Vestibular Neuritis and Labyrinthitis
Vestibular neuritis and labyrinthitis are both disorders that arise after an infection inflames the inner ear (the labyrinth) or the nerves that supply the inner ear. The infection, which is usually viral, can occur during/after an upper respiratory infection or a systemic virus such as influenza, the herpes virus (which causes shingles, cold sores and the chicken pox), measles, mumps or rubella, to name a few.
Symptoms:
Both vestibular neuritis and labyrinthitis cause altered signals from the vestibular system to the brain. This results in acute symptoms of vertigo, dizziness, vomiting and difficulty with vision and balance. While vestibular neuritis affects only the vestibular nerve, labyrinthitis causes inflammation of the entire labyrinth (i.e. the semicircular canals and the cochlea, the organ responsible for sound transmission). If the cochlea is involved, patients with Labyrinthitis can experience hearing loss, or other changes to hearing like tinnitus (ringing in the ears).
After the acute phase (24-48 hours) of both vestibular neuritis and labyrinthitis has passed, chronic symptoms can remain such as blurry or bouncing vision, imbalance and fatigue. Patients may have difficulty concentrating or thinking, particularly in busy environments with a lot of ambient movement (eg. walking in a mall). Patients will often report feeling lightheaded or that they are in 'a fog'.
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Treatment:
Treatment during the acute phase may include medication to control the symptoms of nausea and vomiting, such as Benadryl, Valium, Ativan or Betahistine (SERC). If there is sudden hearing loss (with labyrinthitis), a steroid may also be prescribed to help control the pressure of inflammation, as thus prevent permanent damage to the nerve cells responsible for hearing.
When patients have symptoms that persist beyond the acute period, there is a role for Vestibular Rehabilitation Therapy (VRT). After a detailed assessment by a therapist specially-trained in VRT, an individualized exercise program can be created for the patient to perform at home. The goal of VRT is to retrain the brain to adapt to the abnormal signals coming from the affected ear/damaged nerve. This process of learning is known as compensation. At this point, medications used to control dizzy symptoms are often discontinued, as they can impair the brain's ability to compensate.
For more information on vestibular neuritis or labyrinthitis, please visit the Vestibular Disorders Association (VeDA) at vestibular.org
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