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Vestibular neuritis and labyrinthitis

Vestibular neuritis (or vestibular neuronitis) and labyrinthitis are disorders that result in inflammation of the inner ear and/or the nerve connecting the inner ear to the brain. Generally caused by a viral infection, these conditions cause vertigo (usually experienced as a spinning sensation), dizziness, imbalance, unsteadiness, and sometimes problems with vision or hearing.

In a healthy balance system, the brain combines messages sent by the balance control systems in both ears, but if one side is affected the messages from that side are distorted, causing the symptoms of dizziness and vertigo.

What do the symptoms of vestibular neuritis/labyrinthitis feel like?

Symptoms of vestibular neuritis are characterised by a sudden onset of a constant, intense spinning sensation that is usually disabling and requires bed rest. It is often associated with nausea, vomiting, unsteadiness, imbalance, difficulty with vision and the inability to concentrate.

While neuritis affects only the inner ear balance apparatus, labyrinthitis also affects the inner ear hearing apparatus and/or the cochlear nerve, which transmits hearing information. This means that labyrinthitis can cause hearing loss or ringing in the ears (tinnitus).

What causes vestibular neuritis and labyrinthitis?

The most common causes of vestibular neuritis and labyrinthitis are viral infections, often resulting from a systemic virus such as influenza (‘the flu’) or the herpes viruses, which causes chickenpox, shingles and cold sores. Bacterial labyrinthitis can originate from an untreated middle ear infection, or in rare cases, as a result of meningitis.

The infections that cause vestibular neuritis and labyrinthitis can resolve without treatment within a few weeks. However, if the inner ear is permanently damaged by the infection and the brain does not adequately compensate, symptoms can develop into chronic dizziness, fatigue, disorientation, as well as tinnitus and hearing loss (if labyrinthitis is the cause).

How is a diagnosis made?

If you are referred to a specialist by your GP, your condition can be diagnosed based on your medical history, answers to questions about the initial onset of the symptoms and your current symptoms, a physical examination and possibly the results of tests carried out by an audiologist, including a hearing test.

How are vestibular neuritis and labyrinthitis treated?

Vestibular neuritis can be treated with corticosteroids (a special kind of strong anti-inflammatory medication) in the early stages, and, if necessary, with medications to reduce nausea and the vertigo.

The treatment of labyrinthitis depends on the likely cause. If symptoms persist, a specialist physiotherapist can use vestibular rehabilitation exercises to retrain the brain to interpret the distorted balance messages being transmitted from the damaged inner ear. For more information about vestibular physiotherapy, including how to access a vestibular physiotherapy service, please click here.

Living with damage caused by vestibular neuritis or labyrinthitis

If your treatment involves vestibular rehabilitation exercises, it is important to continue the exercises at home for as long as you are advised to by the specialist, balance physiotherapist. To speed up your adaption process, it is vital to keep moving, despite dizziness or imbalance, even though sitting or lying is more comfortable. The aim is to return to your previous activity, work or sport, which helps with the adaptation process, and allows the balance system to function normally.

Online resources

The Vestibular Disorders Association is a US-based, patient support group. Their website contains useful information about how to understand, live with, and find support for balance disorders. Visit www.vestibular.org

Definition of vestibular neuritis and labyrinthitis medical terms

Vestibular system: a part of the inner ear that sends information about movement of the head to the balance control centre in the brain. See How does the balance system work? for more information.

Neuritis: inflammation of nerves.

Labyrinthitis: inflammation of the labyrinth - a hollow cavity in the inner ear, which contains the vestibular system (controlling balance) and the cochlear (enabling hearing).

Vertigo: a false sensation that you or your surroundings are moving.

Tinnitus: a subjective sound in the ear (such as ringing, buzzing, hissing or rumbling) that is not associated with any external sound.