Vestibular neuritis

Vestibular neuritis (vestibular neuronitis) is an acute vestibular syndrome that is a common cause of severe spontaneous vertigo (see Differential diagnosis of vertigo  for the differential diagnosis of vertigo). Evidence suggests that many cases are due to herpes simplex type 1 reactivation. Diagnosis is based on:
  • a history of acute or subacute onset of severe rotatory vertigo, nausea and postural imbalance, without hearing loss
  • the finding of a unidirectional mixed horizontal and torsional nystagmus and a positive head impulse test, without other neurological signs.

Vertigo due to vestibular neuritis is usually self-limiting, improving over hours to days, even without recovery of function in the affected ear. However, clinical recovery is incomplete in up to 30% of cases (see uncompensated peripheral vestibular lesion). If the patient has nausea or vomiting, treat as described. A corticosteroid may hasten clinical recovery, but the effect on long-term outcomes is not clear. In severe cases, use:

prednisolone (or prednisone) 1 mg/kg (up to 75 mg) orally, daily in the morning for 5 days, then taper dose over 15 days and stop. vestibular neuritis, severe prednis ol one    

Adding antiviral therapy has no benefit.