ConditionEar, nose & throat
Vestibular Neuritis
Vestibular neuritis is inflammation of the vestibular nerve, the balance nerve from the inner ear, usually thought to follow a viral infection. It causes sudden, severe, continuous vertigo with nausea, vomiting and unsteadiness that lasts days, without hearing loss. The worst symptoms ease within a few days, but imbalance and motion sensitivity can last weeks to months while the brain adapts. Vestibular rehabilitation exercises speed recovery. Because a stroke can look similar, sudden vertigo needs prompt medical assessment.
Also called: Vestibular neuronitis, acute vestibular syndrome, acute unilateral vestibulopathy, viral neuritis of the balance nerve
At a glance
- What it is
- Inflammation of the balance nerve on one side, usually viral.
- Main symptom
- Sudden, severe, continuous spinning vertigo lasting days, with nausea, vomiting and unsteadiness.
- Hearing
- Normal. Hearing loss suggests labyrinthitis or another cause.
- Diagnosis
- Bedside eye movement tests (head impulse test, nystagmus), and MRI if stroke cannot be ruled out.
- Treatment
- Short-term anti-nausea medicines, possibly early steroids, and vestibular rehabilitation exercises.
When to get help
Call 911 or go to the ER
- Vertigo with double vision, slurred speech, facial drooping, weakness or numbness, or trouble swallowing: call 911 or your local emergency number
- Vertigo with a sudden severe headache or neck pain
- Being unable to stand or walk at all, even with help
See a doctor within a day or two
- Sudden, continuous vertigo lasting more than a few hours, even without other symptoms
- Vomiting that prevents you from keeping fluids down
- Vertigo with sudden hearing loss or ringing in one ear
Book a routine appointment
- Imbalance or dizziness with head movement persisting more than 2 to 3 weeks after the attack
- Brief spinning with position changes after recovering (possible BPPV, which can follow neuritis)
Usually safe to manage at home
- Gradually improving imbalance after a diagnosed episode, managed with vestibular exercises and staying active
What happens in vestibular neuritis
Each inner ear sends continuous balance signals to the brain. When the vestibular nerve on one side becomes inflamed, its signals drop. The brain interprets the imbalance between the two sides as constant spinning toward the healthy side. Over days to weeks, the brain recalibrates (central compensation), and symptoms fade.
The cause is thought to be reactivation of a dormant virus, often herpes simplex type 1, in the nerve. Many people have had a cold or flu-like illness beforehand.
Vestibular neuritis vs labyrinthitis
| Feature | Vestibular neuritis | Labyrinthitis |
|---|---|---|
| Structure inflamed | Vestibular (balance) nerve | Inner ear (labyrinth), both balance and hearing parts |
| Vertigo | Yes | Yes |
| Hearing loss or tinnitus | No | Yes |
| Recovery | Days to weeks | Similar, hearing may not fully recover |
Symptoms
- sudden, intense spinning vertigo that is present even when still
- nausea and vomiting
- unsteadiness, tending to fall toward the affected side
- jerky eye movements (nystagmus)
- worse with head movement
- no hearing loss
- tiredness and difficulty concentrating
Most people need to lie still for the first 1 to 3 days.
Ruling out stroke
A stroke in the brainstem or cerebellum can cause the same acute vertigo. Emergency doctors use the HINTS exam (Head Impulse, Nystagmus, Test of Skew). In vestibular neuritis:
- the head impulse test is abnormal toward the affected side
- nystagmus beats in one direction only
- the test of skew is normal
Any result suggesting a central cause, inability to walk, severe headache, new neurological signs or high stroke risk prompts an MRI. See stroke and vertigo.
Diagnosis
- history and examination, including HINTS and gait testing
- hearing test (audiogram) to distinguish from labyrinthitis
- video head impulse test and caloric testing to confirm reduced function on one side
- MRI when a central cause is possible
Treatment
First days
- rest in a comfortable position, with the eyes fixed on a point
- anti-nausea medicines such as prochlorperazine, ondansetron or meclizine for up to about 3 days
- fluids, sometimes IV if vomiting is severe
- corticosteroids started within the first days may help nerve function recover, though evidence for long-term benefit is mixed
Stop vestibular suppressant medicines as soon as possible, because they slow brain compensation.
Vestibular rehabilitation
Exercises from a vestibular physical therapist help the brain adapt faster. They include:
- gaze stabilization: keeping the eyes on a target while moving the head
- habituation: repeated exposure to movements that provoke dizziness
- balance and walking training
Start gentle movement as soon as possible. Avoiding movement slows recovery.
Safety
- get up slowly and use support while walking
- do not drive until vertigo and imbalance have resolved
- avoid heights and ladders
Recovery time
- severe vertigo: 1 to 3 days
- improving unsteadiness: 1 to 6 weeks
- full recovery: most people within weeks to a few months
A minority have persistent imbalance or develop persistent postural-perceptual dizziness (PPPD), which responds to rehabilitation, CBT and sometimes SSRIs. Some people develop BPPV afterward. Recurrence is uncommon.
Frequently asked questions
What causes vestibular neuritis?
It is usually caused by inflammation of the balance nerve, thought to be triggered by a viral infection or reactivation of a dormant virus such as herpes simplex. Many people have a cold or flu shortly before.
How long does vestibular neuritis last?
Severe vertigo usually lasts 1 to 3 days. Unsteadiness improves over several weeks, and most people recover fully within weeks to a few months, especially with vestibular rehabilitation exercises.
What is the difference between vestibular neuritis and labyrinthitis?
Both cause sudden vertigo. Vestibular neuritis affects only the balance nerve, so hearing is normal. Labyrinthitis affects the inner ear more broadly, causing hearing loss or ringing in addition to vertigo.
What is the best treatment for vestibular neuritis?
Short-term anti-nausea medicine for the first days, possibly early steroids, and above all vestibular rehabilitation exercises to help the brain compensate. Staying active and reducing suppressant medicines quickly aids recovery.
Can vestibular neuritis come back?
Recurrence is uncommon. Some people later develop BPPV, which causes brief spins with position changes and is easily treated. Ongoing dizziness after recovery should be reassessed.
Sources
This guide was written from current patient and clinical guidance, including:
- Bárány Society: Diagnostic criteria for acute unilateral vestibulopathy/vestibular neuritis (2022)
- American Physical Therapy Association: Clinical practice guideline: Vestibular rehabilitation for peripheral vestibular hypofunction
- NHS: Labyrinthitis and vestibular neuritis
- National Institute on Deafness and Other Communication Disorders (NIDCD): Balance disorders
- MedlinePlus: Vestibular neuritis