ENT - Vestibular neuronitis and labyrinthitis

Question 1

What is vestibular neuronitis?

Answer 1

Inflammation of vestibular nerve, usually due to viral infection

It distorts signals from the vestibular system to the brain

Results in episodes of vertigo
(brain thinks the head is moving when it is not)

Question 2

Presentation of vestibular neuronitis

Answer 2

Acute onset vertigo
Nausea and vomiting
Balance problems
May be a history of recent viral URTI

Question 3

Management of vestibular neuronitis

Answer 3

Short term management (up to 3d):

• Prochlorperazine
• Antihistamines (e.g., Cyclizine, promethazine)
• Just during the acute phase of VN

Referral if symptoms do not improve after 1 week or resolve after 6w (may require further investigation or vestibular rehabilitation therapy (VRT))

Question 4

Prognosis of vestibular neuronitis

Answer 4

Symptoms are most severe for the first few days, after which they gradually resolve over the following 2-6 weeks.

BPPV may develop after VN

Question 5

How to differentiate between VN and acute labyrinthitis

Answer 5

Labyrinthitis – Loss of hearing

Vestibular Neuronitis – No loss of hearing

Question 6

Examination to distinguish between central and peripheral vertigo?

Answer 6

The head impulse test

Question 7

What is the head impulse test?

Answer 7

Involves the patient sitting upright and fixing their gaze on the examiner’s nose.

The examiner holds the patient’s head and rapidly jerks it 10-20 degrees in one direction while the patient continues looking at the examiner’s nose.

The head is slowly moved back to the centre before repeating in the opposite direction.

Ensure they have no neck pain or pathology before performing the test.

RESULTS:

• Normal in central vertigo, no current Sx, or normal
• In peripheral vertigo eyes will saccade as they eventually fix back on examiner

Question 8

What is labyrinthitis?

Answer 8

Inflammation of the bony labyrinth of the inner ear, including the semicircular canals, vestibule (middle section) and cochlea

Inflammation usually due to viral URTI
- Rarely secondary to bacterial OM or meningitis

Question 9

Presentation of labyrinthitis?

Answer 9

Acute onset vertigo
Also can have:
Hearing loss
Tinnitus

Question 10

Diagnosis of labyrinthitis

Answer 10

Clinical diagnosis based on Hx/Exam

But important to exclude central cause of vertigo
- head impulse test to diagnose peripheral causes of vertigo

Question 11

Management of labyrinthitis?

Answer 11

Same as VN

Supportive care and short-term use (up to 3 days) of medication to suppress the symptoms:

• Prochlorperazine
• Antihistamines (e.g., Cyclizine, promethazine)

Abx used in bacterial labyrinthitis