Vestibular neuronitis

This is acute inflammation of the vestibular nerve (1).

• the cause of the disease is unknown but is thought to be precipitated by sinusitis, influenza, and upper respiratory tract viral illnesses in the young (2) or vascular disease in the elderly
• commonly seen in previously well young or middle aged adults (usually between 20 and 40 years old) (2).

It is characterised by

• incapacitating sustained (non-positional) vertigo in a previously healthy young or middle aged adult (3).
  • vertigo may be abrupt (in 73%) or increase over a few hours (27%) (3)
  • commonly occurs on first awakening (2)
• the patient may feel very unwell and they often lie still in bed
• unidirectional, predominantly horizontal nystagmus (3) and an unsteady gait (2)
• nausea and vomiting are common (3)
• absent tinnitus or deafness (3)
• no other neurological symptoms or signs (3).

After 2-5 days of the acute attack, a steady resolution usually occurs over a period of 6 to 12 weeks.

There is is limited evidence to support the use of corticosteroids for the treatment of vestibular neuronitis in the emergency department (5)

This condition is also known as acute vestibular failure.

Although the terms vestibular neuronitis and labyrinthitis has been used interchangeably in the past, it is now considered as two separate conditions (4).

Reference:

• (1) Swartz R, Longwell P. Treatment of vertigo. Am Fam Physician. 2005;71(6):1115-22 http://www.aafp.org/afp/2005/0315/p1115.html
• (2) Hanley K, O'Dowd T, Considine N. A systematic review of vertigo in primary care. Br J Gen Pract. 2001;51(469):666-71 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314080/pdf/11510399.pdf
• (3) Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493
• (4) Kuo CH, Pang L, Chang R. Vertigo - part 2 - management in general practice. Aust Fam Physician. 2008;37(6):409-13
• (5) Oliveira J. e Silva, L, Khoujah, D, Naples, JG, et al. Corticosteroids for patients with vestibular neuritis: An evidence synthesis for guidelines for reasonable and appropriate care in the emergency department. Acad Emerg Med. 2022; 00: 1- 10. doi: 10.1111/acem.14583