfunction of the vestibular system in the inner ear...

, a series of attacks, or a persistent condition which diminishes over three to six weeks. It is a type of unilateral vestibular dysfunction and may be associated with nausea

Nausea

Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

, vomiting

Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

, and previous upper respiratory tract

Respiratory tract

In humans the respiratory tract is the part of the anatomy involved with the process of respiration.The respiratory tract is divided into 3 segments:*Upper respiratory tract: nose and nasal passages, paranasal sinuses, and throat or pharynx...

 infections. It generally has no auditory

Auditory system

The auditory system is the sensory system for the sense of hearing.- Outer ear :The folds of cartilage surrounding the ear canal are called the pinna...

 symptoms, unlike labyrinthitis

Labyrinthitis

Labyrinthitis is an inflammation of the inner ear, and a form of unilateral vestibular dysfunction. It derives its name from the labyrinths that house the vestibular system . Labyrinthitis can cause balance disorders....

. Vestibular neuronitis may also be associated with eye nystagmus. The etiology is not clearly understood, and the term "neuronitis" is inaccurate because there is no evidence of inflammation. The term is usually retained due to its common usage. It appears to be caused by an imbalance of neuronal input between the left and right inner ears.

Diagnosis

In large part, the process involves ascertaining that the entire situation can be explained by a lesion in one or the other vestibular nerve. It is not possible on clinical examination to be absolutely certain that the picture of "vestibular neuritis" is not actually caused by a brainstem or cerebellar stroke, so mistakes are possible. Nevertheless, this happens so rarely that it is not necessary to perform MRI scans or the like very often. Signs of vestibular neuritis include spontaneous nystagmus

Nystagmus

Nystagmus is a condition of involuntary eye movement, acquired in infancy or later in life, that may result in reduced or limited vision.There are two key forms of Nystagmus: pathological and physiological, with variations within each type. Nystagmus may be caused by congenital disorders,...

 and unsteadiness. One may notice that vision is disturbed or jumpy on looking to a particular side. This usually means that the opposite ear is affected – it is called Alexander's law

Alexander's law

Alexander's law states that in individuals with nystagmus, the amplitude of the nystagmus increases when the eye moves in the direction of the fast phase .It is manifested during spontaneous nystagmus in a patient with a vestibular lesion...

 and is due to asymmetric gaze evoked nystagmus. Occasionally other ocular disturbances will occur such as vertical double vision – skew deviation

Skew deviation

Skew deviation is an unusual ocular deviation , wherein the eyes move upward , but in opposite directions. Skew deviation is caused by abnormal prenuclear vestibular input to the ocular motor nuclei, most commonly due to brainstem or cerebellar stroke. Other causes include multiple sclerosis and...

. However if symptoms persist beyond one month, reoccur periodically, or evolve with time, testing may be proposed. In this situation, nearly all patients will be asked to undergo an audiogram and an ENG

Electronystagmography

Electronystagmography is a diagnostic test to record involuntary movements of the eye caused by a condition known as nystagmus. It can also be used to diagnose the cause of vertigo, dizziness or balance dysfunction by testing the vestibular system....

. An audiogram is a hearing test needed to distinguish between vestibular neuritis and other possible diagnoses such as Ménière's disease

Ménière's disease

Ménière's disease is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo and tinnitus and progressive hearing loss, usually in one ear. It is named after the French physician Prosper Ménière, who, in an article published...

 and Migraine

Migraine

Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...

. The ENG test is essential to document the characteristic reduced responses to motion of one ear. In severe cases, Vestibular Neuritis can become a chronic health problem that may lead to damage of the vestibular nerve(s) which can subsequently result in complications relating to balance and equilibrium which may persist for months or more. If symptoms do not improve, Vestibular Rehabilitation Therapy (V.R.T.) should be used, which is a form of physical therapy that helps dizziness and balance disorders. It is highly effective in alleviating the oftentimes debilitating attacks of vertigo and constant dizziness suffered by those with Vestibular neuritis as well as other inner ear disorders and diseases.

Causes

Some patients will report having an upper respiratory infection (common cold) or a flu prior to the onset of the symptoms of vestibular neuronitis, others will have no viral symptoms prior to the vertigo attack.

Some cases of vestibular neuronitis are thought to be caused by an infection of the vestibular ganglion by the Herpes Simplex

Herpes simplex

Herpes simplex is a viral disease caused by both Herpes simplex virus type 1 and type 2 . Infection with the herpes virus is categorized into one of several distinct disorders based on the site of infection. Oral herpes, the visible symptoms of which are colloquially called cold sores or fever...

 type 1 virus. However, the cause of this condition is not fully understood, and in fact many different viruses may be capable of infecting the vestibular nerve.

Acute localized ischemia

Ischemia

In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...

 of these structures also may be an important cause. Especially in children, vestibular neuritis may be preceded by symptoms of a common cold. However, the causative mechanism remains uncertain.

Symptoms

The main symptom of vestibular neuronitis is vertigo, which appears suddenly, often with nausea and vomiting. Vertigo usually lasts for several days or weeks. In rare cases it can take months to go away entirely. Vestibular neuronitis does not lead to loss of hearing.

Treatment

The treatment for vestibular neuronitis depends on the etiology of the dysfuction. However, symptoms of vertigo can be treated in the same way as other vestibular dysfunctions, such as labyrinthitis

Labyrinthitis

Labyrinthitis is an inflammation of the inner ear, and a form of unilateral vestibular dysfunction. It derives its name from the labyrinths that house the vestibular system . Labyrinthitis can cause balance disorders....

, with vestibular rehabilitation.

External links

• WebMD
• University of Pennsylvania
• On-line article on difference between Vestibular neuritis and Labyrinthitis
• Dizzytimes.com Online Community for Sufferers of Vertigo and Dizziness