Neuritis vestibularis is the medical term for a dysfunction of the organ of balance. In this case, the affected person suffers from rotary vertigo.
What is neuritis vestibularis?
In medicine, neuritis vestibularis is also known as neuropathia vestibularis. This refers to an acute or chronic disturbance in the function of the organ of balance, which is located in the inner ear. Other names for the disease are vestibulopathy, vestibular neuropathy, and neuronitis vestibularis. Neuronitis means “inflammation of the nerves“. Sometimes the condition is also called “hearing loss of the vestibular organ.” The incidence of neuritis vestibularis is 3.5 per 100,000 per year. It accounts for about seven percent of diagnoses in specialized clinics for vertigo. Neuropathia vestibularis is one of the three most common forms of vertigo. In most cases, the vertigo disease occurs between the ages of 30 and 60. In addition, vestibulopathy often presents in the spring or early summer.
Causes
The possible causes of neuritis vestibularis are still unclear. It is suspected that viruses are responsible for the onset of the disease. It is not uncommon for viral infections to occur before the onset of neuropathia vestibularis. However, circulatory disorders can also be the triggers of the vertigo disease. These cause functional disturbances or even a functional failure of the vestibular organ on the side of the body affected by the disease. While the brain of the affected person continues to receive normal signals on the healthy side, the diseased side shows no signal at all or only a disturbed signal. Due to this imbalance, the patient suffers from severe vertigo attacks in the early stages. Other rare causes are thought to be herpes infections, Lyme disease, and autoimmune diseases.
Symptoms, complaints, and signs
A typical symptom of neuritis vestibularis is severe spinning vertigo. This is usually accompanied by nausea and vomiting. The general condition of the patient also suffers from the disease. It is not uncommon for the vertigo to be so severe that the affected person is unable to walk without help. In some cases, the symptoms improve if the patient lies quietly on his back and closes his eyes. However, if even slight movements are performed, the condition worsens again. The symptoms of neuritis vestibularis usually last for a few days. As the condition progresses, however, they gradually improve. Another accompanying symptom of neuropathia vestibularis is nystagmus, in which jerky eye movements occur. The eyes move in the direction of the nerves of the vestibular organ, which are not affected by the disease. In addition, a tendency to fall to the affected side when standing or sitting is considered typical. As a rule, the patient’s hearing is not affected by neuritis vestibularis.
Diagnosis and course of the disease
If neuritis vestibularis is suspected, a physician should be consulted. This first deals with the anamnesis (medical history) of the patient and lets him describe the symptoms. Also of interest are possible previous diseases. The nystagmus of the eyes also plays an important role. To check this, the patient puts on special Frenzel glasses. The next step is to perform a vestibular examination to check balance. This involves exposing the auditory canal to a warm irrigation. The eyes are also checked during this procedure. People suffering from vestibular neuritis do not show any changes in the direction of nystagmus. Special ear, nose and throat examinations or diagnostic imaging procedures may also be useful. These include sonography (ultrasound examination), computed tomography (CT) or magnetic resonance imaging (MRI). The ear, nose and throat specialist makes the diagnosis by performing a caloric examination of the inner ear. This involves a thermal hypoexcitability at the organ of equilibrium, which is caused by warm or cold water or air, respectively. Since vertigo attacks can also have numerous other causes, their differentiation is particularly important when neuritis vestibularis is suspected. Possible diseases may be Meniere’s disease or benign positional vertigo.Neuritis vestibularis usually takes a positive course. In most patients, the sense of balance is restored or at least improved after a period of about twelve weeks. However, about 15 percent of all those affected also suffer from benign positional vertigo.
When should you see a doctor?
Gait unsteadiness and an increased incidence of accidents or falls are signs of an existing irregularity. They should be presented to a physician so that serious damage can be prevented. In case of dizziness, nausea and vomiting a doctor is needed. Characteristic is a so-called spinning dizziness, which triggers an impossibility to walk straight. If there is a lopsidedness of the body during locomotion, unsteadiness of movement or an overall very unstable appearance, a doctor should be consulted. If unusual eye movements of the affected person are noticed by bystanders, this should be discussed with a physician. Characteristic of vestibular neuritis is a temporary spontaneous healing. This occurs as soon as the affected person allows himself to rest in the supine position and closes his eyes. At the same time, the symptoms increase in intensity as soon as slight movements are performed. If help is needed to move around, if everyday tasks can no longer be performed alone, or if hearing is impaired, a doctor should be consulted. Often there is a feeling of pressure in the ear, ringing in the ears or certain frequencies can no longer be heard as usual. A tendency of the affected person to fall when sitting or standing is considered unusual. It should be clarified by a doctor so that the cause of the complaints can be diagnosed and treatment initiated.
Treatment and therapy
Sometimes, neuritis vestibularis may require that affected individuals be treated as inpatients in a hospital. Thus, patients must remain on bed rest for a period of time. They are given appropriate medications to treat symptoms such as dizziness, vomiting and nausea. To improve blood circulation, several infusions take place. These are also helpful to replace fluids lost due to vomiting. The glucocorticoid methylprednisolone is considered a proven medication. Treatment with the substance lasts about a week. In the course of therapy, the dose is gradually reduced to restore the vestibular nerve. If the disorder does not improve again after a short time, training measures take place in which the patient learns how to deal with his or her complaints. The focus is on intensive balance training. It serves to accelerate the healing process. To this end, the physician exposes the vestibular system under controlled conditions to situations that cause dizziness. The stimulus can be used to promote recovery.
Complications
In general, the prognosis for neuritis vestibularis is favorable. Serious complications occur only occasionally. In most cases, the dizziness resolves after about a quarter of a year. In rare cases, however, recurrences can occur, but these then affect the other ear. In addition, benign positional vertigo occurs in the same ear in about 15 percent of all patients. This can also be treated well and is only a temporary phenomenon. However, the situation becomes more complicated for those affected who experience the disease-related rotational vertigo as a traumatic event. In these cases, phobic vertigo may also develop. Since this cannot be attributed to organic causes but exclusively to psychological causes, the therapy here must concentrate on eliminating the anxiety disorder. A possibly serious complication of vertigo can be triggered by a dangerous fall, which is often associated with serious injuries and bone fractures. This risk particularly affects older people whose bone stability is already additionally reduced by osteoporosis. Very rarely, neuritis vestibularis results in chronic bilateral loss of labyrinth. Here, the standing and walking motor function is disturbed in darkness or with closed eyes. In the long term, this double strain on both ears often leads to complete disorientation in space. The practice of dangerous professions or risky sports is then no longer possible.
Outlook and prognosis
The course and prognosis of vestibular neuritis are favorable. In most cases, spontaneous healing occurs within two to three weeks. In the majority of affected individuals, the sense of balance normalizes completely or at least partially after 12 weeks at the latest. However, some patients still experience dizziness after several months. In only rare cases does the dizziness change into other forms of vertigo or balance disorders. For example, up to 15 percent of those affected also experience what is known as benign paroxysmal positional vertigo (benign positional vertigo) in the affected ear. This is characterized by brief attacks of rotational vertigo during movements or changes in the position of the head (looking down or up, turning the head) or when lying down. The persistent spinning vertigo can also traumatize the affected person to such an extent that a phobic spinning vertigo develops due to an anxious expectation of a possible vertigo attack. The individual prognosis in this case depends primarily on the affected person being physically activated again as quickly as possible. The general condition is also significant for the prognosis. Older affected persons often suffer longer from the existing symptoms due to their comparatively poorer general condition. Recurrences (recurrence of vertigo) occur only in very rare cases and then generally affect the ear that was not previously affected.
Prevention
Preventive measures against neuritis vestibularis are not known. Thus, the causes of the vertigo disease are still in the dark.
Follow-up
In most cases of neuritis vestibularis, the patient has very few and limited options for direct follow-up care. Therefore, the affected individual should ideally see a physician at an early stage, including initiating treatment to prevent the occurrence of further complications and symptoms. There can be no self-healing, so medical treatment is always necessary. Most patients are usually dependent on taking various medications. The affected person should follow all instructions of the doctor and take the medication regularly and also in the correct dosage. A doctor should always be consulted first if there are any questions or if anything is unclear. Furthermore, in many cases the support of the affected person by his own family is necessary. Affected persons should drink plenty of fluids to alleviate the symptoms. The medication itself can be slowly discontinued after consultation with a doctor. Often, contact with other sufferers of neuritis vestibularis can also be very useful, as this leads to an exchange of information, whereby this can significantly facilitate the patient’s daily life.
What you can do yourself
After a clear diagnosis of neuritis vestibularis, measures of everyday life and self-help can have an effect on improving the handling of the disease and on shortening the healing process. Regardless of whether the disease is due to circulatory disorders in the vestibular organs or other underlying causative factors, practical exercises are useful in addition to drug treatment. They also serve to directly encounter and relieve the vertigo and nausea attacks. To overcome nystagmus, the choppy involuntary eye movement. For example, it helps to sit upright on a chair and in front of the eyes with 30 cm to 50 cm distance, move the hand to the right and to the left with the finger extended. The eyes should follow the hand or finger without turning the head. Through the exercise, the involuntary eye movement (nystagmus) is superimposed by a voluntary eye movement and weakens the nystagmus. Other regularly performed exercises that normally serve to strengthen the vestibular organs also help to overcome nausea due to neuritis vestibularis. Specifically, these are exercises such as “standing on one leg,” “walking on one line,” or “walking sideways and backwards.” Blood flow is promoted through physical exercise. Combinations of movement and training of balance, such as dancing, are particularly effective.
