Vestibular neuronitis (VN), or so-called labyrinthitis, is affiliated with viral or post-infectious inflammatory lesions of the particular vestibular structure located at the eighth pair of cranial nerves.
Vestibular neuronitis is characterized by rapid onset with marked persistent dizziness, nausea, vomiting, and unsteadiness when walking. Objective examination data corresponds to acute lesions of the peripheral parts of the vestibular analyzer. They primarily cover spontaneous vestibular nystagmus, a positive test of “impulse head rotation”, and unsteadiness when walking without losing the ability to walk. The isolated vestibular disorders do not lead to impaired hearing. In cases of a combination of those disorders with unilateral hearing loss, the syndrome is called labyrinthitis.
The diagnosis of inner ear dysfunctions is usually based on clinical findings. The clinical picture of cerebellar hemorrhage or cerebellar infarction may be similar to vestibular neuronitis; therefore, neuroimaging is required to exclude these conditions.
The sufferers usually describe severe vestibular symptoms that persist for several days, followed by a decrease in the severity of symptoms, restoration of a sense of balance. Corticosteroid therapy can speed up patient recovery.
According to the prognosis of the complication effects and recurrence cases, only 2% to 11% of the patients could have the repeated inner ear disorders.
Symptoms and signs for vestibular disorders
The aforesaid disorders have a monophasic course that implies an acute or subacute onset with the subsequent subsiding symptoms. The duration of clinical manifestations averages from one week to three months (full indications last from several days to few weeks). After this period has expired, the disease disappears without a trace.
The disease begins with severe dizziness, accompanied by a particular type of nystagmus. Vertigo increases with head movements and decreases with fixation of the gaze. In 78% of cases, it appears suddenly; in 22% of patients 1-2 days before the onset of the disease, there are phenomena in the form of instability and little impaired coordination of movements. The specialized doctors often observe oscillopsia, meaning a fuzzy visual perception of surrounding objects when performing passive or active head movements due to image instability on the retina. Coordination of movements and their balance is severely disturbed. Almost all patients have nausea, and 65% have vomiting.
The first day of the disease requires the patient to keep to the bed regime because the slightest head movements provoke nausea and vomiting. On the 2nd-5th day, the patient can move inside the room; however, the unsteadiness of the gait remains, and sudden head movements or walking long distances provoke nausea. On the 10-14th day, the patient complains of “heaviness” in the head, fatigue, but in general, he feels healthy and can return to his usual way of life.
At the beginning of the disease development, the brain “understands” that the vestibular apparatus is transmitting an incorrect sensory signal: a restorative labyrinth is always in an active state, but the other (affected) is depressed, which is interpreted by the brain as a constant rotation in a healthy direction. Whereas it is impossible to restore the affected vestibular nerve conducting abilities in a short time, the brain blocks the activity of a healthy labyrinth, aligning the flow of sensory signals from both vestibular apparatuses. Once the vestibular nerve recovers, the control system returns to its original, healthy state.
Diagnostic and treatment measures for vestibular neuritis or labyrinthitis
Vestibular neuritis is also distinguished by accompanying diseases like labyrinthitis, Meniere’s disease, neuroma (tumor) of the VIII pair of cranial nerves, multiple sclerosis, stroke, and vestibular migraine.
In the vast majority of cases, the diagnosis is based on a typical clinical picture. The diagnosis can be confirmed using the specialized equipment and methods:
- VNG which helps to record the movement of the eyeballs when performing a series of tests;
- impulse head movement test. This test assesses the functionality of six semicircular canals at once. This component of the inner ear is also responsible for coordination;
- Fuduko’s test or a march test, when a deviation of the patient’s current state from the initial position is assessed.
Other tests and examinations, including audiometry (hearing) and MRI of the brain, are performed when indicated to rule out other causes of vertigo.
The main directions of therapy for patients with VN are reducing dizziness, nausea, vomiting (symptomatic treatment), and the acceleration of vestibular compensation.
Symptomatic treatment includes the use of drugs that suppress vestibular function:
- antihistamine agents,
- benzodiazepine tranquilizers,
Symptomatic treatment is recommended for no more than three days since it reduces vestibular compensation, which leads to persistent dizziness.
The pharmacological therapy could also apply glucocorticosteroids. However, their effectiveness is currently being questioned because there is no convincing evidence of accelerated recovery of the vestibular nerve in treated patients.
Despite the presumptive viral etiology of VN, associated with herpes simplex virus type 1, the use of antiherpetic drugs also does not accelerate the healing process, and they should not be used in its treatment.
Since about the third day of illness, patients with VN are recommended vestibular gymnastics – exercises that accelerate compensatory processes, from simpler to more complex. These are exercises for fixing the gaze, training eye movement reactions, for maintaining balance in various postures while standing and in motion.
How is labyrinthitis dangerous?There is some information about the etymology of the mentioned diseases, most likely resulting from virus agents. The virus nature makes them more resistant to complete withdrawal out of the organism. In such a way, they could exist in a hidden state and accumulate their living functions under comfortable conditions.
What are the causes of vestibular neuritis or labyrinthitis?The famous triggers of vestibular disorders are allergies, food infections, metabolic disturbances, and frequent alcohol consumption. Anyway, the mentioned inner ear disorders could refer to accompanying symptoms of more severe and fatal diseases. So, if you have any suspicious neurological abnormalities (vertigo, vomiting, dizziness, etc.), you need to immediately contact our clinic to receive the proper medical consultations and examinations. Our doctors have a rich experience in remedying these complicated ailments.
What treatment options are the most effective ones in case of VN diagnosed?The healing process is specific and needs the mutual affords of the treating doctor and the patient. Upon the well-organized diagnosis manipulations, the doctor should prescribe the respective medical products (antihistamine agents, benzodiazepine tranquilizers, antiemetics, etc.) to reduce the signs of the disease. Also, a patient is advised to do physical exercises in the form of particular movements of the head. The actions should be accurate and provide minimum adverse effects.
What is the medical treatment the best to overcome VN-like ailments?It would be best if you choose only the certified and well-respected clinic whose specialists have the respective knowledge to improve your health without any hazardous consequences because the VN healing process is long and requires particular skills.
How could the VN-like disturbances be prevented?Every person should follow few rules to eliminate the possible chances of the VN disease catch: timely treat viral and infectious diseases; do not abuse alcohol; adhere to a healthy lifestyle; undergo a preventive examination at least once a year; at the first sign of the disease, apply for a consultation with a doctor. Unfortunately, VN-concerned ailments have become typical occurrences disturbing many people; however, our clinic is ready to consult you in case of any resembled disorders which could mean more dangerous diseases. We are glad to help people because we know a secret for healthy, long-term, and joyful living conditions.