Common Vestibular Issues
Vestibular Neuritis/Labyrinthitis
What is Vestibular Neuritis/Labyrinthitis and what are the symptoms?
Vestibular Neuritis and Labyrinthitis are disorders resulting from an infection that inflames the inner ear, or the nerves connecting the inner ear to the brain (1). This inflammation disrupts the transmission of sensory information from the ear to the brain resulting in vertigo, dizziness, and difficulties with balance, vision and/or hearing (1).
Symptoms of vestibular neuritis can be mild or severe and often include a violent spinning sensation (vertigo) lasting around 24 – 48 hours. Other symptoms may include nausea, vomiting, unsteadiness, imbalance, difficulty with vision and impaired concentration. At times symptoms can be so severe that they affect the ability to stand or walk (2). Once the initial symptoms have subsided clients may be left with ongoing symptoms of dizziness which is worse with head movement, impaired balance, poor concentration and fatigue. Viral Labyrinthitis may produce the same symptoms along with tinnitus (ringing in the ears) and or hearing loss.
What causes it?
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 dizziness or vertigo. Infections of the inner ear are usually due to reactivation of the herpes simplex virus that affects the vestibular system (2). Such inner ear infections are not the same as middle ear infections, which are common in childhood.
How is it diagnosed?
Vestibular Neuritis is diagnosed based on the description of your symptoms, a thorough medical history, along with specific tests (such as the head impulse test) for this condition. Your therapist will perform a comprehensive Physiotherapy assessment to determine whether the cause of your symptoms is likely due to Vestibular Neuritis.
If required, you may also be referred for Vestibular Function testing – which includes comprehensive diagnostic testing of inner ear function. Your Physiotherapist will determine whether this testing is required.
How is it treated?
In the early stage of Vestibular Neuritis (the first 72 hours) medications are often prescribed to reduce the inflammation process and to assist in suppressing your symptoms (3). Medications may include:
Steroids to treat the infection (such as Prednisolone)
Anti-emetics to reduce nausea (such as Stemetil)
Benzodiazepines to help suppress the vestibular system (such as Valium)
Along with medication, vestibular rehabilitation exercises may be provided to help the brain adapt to the altered signals resulting from labyrinthitis or neuritis in a process called compensation. These exercises may include exercises to stabilise vision, exercises that help to desensitise the body to movement and also exercises to help to restore your balance (4). Your Physiotherapist will prescribe these exercises based on a comprehensive assessment.
References:
1. Strupp M, Brandt T. Vestibular Neuritis. Oxford: Oxford University Press; 2013.
2. Walker MF. Treatment of vestibular neuritis. Current Treatment Options in Neurology. 2008;11(1):41.
3. 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.
4. Hillier SL, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews. 2007(4).