Acute labyrinthitis (aka vestibular neuronitis)

Question 1

what is it?

Answer 1

Vestibular neuronitis is a disorder characterised by acute, isolated, spontaneous, and prolonged vertigo of peripheral origin

thought to be due to inflammation of the vestibular nerve and may occur after a viral infection

Question 2

what are the complications of vestibular neuronitis?

Answer 2

• benign paroxysmal positional vertigo

- phobic postural vertigo (dizziness and fears of falling despite lack of actual falls)

Question 3

what are the signs?

Answer 3

• nystagmus
• positive head impulse test
• hearing and otoscopy is normal

history and examination are diagnostic

Question 4

what are the symptoms?

Answer 4

• rotational vertigo
• nausea and vomiting
• malaise
• pallor
• sweating
• hearing loss and tinnitus are not features (but may be present in labrynthitis)

Question 5

what is the head impulse test?

Answer 5

used to diagnose vestibular neuronitis

where patient turns their head in specific motions with their eye movements staying on the examiner

any movement of eyes is a positive test

Question 6

what are some causes of vertigo?

Answer 6

• BPPV
• labyrinthitis
• menieres
• central causes e.g migraines, stroke, cerebellar tumour and multiple sclerosis

Question 7

what advise can be given to a patient with vestibular neuronitis?

Answer 7

• symptoms will settle over several weeks
• may need bed rest
• inform employer and avoid driving if affected
• discuss risk of falling in the home and ways to manage

Question 8

how are symptoms of vertigo treated?

Answer 8

• alleviated symptoms of nausea, vomiting and vertigo, can give prochlorperazine or antihistamine. Take medication for minimum time possible as it may delay recovery
• return if symptoms deteriorate or have not fully resolved after 1 week

Question 9

when should a patient be refered?

Answer 9

• severe nausea and vomiting

- refer to a balance specialist if symptoms persist or not typical of vestibular neuritis