Vestibular neuritis is an important balance organ disease that develops as a result of inflammation of the balance nerve located in the inner ear and manifests with sudden onset, intense dizziness. Patients generally have difficulty standing up due to vertigo, which appears suddenly and feels as if the surroundings are spinning rapidly; severe nausea, vomiting, and loss of balance accompany the condition. This situation often requires emergency room visit and seriously restricts daily life.

Vestibular neuritis mostly appears following viral infections. Inflammation developing in the vestibular nerve following diseases such as flu, upper respiratory tract infections, or COVID-19 causes the brain to be unable to correctly interpret balance signals. This disease is seen more frequently especially in adults aged 30-60 and is one of the most common causes of acute vestibular syndrome.

Although vestibular neuritis is a disease that can completely heal with early diagnosis and correct treatment, in cases where treatment is delayed, chronic complaints such as long-lasting imbalance, swaying sensation while walking, and visual focusing problems can become permanent. Therefore, correct recognition and management of vestibular neuritis are of great importance.

In this guide, we will explain, based on scientific foundations, how dizziness attacks caused by vestibular neuritis develop, which tests are used in the diagnostic process, and the most current treatment options. The aim is to support patients in faster recovery and preservation of quality of life.

What is Vestibular Neuritis?

Vestibular neuritis is a dizziness disease that occurs as a result of inflammation of the vestibular nerve that ensures balance in the inner ear. This condition causes sudden disruption of signals transmitted to the brain’s balance center and manifests with severe, suddenly starting vertigo attacks. Patients generally describe it as “the ground is slipping from under my feet,” “the surroundings suddenly started spinning.”

The most important feature of vestibular neuritis is absence of hearing loss. Therefore, it is easily distinguished from labyrinthitis disease where both dizziness and hearing loss are seen together. The disease mostly affects one ear and the function of the balance nerve on that side temporarily weakens.

As a result of inflammation, nerve transmission in the vestibular nerve is disrupted; this confuses the brain and creates sudden disconnection in balance perception. As the body tries to compensate for this unexpected situation, symptoms such as nausea, vomiting, sweating, and involuntary eye drift (nystagmus) develop.

Vestibular neuritis is generally limited to a single attack and significant improvement is seen over time with brain adaptation (central compensation). However, in some people, imbalance complaints that can last for months may remain. At this point, vestibular rehabilitation exercises are one of the most critical stages of treatment.

In conclusion, vestibular neuritis is a disease that starts rapidly, leads to intense dizziness but can completely heal with correct treatment.

What Causes Vestibular Neuritis?

Although the exact cause of vestibular neuritis is not fully known, the strongest scientific view is that this disease appears following viral infections. Following diseases such as upper respiratory tract infections, flu, common cold, or COVID-19, the immune system’s response can lead to inflammation of the vestibular nerve. Therefore, many patients have a history of fever, nasal discharge, or sore throat lasting a few days before the severe dizziness attack.

Herpes viruses (especially Herpes Simplex and Varicella Zoster) can remain silently in the vestibular nerve for a long time and can reactivate during periods when the immune system is weakened, causing sudden damage to the nerve. This mechanism is the most commonly accepted theory in explaining the disease.

In some cases, it is thought that vestibular neuritis develops as a result of autoimmune processes. The body may mistakenly attack its own vestibular nerve and this situation can cause disruption of nerve transmission.

Other conditions with the possibility of triggering the disease are:

• Severe stress and sleep deprivation
• Weakening of the immune system
• Seasonal infection periods
• Sudden temperature changes
• Physical traumas
• Smoking and chronic diseases

Vestibular neuritis can be seen at any age but most commonly appears in the 40-70 age range. The occurrence rate is similar in women and men.

What are the Symptoms of Vestibular Neuritis?

Vestibular neuritis symptoms generally start suddenly and can create great fear and helplessness in the patient. The most prominent symptom is sudden onset severe dizziness (vertigo) in the form of spinning surroundings. Patients describe it as “The ground is slipping from under my feet” or “Everything suddenly started spinning.” This vertigo is generally a continuous spinning sensation, does not come in short-duration attacks, and reaches maximum severity in the first 24-48 hours, then gradually lightens over days.

Intense imbalance mostly accompanies dizziness. The patient has difficulty standing, shows tendency to fall toward the affected side when trying to walk. For this reason, most patients have to apply to the emergency room. Autonomic symptoms such as nausea, vomiting, cold sweating, palpitations, blood pressure changes are also very frequently seen.

Another finding specific to vestibular neuritis is involuntary eye drifts called nystagmus. This finding allows the neurology or ENT specialist to get important diagnostic clues during examination.

As a distinguishing feature, hearing is preserved. In vestibular neuritis, tinnitus or significant hearing loss is not expected. This situation shows that the hearing part of the inner ear is not affected and plays a critical role in distinguishing from other diseases such as labyrinthitis.

The natural course of the disease is as follows:

• First 1-3 days: Severe vertigo + intense nausea-vomiting
• 1-2 weeks: Imbalance, slipping while walking, and movement sensitivity
• 3-12 months: Gradual recovery with central nervous system compensation

In some people, fear of movement, anxiety, and panic attacks can develop after the acute period. Therefore, psychological support is an important part of the recovery process.

Vestibular neuritis is distinguished among dizziness diseases by its sudden onset and preservation of hearing. When diagnosis and treatment are delayed, the recovery process can be prolonged.

Barany Society Vestibular Neuritis Diagnostic Criteria (Acute Unilateral Vestibulopathy / Vestibular Neuritis)

For diagnosis, all of items A, B, C, and D must be met:

A) Acute Vestibular Syndrome

• Sudden onset severe vertigo
• Continuous rotational dizziness continues for hours-days
• Nausea, vomiting, imbalance, and restlessness accompany

B) Unilateral Peripheral Vestibular Dysfunction Findings

At least one of the following findings must be present:

• Spontaneous nystagmus in the direction opposite to the affected ear
  (nystagmus that decreases with visual fixation)
• Head Impulse Test positive (catch-up saccades)
• More than 25% canal paresis in caloric test
• Semicircular canal gain reduction with Video Head Impulse Test (vHIT)

C) Normal Hearing Function

• Sensorineural hearing loss should NOT be present
• Tinnitus and ear fullness should not be prominent

This item is very important to distinguish vestibular neuritis from labyrinthitis.

D) Exclusion of Central Causes

• No brainstem-cerebellar findings in neurological examination
• Nystagmus characteristics are compatible with peripheral vertigo
• In necessary cases, pathologies such as stroke are ruled out with brain MRI

Supportive (But Not Mandatory) Findings

• History of viral infection beforehand (common cold, flu, etc.)
• Tendency to fall toward affected side
• Romberg and tandem test impairment
• Central compensation development over time (weeks-months)

How is Vestibular Neuritis Diagnosed?

Vestibular neuritis diagnosis is largely based on clinical evaluation. Sudden onset of complaints, continuous and severe rotational dizziness appearing without hearing loss are the strongest clues in diagnosis. Therefore, detailed history taking is the first step. Duration of dizziness, triggering upper respiratory tract infection history, severity of balance disorder, and accompanying symptoms must be queried.

In neurology or Ear Nose Throat examination, spontaneous nystagmus (involuntary eye drift) is evaluated. In vestibular neuritis, this nystagmus is generally toward the unaffected side. Head Impulse Test (HIT) is the most valuable examination test in this disease; being positive supports peripheral vestibular damage. In balance tests, the patient especially shows tendency to fall toward the affected side. Additionally, negative Dix-Hallpike test is important in distinguishing the disease from BPPV.

Vestibular function tests can be performed to confirm diagnosis.

• VNG (Video-Nystagmography): Eye movements are objectively evaluated.
• Caloric test: Canal paresis (function loss) is detected in the affected ear.

Since hearing is not affected in vestibular neuritis, normal audiometry test is very important in differential diagnosis with diseases causing hearing loss such as labyrinthitis.

Since not every dizziness may be innocent, central nervous system-origin vertigo must definitely be excluded. If the following situations exist, brain MRI is requested:

– Accompanying neurological symptoms such as severe double vision, speech disorder, arm-leg weakness
– Severe headache accompaniment
– Nystagmus showing atypical characteristics
– Expected improvement not seen in 24-48 hours

Blood tests (CRP, ESR, etc.) are used for support purposes only in case of infection or inflammation suspicion. Vestibular neuritis diagnosis is made with the combination of sudden and continuous vertigo + preservation of hearing + peripheral vestibular test disorder.

What are the Treatment Methods in Vestibular Neuritis Disease?

Vestibular neuritis treatment is based on acute period management, accelerating recovery, and restoring balance functions. Treatment approach is individualized according to the stage of disease and patient’s clinical condition.

Corticosteroid treatment is the most effective method in the acute period. Prednisolone is generally applied with a treatment regimen given for 7-10 days and gradually reduced. Especially starting within the first 72 hours provides significant superiority in recovering vestibular nerve function. In patients with viral infection suspicion, if the physician deems appropriate, antiviral treatment (e.g., valacyclovir) can be added to cortisone treatment.

Symptomatic treatment may be needed in the first days due to severe dizziness and nausea. Betahistine, meclizine, or dimenhydrinate can be used in vertigo control; however, since long-term use will delay central compensation, it should be limited to 3-5 days. Ondansetron and metoclopramide are effective choices in nausea and vomiting. Short-term benzodiazepine support can be considered in patients experiencing severe anxiety.

The most critical stage of the recovery process is the vestibular rehabilitation period. Early mobilization after vertigo decreases is very important for the brain to reorganize the balance system. In patients not receiving rehabilitation, the recovery process can be prolonged and the risk of developing chronic dizziness increases.

In the follow-up process, early control in the first week, then evaluations at 1st and 3rd months are recommended. Approximately 80-90% of patients completely recover. In a small group, mild balance problems may continue; in this case, the rehabilitation program is expanded.

Vestibular Rehabilitation Exercises

Vestibular rehabilitation is the most important step of treatment for the balance system to recover after vestibular neuritis. The brain needs repetitive and controlled movements to be able to compensate for the deficiency of the damaged nerve.

In the first days, starting with light eye and head movements according to patient tolerance. Gaze stabilization exercises (VOR exercises) involving focusing on a target during head movements strengthen the vestibulo-ocular reflex and rapidly increase the patient’s image stabilization capacity.

When dizziness significantly decreases, standing and walking exercises that improve balance skills are added. Tandem walking, standing on one foot, and balance work on different surfaces accelerate compensation. Functional training including daily life movements helps the patient regain self-confidence.

In the chronic period, habituation exercises aimed at reducing movement sensitivity, virtual reality applications, and dual-task activities (balance + cognitive task) provide significant benefit. With regular application, the vast majority of patients return to normal activities within 4-8 weeks.

Application recommendation:

• 2-3 times per day,
• 15-20 minute sessions
• With increasing tempo according to symptom tolerance…

Mild dizziness during exercises is natural; however, if severe worsening occurs, a break should be taken. Having a companion in the first days is recommended for safety.

Vestibular neuritis is a disease that can largely completely heal with cortisone treatment started at the right time + early rehabilitation. Patience, continuity, and regular follow-up in treatment determine success.

Frequently Asked Questions About Vestibular Neuritis (FAQ)

1. What is the Difference Between Vestibular Neuritis and Meniere’s Disease?

Although both vestibular neuritis and Meniere’s disease cause dizziness, there are important differences in terms of hearing findings. In vestibular neuritis, hearing is completely normal, tinnitus or pressure sensation in the ear is not expected. In Meniere’s disease, vertigo attacks are definitely accompanied by hearing loss, tinnitus, and ear fullness. Vestibular neuritis generally starts with a single sudden attack and gradually improves; in Meniere’s disease, dizziness is in the form of recurrent attacks. Additionally, vestibular neuritis mostly appears after virus, while in Meniere’s disease, fluid pressure in the inner ear has increased. Therefore, treatment approaches are also different: corticosteroid and rehabilitation in vestibular neuritis, while salt-restricted diet and diuretics are prominent in Meniere’s.

2. How Long Does Vestibular Neuritis Last? Does It Completely Pass?

The most severe period of vestibular neuritis lasts 2-7 days. In the first 24-48 hours, dizziness reaches the highest level, then decreases day by day. Most patients can return to normal life within 1-2 weeks. With appropriate treatment, complete recovery is achieved in 80-90% of patients. However, in some people, mild imbalance can continue for 3-6 months; this situation rapidly improves with vestibular rehabilitation. The disease is mostly experienced as a single attack and the recurrence rate is at 2-5% level.

3. Can I Work During Vestibular Neuritis? How Much Rest Is Needed?

Working in the acute period is both risky and negatively affects treatment. For the first 3-5 days, due to severe dizziness, the patient often cannot get out of bed. Workers in risky jobs (driving, working at heights, machine use) need to take leave for at least 1-2 weeks. Desk workers can generally make a gradual return within 1 week. However, staying completely immobile is also not correct; early and controlled mobilization accelerates recovery. The decision to return to work must definitely be given by the doctor with individual evaluation.

4. Can Vestibular Neuritis Exercises Be Done at Home? How Long Should They Continue?

Yes — vestibular rehabilitation exercises can be applied at home and are the most critical part of recovery. It is recommended that exercises be taught by a physiotherapist before application.

Exercise plan:

• 2-3 times per day
• Each session 15-20 minutes
• Total 6-8 weeks application

Exercises may increase dizziness in the first days; this is an expected situation and shows that the brain is adapting. Even after symptoms completely pass, continuing protective exercises for 2-3 weeks reduces recurrence risk.

5. Does Vestibular Neuritis Recur? How Can I Protect Myself?

Vestibular neuritis is mostly experienced once. Repetition is seen in only 2-5% of cases. To prevent recurrence, strengthening the immune system is important:

– Regular sleep and healthy nutrition
– Good rest during common cold/flu periods
– Stress management and regular exercise

If someone who has had neuritis before experiences dizziness again with similar severity, they should apply to a doctor within the first 72 hours; early cortisone treatment significantly accelerates recovery.

6. If MRI Is Normal in Vestibular Neuritis, Is the Disease Still Present?

Yes. Vestibular neuritis is a disease diagnosed not with imaging but with clinical findings.

The role of brain MRI:

• Cerebellar stroke
• Multiple sclerosis
• To exclude serious brain and ear pathologies such as acoustic neuroma.

In vestibular neuritis, brain MRI can be completely normal. Sometimes contrast uptake in the balance nerve can be detected on contrast-enhanced MRI. Therefore, normal MRI does not exclude diagnosis; correct history, examination, and vestibular tests are sufficient for diagnosis.