Medicines for Vestibular neuritis

What it is

Vestibular neuritis (or vestibular neuronitis) is inflammation of the vestibular nerve — the nerve that carries balance information from the inner ear to the brain — usually thought to follow a viral infection. When this balance nerve is affected on one side, the brain receives mismatched signals, causing sudden, severe vertigo (a strong spinning sensation), often with nausea, vomiting, unsteadiness, and difficulty walking. A key feature is that, unlike some other inner-ear conditions, vestibular neuritis affects balance but not hearing — so there is usually no hearing loss or ringing (if hearing is affected too, a related condition called labyrinthitis is more likely). The vertigo typically comes on quite suddenly and is severe at first, often lasting for a few days, and can be very distressing and disabling initially. Over the following days to weeks, it gradually improves as the acute inflammation settles and, importantly, as the brain adapts and "recalibrates" to compensate for the affected nerve. Most people recover well, though some have milder unsteadiness or brief dizziness for a while as the brain adjusts. Because sudden severe vertigo can occasionally have other, more serious causes (such as a stroke, particularly with certain other symptoms), a first severe episode should be assessed to confirm the diagnosis.

How it is treated

Assessment first confirms that the vertigo is due to vestibular neuritis and excludes other causes, particularly a stroke, which can occasionally mimic it (certain features, such as severe headache, double vision, slurred speech, weakness, or the pattern of the eye movements, prompt urgent evaluation). Once confirmed, management focuses on relieving the acute symptoms and supporting recovery. In the first few days, when the vertigo, nausea and vomiting are severe, short-term medicines to reduce these symptoms (such as anti-sickness and vestibular sedative medicines) can help, along with rest and staying hydrated. Importantly, these symptom-relieving medicines are used only for a short time, because using them for too long can actually slow the brain's natural adaptation. The key to recovery is then to gradually return to normal activity and movement as the severe symptoms ease, rather than staying still — because movement and activity help the brain recalibrate and compensate; for people whose balance is slow to recover, a specific programme of balance retraining exercises (vestibular rehabilitation), guided by a physiotherapist, is very effective at speeding recovery. Most people recover well over weeks. The reassuring message is that vestibular neuritis, though it causes distressing sudden vertigo, usually settles over days to weeks as the brain adapts, that recovery is helped by staying active and, if needed, balance retraining, and that a first severe episode should be assessed to confirm the cause.