See Vertigo & Dizziness

Vestibular neuronitis

Vestibular neuronitis is a cause of vertigo that often develops following a viral infection.

Features

• recurrent vertigo attacks lasting hours or days
• nausea and vomiting may be present
• horizontal nystagmus is usually present
• NO hearing loss or tinnitus

Differential diagnosis

• viral labyrinthitis
  • it also follows viral infection and presents with vertigo; but it characteristically involves both the vestibular and cochlear portions of the inner ear. Therefore, patients typically present with hearing loss and/or tinnitus in addition to vertigo
• posterior circulation stroke: the HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

Management

• buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
• a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
• vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms

Labyrinthitis

Labyrinthitis is an inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs. Labyrinthitis can be viral, bacterial or associated with systemic diseases. Viral labyrinthitis is the most common form of labyrinthitis.

Labyrinthitis should be distinguished from vestibular neuritis as there are important differences: vestibular neuritis is used to define cases in which only the vestibular nerve is involved, hence there is no hearing impairment; Labyrinthitis is used when both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment.

Epidemiology