A typical case of Vestibular Neuritis involves the patient waking in the morning and suddenly being aware of the room spinning. It can seem like the end of the world and is extremely distressing. Profuse vomiting often occurs. The GP is usually called or the patient is taken to hospital by a worried relative. The vomiting settles with medications (usually prochlorperazine/stemetil) designed to settle the acute symptoms. Over the course of the first 24 hours the patient learns that the most comfortable position is to stay in bed and keep the head very still. In this position the spinning dizziness settles. Any head movement in the first 24 hours however, tends to bring back the intense dizziness. By day two the symptoms are improving and the patient may attempt to gingerly get out of bed. Over the next week or two a gradual recovery takes place until the patient is once again functioning normally.
This condition is not associated with hearing loss. No ringing (tinnitus) is heard unless already present.
For most patients – particularly the young and healthy – the recovery period may be limited to a few days or weeks. For a significant number however the recovery period is prolonged to weeks or months. There may be an incomplete recovery for some requiring the intervention of a balance specialist ( see incomplete central compensation page and vestibulo-ocular reflex dysfunction page). Those experiencing an incomplete recovery often struggle to describe what they feel, and talk about ‘walking on sponge’, ‘just not feeling right’, or ‘having moments when everything gives a jolt’.
Typically, symptoms occur when in motion, in visually complex environments, and with sudden head movements.
Diagnosis is based upon gaining an accurate history a full neuro-otological examination and testing of hearing. Investigations depend upon the findings of the consultation and may include blood tests, MRI scanning, Computerised Dynamic Posturography and Video-Nystagmography with neck positional testing.
These investigations allow a customized programme of rehabilitation exercises to be constructed for the patient. Medications previously given to suppress the dizziness or imbalance experienced, need to be stopped, in order for the brain to reset the balance function centres.
It is thought that the cause of this condition is a virus which can, in some cases, cause a similar dizzy event months, or years later. Further events can be reduced in severity and duration by ‘rescue’ medications if they occur.