Vestibular Neuronitis

Question 1

Pathophysiology of vestibular neuronitis

Answer 1

Inflammation of the vestibular nerve usually attributed to a viral infection

Question 2

Presentation of vestibular neuronitis

Answer 2

Acute onset vertigo

History of a recent viral URTI

Symptoms are most severe for the first few days.

Associated with:

• Nausea and vomiting
• Balance problems

Question 3

What type of vertigo is vestibular neuronitis

Answer 3

Peripheral vertigo

Question 4

Management of vestibular neuronitis

Answer 4

Patients may need admission if dehydrated due to severe nausea and vomiting.

Prochlorperazine
Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

Can be used for up to 3 days

Question 5

Prognosis of vestibular neuronitis

Answer 5

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

Benign paroxysmal positional vertigo (BPPV) may develop after vestibular neuronitis

Question 6

When to refer a patient with vestibular neuronitis

Answer 6

Symptoms do not improve after 1 week

Does not resolve after 6 weeks

Question 7

Management when referred

Answer 7

Vestibular rehabilitation therapy (VRT) - exercises to train the CNS to compensate