The Vertigo Co
Labyrinthitis and Vestibular Neuritis Treatment Melbourne
The Vertigo Co provides treatment of a range of vestibular disorders including labyrinthitis and vestibular neuritis.
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Vestibular System Disorders: Vestibular Neuritis And Labyrinthitis
Vestibular Neuritis and Labyrinthitis are similar conditions, usually resulting from an infection, often in the inner ear. The nerves connecting the inner ear to the brain become inflamed. This inflammation disrupts the transmission of sensory information from the ear to the brain resulting in symptoms such as vertigo, dizziness, and difficulties with balance, vision and/or hearing (1).
Vestibular Neuritis
Vestibular neuritis involves swelling of the vestibular branch of the vestibulocochlear nerve (the 8th cranial nerve). This part of the cranial nerve is responsible for balance and usually tells your brain important information about your positioning so that you can stay upright and maintain normal movement.
Labyrinthitis
Labyrinthitis involves inflammation of the vestibular labyrinth, which is a structure within the inner ear, and/or the cochlear part of the 8th cranial nerve. These are important to typical hearing function.
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Symptoms Of Vestibular Disorders: Vestibular Neuritis And Labyrinthitis
Symptoms of vestibular neuritis and labyrinthitis are generally similar and can be mild to severe. The main difference is that labyrinthitis can involve one-sided hearing loss or tinnitus, which is ringing in the ears, while vestibular neuritis does not. Improvement of severe symptoms usually occurs within a few days. Milder symptoms may remain for a few weeks. In some cases, symptoms may persist for a few months.
Symptoms of these vestibular disorders can include:
Spinning sensation (vertigo)
Nausea and/or vomiting
Unsteadiness
Imbalance
Difficulty with vision
Impaired concentration
Difficulty walking or standing
Fatigue
Why Does Vestibular Neuritis And Labyrinthitis Occur?
Although these two conditions result in similar symptoms, they involve different parts of the ear and have different causes.
Ear Anatomy
The inner ear consists of a system of fluid filled tubes and sacs called the labyrinth. The labyrinth serves two functions: hearing and balance. The hearing function involves the cochlea, a snail shaped tube filled with fluid and sensitive nerve endings that transmit sound signals to the brain. The balance function is served by the vestibular organs including the semicircular canals, and the otolith organs, which provide the brain with information about head movement.
Signals travel from the labyrinth to the brain via the vestibular nerve and the cochlear/auditory nerve, which transmit messages to the brain for processing. When one side is affected or damaged by an infection, the brain receives mismatched information resulting in symptoms such as dizziness, vertigo, or hearing difficulties.
Figure 1. Vestibular Neuritis showing inflammation of the Vestibular Nerve
Causes of Vestibular Neuritis and Labyrinthitis
Diagnosis Of Vestibular Neuritis And Labyrinthitis
Vestibular Neuritis is diagnosed based on the description of your symptoms and a thorough medical history. Your physiotherapist will perform a comprehensive assessment to determine whether the cause of your symptoms is likely due to vestibular neuritis or labyrinthitis. This includes a variety of tests that focus on eye and head movements and balance. One in particular is the Head Impulse Test (HIT) which confirms the diagnosis of the Vestibular Neuritis/Labyrinthitis.
If required, you may also be referred for Vestibular Function Testing (VFTs) with a Vestibular Audiologist. This involves comprehensive diagnostic testing of your inner ear function. This testing can determine the type of vestibular neuritis you have: superior, inferior or total. Superior is most common, followed by inferior and total.
How Are Vestibular Neuritis And Labyrinthitis Treated?
These conditions can affect daily life significantly, even if for just a few days. If you have consulted a doctor, they may provide medications that can deliver some relief. These may include steroids to treat the infection, antiemetics to reduce nausea, and benzodiazepines to help suppress the vestibular system. Medical advice may include waiting for the infection to resolve. However, along with medication, vestibular rehabilitation therapy exercises are very beneficial in helping the brain adapt to the altered signals and improving your ability to get back to your regular daily activities. This is a process called compensation.
The acute phase of vertigo typically lasts about 72 hours, followed by a period of dizziness and imbalance, which can persist for around 6 – 12 weeks. Vestibular physiotherapy and vestibular rehabilitation can be significantly beneficial to recovery. Around 10 – 15% of people with vestibular neuritis will go on to develop benign paroxysmal positional vertigo (BPPV). This is when small crystals in the ear, called otoconia, become dislodged and require repositioning with manoeuvres that your Vestibular Physiotherapist can assist with.
Physiotherapy Exercises
Our physiotherapists tailor exercises based on your requirements and goals. This can involve a program including aspects such as:
Gaze stability exercises
Habituation exercises
Balance exercises
By providing exercises designed to stabilise vision, desensitise the body to movement, and help restore balance (4), your physio will help you work towards relieving your symptoms and getting back to your normal self. By recalibrating and retraining your vestibular system, the normal processes that help to maintain your balance and movement can be reinstated.
Vestibular Neuritis and Labyrinthitis FAQs
The length of time it takes your body to recover differs from person to person. Most people recover within the expected time frame of 6 – 12 weeks. Some people however have difficulty compensating and may take longer. Unfortunately there is no way to “speed up recovery” apart from Vestibular Physiotherapy. Our specialist physiotherapy service focuses on the symptoms and underlying factors to encourage recovery and improvement of the issue as promptly as possible.
In the first 72 hours prompt administration or Steriods such as Prednisolone is considered best practice followed by Vestibular Physiotherapy. This is pivotal in helping the brain to compensate for any dizziness and balance issues associated with the condition.
You may require further professional assistance depending on the severity of your case. We can provide advice and recommendations if required.
Vestibular Neuritis is quite rare with an annual incidence of only 3.5 per 100,000 people, meaning most people will not experience it in their lifetime. Sequential Vestibular Neuritis (occurring more than once) is around 2% which is very rare. As the condition is viral the main prevention strategies would be keeping healthy and well, however like most viruses this particular virus gets into the ear and many people do not even know they have it until their symptoms commence!
We understand that stress can contribute to these conditions, but it is not entirely understood how or why. It may exacerbate or trigger certain symptoms, or play a role in factors such as reducing the strength of your immune system or reactivating latent viruses.
Manage Vestibular Neuritis or Labyrinthitis With The Vertigo Co
If you are having difficulties with inner ear balance symptoms or have had a diagnosis of vestibular conditions, our experienced team of vestibular physiotherapists is here to help. After an initial assessment, your physio will help you work towards the best treatment outcome possible with various exercises and management strategies so you can return to your usual activities and feel better.
Please contact our friendly team to organise your first appointment.
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Resources :
- Vestibular Disorders Association (VEDA) Website: https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/labyrinthitis-and-vestibular-neuritis/
- Dr. Timothy Hain (Vestibular neurologist, University of Chicago) offers extensive educational information https://dizziness-and-balance.com/disorders/unilat/vneurit.html
References:
- Strupp M, Brandt T. Vestibular Neuritis. Oxford: Oxford University Press; 2013.
- Walker MF. Treatment of vestibular neuritis. Current Treatment Options in Neurology. 2008;11(1):41. https://pubmed.ncbi.nlm.nih.gov/19094835/
- Sjögren J, Magnusson M, Tjernström F, Karlberg M. Steroids for Acute Vestibular Neuronitis-the Earlier the Treatment, the Better the Outcome? Otol Neurotol. 2019;40(3):372-4. https://pubmed.ncbi.nlm.nih.gov/30681432/
- Hillier SL, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews. 2007(4). https://pubmed.ncbi.nlm.nih.gov/21752206/