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Vestibular neuritis

 Sudden severe vertigo is one of the most frightening medical experiences a person can have — and vestibular neuritis is one of its most common causes. In this course, we walk through the full picture: the characteristic clinical history that distinguishes vestibular neuritis from other causes of vertigo, the physical examination findings that confirm the diagnosis, and a critical, evidence-based review of management options. Healthcare providers will find additional detail on examination findings and clinical decision-making throughout.

 

This material is intended for educational purposes only, and does not substitute evaluation by a qualified health care professional.

In developing this course we reviewed literature (so that you don't have to!)

  

The article that originally described this condition:

  • Ruttin E, "Zur differential diagnose der Laybrinth- und Hörnerverkrankungen [On the differential diagnosis of labyrinthine and hearing diseases]," Zeitschrift für Ohrenheilkunde [Journal of Otology] 1909;57: 327-331.

 

Literature that may be useful to patients:

  • Bogdanova A, Dlugaiczyk J, Heckmann JG, Schwab S, “Corticosteroids in patients with vestibular neuritis: An updated meta-analysis,” Acta Neurol Scand 2022;146: 429-439. doi: 10.1111/ane.13676
  • Clemis J, Becker G, “Vestibular neuronitis,” Otolaryngol Clin North Am 1973;6:139-155.
  • Huppert D, Strupp M, Theil D et al, “Low recurrence rate of vestibular neuritis: A long-term follow-up,” Neurology 2006;67:1870-187.
  • Kim G, Seo JH, Lee SJ, Lee DH, “Therapeutic effect of steroids on vestibular neuritis: Systematic review and meta-analysis,” Clin Otolaryngol 2022;47: 34-43. doi: 10.1111/coa.13880
  • Leong KJ, Lau T, Stewart V, Canetti EFD, “Systematic Review and Meta-analysis: Effectiveness of Corticosteroids in Treating Adults With Acute Vestibular Neuritis,” Otolaryngol Head Neck Surg2021;194599820982910. doi: 10.1177/0194599820982910
  • Mandalà M, Santoro GP, Awrey J et al, “Vestibular neuritis: recurrence and incidence of secondary benign paroxysmal positional vertigo,” Acta Otolaryngol 2010;130(5):565-7.
  • Schuknecht H, Kitamura K, “Vestibular neuronitis,” Ann Otol Rhinol Laryngol 1981;90(Suppl):1-19.
  • Strupp M, Arbusow V, Maag K et al, “Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis,” Neurology 1998;51(3):838-844.
  • Strupp M, Bisdorff A, Furman J, Hornibrook J, Jahn K, Maire R, Newman-Toker D, Magnusson M, “Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria,” J Vestib Res 2022;32: 389-406. doi: 10.3233/VES-220201
  • Strupp M, Brandt T, “Vestibular neuritis,” Semin Neurol 2009;29(5):509-19.
  • Strupp M, Zingler VC, Arbusow V, et al, “Methylprednisolone, valacyclovir, or the combination for vestibular neuritis,” NEJM 2004;351(4):354-61.
  • Yoo MH, Yang CJ, Kim SA, Park MJ, Ahn JH, Chung JW, Park HJ, “Efficacy of steroid therapy based on symptomatic and functional improvement in patients with vestibular neuritis: a prospective randomized controlled trial,” Eur Arch Otorhinolaryngol 2017;274: 2443-2451. doi: 10.1007/s00405-017-4556-1

 

Literature for specialists who want to dig deeper:

  • Dix M, Hallpike C, “The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system,” Ann Otol Rhinol Laryngol 1952;61:987-1016.
  • Fishman JM, Burgess C, Waddell A, “Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis),” Cochrane Database Syst Rev: 2011;CD008607. doi: 10.1002/14651858.CD008607.pub2
  • Halmagyi GM, Curthoys IS, “A clinical sign of canal paresis,” Arch Neurol 1988;45: 737-9. doi: 10.1001/archneur.1988.00520310043015.
  • MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS, “The video head impulse test: diagnostic accuracy in peripheral vestibulopathy,” Neurology 2009;73: 1134-41. doi: 10.1212/WNL.0b013e3181bacf85
  • Navari E, Casani AP, “Lesion Patterns and Possible Implications for Recovery in Acute Unilateral Vestibulopathy,” Otol Neurotol 2020;41: e250-e255. doi: 10.1097/MAO.0000000000002476
  • Neuhauser HK, Lempert T, “Vertigo: Epidemiologic aspects,” Semin Neurol 2009;29(5):473-481.
  • Taylor RL, McGarvie LA, Reid N, Young AS, Halmagyi GM, Welgampola MS, “Vestibular neuritis affects both superior and inferior vestibular nerves,” Neurology 2016;87: 1704-1712. doi: 10.1212/WNL.0000000000003223
  • Yacovino D, Barreiro M, Rango G, Sacheri C, Gualtieri F, “Neuritis vestibular: eficacia de la prednisona en la recuperación funcional [Vestibular neuritis: efficacy of prednisone in functional recovery],” Neurología Argentina 2010;2: 149-154. doi: 10.1016/S1853-0028(10)70051-3