Disease Description (Causes and Symptoms)
- Definition: Vestibular neuronitis is a condition in which acute inflammation develops in the vestibular nerve, which transmits sensory information from the vestibular organs of the inner ear, causing severe spinning or whirling dizziness (rotational vertigo) and balance problems.
- Causes/Pathophysiology: Although the exact cause is unknown, it is generally thought to result from viral or immune-mediated inflammation of the vestibular nerve, usually after an upper respiratory viral infection. Rarely, the possibility of impaired blood flow (ischemia) to the vestibular nerve has also been proposed. The lesion is commonly limited to the peripheral vestibular system (the vestibular organs and vestibular nerve).
- Main symptoms: Sudden-onset severe rotational dizziness (lasting from several hours to several days), nausea and vomiting, difficulty walking and balance problems, nausea, and sometimes tinnitus, malaise, and sweating. Typically, other central nervous system symptoms (speech difficulties, facial paralysis, limb paralysis, etc.) do not occur. The symptoms are continuous and intense at first and gradually improve after several days, but mild imbalance may persist for several weeks to several months.
Treatment Methods
- Acute phase (first several days)
- Symptom-relieving medications: Antiemetics (e.g., metoclopramide) and vestibular suppressants (e.g., meclizine or short-term use of benzodiazepines) may be used to control nausea, vomiting, and severe dizziness.
- Steroids: Some guidelines and studies have reported that initial high-dose oral steroids (e.g., prednisone) may help restore peripheral vestibular function, but whether to use them is determined based on the patient's condition and the physician's judgment.
- Consideration of inpatient treatment: In cases of severe vomiting, dehydration, inability to walk, or when differential diagnosis is necessary (to rule out brain disease).
- Recovery phase (after symptoms improve)
- Early activity recommended: Avoid prolonged use of sedatives and resume daily activities and walking as soon as possible to promote central compensation and vestibular adaptation.
- Vestibular rehabilitation (physical therapy): When persistent imbalance or dizziness remains, specialized vestibular rehabilitation exercises (such as eye-head coordination and somatosensory-vestibular training) can promote recovery.
- Procedures/surgery: Vestibular neuronitis is basically a nonsurgical condition, and surgery is not necessary.
- Lifestyle management and precautions
- During the acute phase, the risk of falling is high, so get assistance when walking and do not drive or operate machinery.
- Avoid excessive use of sedatives and alcohol, as they may delay recovery.
- If the symptoms suddenly change or new neurological symptoms (speech difficulties, weakness in the arms or legs, paralysis on one side of the face, etc.) appear, visit an emergency room immediately.
Checklist Before an Outpatient Visit (Including Preparation Items and Example Questions)
- Items to prepare/bring
- A list of all medications currently being taken (including prescription drugs, OTC medicines, and herbal medicines) or medication bags
- Recent test results performed at a hospital (CT/MRI, blood tests, otolaryngology tests, etc.) and medical records, if available
- Notes on when the symptoms began and how they have progressed (the time the dizziness started, its duration, factors that worsen or improve it, and accompanying symptoms such as vomiting and tinnitus)
- A record of activity limitations when the dizziness is severe (impact on driving, work, and daily life)
- Recommended photos/videos to show the doctor during the outpatient visit: If you have a video showing your walking ability or involuntary eye movements (nystagmus) at the time of onset, it may help with diagnosis.
Examples of General Questions to Ask the Doctor
- "What are the main side effects of the medication you prescribed, and how long should I take it?"
- "What is my prognosis? How long does it usually take to return to daily life, driving, and work?"
- "How likely is recurrence, and are there any lifestyle guidelines to reduce the risk of recurrence?"
Examples of Condition-Specific Questions
- "How can you determine with certainty whether these symptoms are caused by a central cause, such as a stroke? Do I need an MRI or additional tests?"
- "When should I start vestibular rehabilitation (physical therapy), and what are the expected treatment duration and effects?"
(Note: If necessary, the doctor may recommend a neurological examination, observation of nystagmus, and, if needed, brain MRI or vestibular function tests (VEMP, dynamic visual acuity testing, vestibular evoked myogenic potential testing, etc.).)