Vestibular neuritis (VN) is the idiopathic inflammation of the vestibular nerve. Although the etiology is unclear, it is thought to be viral in origin because it commonly occurs after upper airway infections. The disorder manifests as acute vestibular syndrome with persistent, acute-onset vertigo, nausea and vomiting, and gait instability in otherwise healthy patients. When hearing loss is present, it is sometimes referred to as labyrinthitis. Diagnosis is clinical and should include a complete otoneurological examination to exclude a central cause of acute vestibular syndrome, such as cerebellar stroke or lateral medullary syndrome. Vestibular rehabilitation therapy is the most important aspect of treatment and should be initiated as soon as possible. Symptomatic therapy with vestibular suppressants may be considered during the acute phase. Glucocorticoids are no longer routinely recommended as there is insufficient evidence regarding their long-term efficacy. The acute phase of severe vertigo usually lasts a few days and symptoms typically resolve in 2–3 weeks with treatment. In refractory cases, which are rare, vestibular ablation therapy or surgery involving the inner ear may be necessary.
See also “Vertigo.”
See also “Acute vestibular syndrome.”
- Vestibular neuritis: inflammation of the vestibular nerve with features of vestibular hypofunction, such as vertigo, nausea, vomiting, and gait instability, usually without hearing loss 
- Labyrinthitis: ipsilateral sensorineural hearing loss associated with features of vestibular neuritis 
- Acute peripheral vestibulopathy: a term used to encompass peripheral causes of acute vestibular syndrome (i.e., vestibular neuritis and labyrinthitis) 
- Acute or subacute onset 
Progression and duration of symptoms
- Usually develop over several hours
- Severe symptoms usually last for 1–2 days
- Mild symptoms may persist for weeks or even months.
- Characteristic findings on
- Neurological examination is otherwise normal.
The presence of neurological abnormalities (e.g., truncal ataxia) in a patient with acute vestibular syndrome should raise suspicion for a central cause (e.g., cerebellar stroke, lateral medullary syndrome).
Subtypes and variants
- Definition: inflammation of the inner ear, notably the membranous labyrinth
- Infectious: viruses, bacteria, fungi
- Autoimmune systemic diseases (e.g., due to vasculitis)
- Other: head trauma, vascular ischemia, ototoxic drugs (e.g., aminoglycosides)
- Pathophysiology: toxins or bacteria spread to the inner ear (labyrinth) through the round or oval window
- Severe vertigo, nausea, and vomiting
- Hearing loss, tinnitus
- Nystagmus direction toward healthy ear: Labyrinthitis causes decreased vestibular activity (due to damage) and is typically associated with nystagmus toward the healthy ear. 
- Fever, ear rash, facial paralysis in case of herpes zoster oticus
- Treatment: based on the underlying cause
- Vestibular neuritis is a clinical diagnosis.
- Perform a complete otoneurological examination to in all patients.
- Obtain urgent neuroimaging if clinical evaluation suggests central vertigo and in patients with .
- Viral testing (culture or serology) is not routinely recommended 
- See also “ ” for information on additional investigations for ,e.g., audiometry and .
Hospital admission may be necessary in patients with severe symptoms or if there is any concern for a central etiology of symptoms.
Therapy is primarily supportive; see “” for more information.
- Antiemetics and : only indicated in the acute setting.
Corticosteroids (e.g., prednisone ) 
- Not routinely recommended 
- There is evidence they improve recovery at the one-month mark, but long-term benefits are uncertain. 
- If considered , they should be started within 72 hours of symptom onset. 
- Antiviral therapy: not routinely recommended 
Other therapies 
- Vestibular rehabilitation therapy: facilitates central vestibular compensation and accelerates recovery.
- Interventional therapy
- BPPV: In about 10–15% of patients, BPPV develops within weeks of vestibular neuritis onset. 
- Persistent postural perceptual dizziness: fear of falling or unsteadiness without actual falls or vestibular dysfunction to explain the symptoms 
We list the most important complications. The selection is not exhaustive.
- Spontaneous recovery or central vestibular compensation and habituation within a few weeks is common (good prognosis). 
- Recurrence is uncommon (2–11%).