Vestibular neuritis and labyrinthitis
Vestibular neuritis and labyrinthitis are presumed viral or post-viral inflammatory disorders of the vestibular nerve or labyrinth causing sudden-onset, continuous vertigo lasting days, with labyrinthitis distinguished by added cochlear symptoms of hearing loss and tinnitus. The essential diagnostic task is excluding a posterior-circulation stroke at the bedside using the HINTS exam before treating with short-course vestibular suppressants, early corticosteroids, and vestibular rehabilitation.
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What this article covers
- Overview
A presumed viral or post-viral inflammatory syndrome of the peripheral vestibular system: vestibular neuritis is inflammation confined to the vestibular portion of the eighth cranial nerve, sparing…
- Epidemiology
Common cause of acute vestibular syndrome in adults presenting with new, sustained vertigo, alongside stroke and, less acutely, BPPV and Meniere disease.
- Risk factors
Recent or concurrent viral upper respiratory infection, the most consistently cited antecedent.
- Pathophysiology
Inflammation of the vestibular nerve (vestibular neuritis) disrupts the resting tonic firing rate the brain uses to sense head position, producing a sudden asymmetric vestibular signal the brain…
- Clinical features
Sudden-onset, severe, continuous vertigo lasting days, not brief seconds-to-minutes episodes; this duration and continuity is the hallmark that separates this disease from BPPV and from Meniere disease's shorter, recurrent attacks.
- Differential diagnosis
Posterior-circulation (vertebrobasilar) stroke or TIA: the most dangerous mimic; can present as isolated vertigo without other focal deficits; discriminator is a concerning HINTS component (normal…
- Diagnosis
This is a clinical diagnosis of exclusion: once the more serious causes of acute vertigo, chiefly cerebellar or brainstem stroke, have been ruled out, the pattern of acute, continuous vertigo…
- Management
First, exclude and manage a central cause using the HINTS-driven approach above; do not proceed with symptomatic peripheral-vertigo treatment until stroke has been reasonably excluded in any high-risk or HINTS-concerning patient.
- Complications
Missed posterior-circulation stroke if central features are not recognized at initial presentation, the most serious complication of misdiagnosis rather than of the disease itself.
- Prognosis
Vestibular neuritis and labyrinthitis typically resolve spontaneously within weeks to months, with acute severity peaking in the first days and gradually improving as central compensation occurs.
- Prevention
No vaccine or specific preventive measure is established for vestibular neuritis or labyrinthitis, consistent with its presumed sporadic post-viral mechanism.
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Related articles
- Benign paroxysmal positional vertigo (BPPV)
BPPV is the most common cause of vertigo, produced by displaced otoconia in a semicircular canal, most often the posterior canal, and is diagnosed at the bedside with the Dix-Hallpike maneuver and treated first-line with the canalith repositioning (Epley) maneuver rather than medication.
- Vestibular schwannoma (acoustic neuroma)
Vestibular schwannoma is a benign Schwann-cell tumor of CN VIII in the internal auditory canal/cerebellopontine angle that presents with slowly progressive unilateral sensorineural hearing loss and disequilibrium rather than true vertigo. Diagnosis rests on asymmetric audiometry followed by contrast-enhanced MRI, and management is a size- and growth-driven choice among observation, stereotactic radiosurgery, and microsurgical resection.