Vestibular Neuritis rehabilitation with a physical therapist

Vestibular Neuritis (Vestibulopathy)—Info:

Vestibular neuritis is caused by inflammation of the vestibular nerve, leading to sudden, severe vertigo, dizziness, balance problems, nausea, and vomiting. Viruses are usually to blame for this condition, which affects the brain's spatial orientation nerve.

Exactly What Is Vestibular Neuritis?

Vestibular neuritis is an inflammation of the vestibular branch of the vestibulocochlear nerve (cranial nerve VIII), which sends balance signals from the inner ear to the brain. Balance and spatial orientation signals are disrupted, creating vertigo and instability. Labyrinthitis affects both balance and hearing, whereas vestibular neuritis only affects balance.

Symptoms

• Instant, acute vertigo lasting hours to days
• Dizziness and unsteadiness
• Disrupted balance signals cause nausea and vomiting.
• Involuntarily moving eyes
• Contrary to labyrinthitis, there is no loss of hearing.

Causes

• Most triggers are viral diseases such as colds, flu, and herpes.
• Rarely, bacterial infections or autoimmune reactions may cause it.
• Inflammation of the vestibular nerve disrupts brain signalling.

Diagnosis

• Clinical evaluation: Neurological and balance testing.
• Rule out stroke, Ménière's disease, or multiple sclerosis.
• Imaging (MRI/CT): Used to rule out CNS causes.

Treatment

The video about vestibular therapy

• Manage symptoms with short-term usage of vestibular suppressants.
• Anti-nausea drugs
• Corticosteroids: Reduce nerve inflammation for some.
• Brain retraining and balance exercises are a vestibular rehabilitation treatment (VRT).
• Most patients recover within a few weeks, though mild imbalances can last months.

Important Info

• An acute episode of vestibular neuritis can be severely debilitating but not fatal.
• Rest, rehabilitation, and time typically fix it.
• Hearing is preserved, unlike labyrinthitis.
• Early medical evaluation helps rule out stroke.

Vestibular neuritis—brain damage?

Vestibular neuritis is not a brain injury. It is an inner ear condition caused by vestibular nerve inflammation that impairs brain-sent balancing signals. Though severe and disabling, vertigo and dizziness do not damage the brain.

Important Difference

• The difference lies in the inflammation of the inner ear vestibular nerve.
• Damage to brain tissue can occur due to stroke, trauma, or neurodegenerative illness.
• Difference: Vestibular neuritis affects brain signal input, not brain tissue.

Causes of Symptom Confusion

• The vestibular nerve links the brainstem and inner ear.
• During inflammation, the brain misinterprets balance information due to incorrect or decreased impulses.
• This produces vertigo, imbalance, nausea, and nystagmus, which resemble neurological issues.
• Unlike stroke or brain injury, hearing and brain tissue frequently survive.

Recovery, Outlook

• Extreme vertigo can persist for hours to days.
• Most people recover within weeks as the brain adapts (central compensation).
• Long-term: Some have a lasting imbalance but no brain damage.
• Treatment options include anti-nausea and vestibular suppressants, steroids, and vestibular rehabilitation.

Important info

• Vestibular neuritis is inner ear nerve irritation, not brain injury.
• Though strong, symptoms are usually transient.
• Vertigo can overlap with neurological problems; thus, medical evaluation is necessary to rule out stroke or other brain conditions.
• Most patients recover totally with proper care.

Recovery from vestibular neuritis

Depending on severity and individual conditions, vestibular neuritis might take 4–6 weeks to 2–3 months to fully recover. Most people recover within a few weeks. Patients may have months-long imbalances.

Typical Recovery Time

First few days: Acute phase

• The acute phase is characterised by sudden, acute vertigo, nausea, vomiting, and instability.
• This stage has the most severe symptoms.

Subacute phase (1–4 weeks): Vertigo progressively improves.

• When moving fast or in visually complex situations, patients may feel shaky.
• During the recovery phase (4–8 weeks), many patients achieve a near-normal balance.
• Central compensation helps the brain use signals from the unaffected ear.
• Extended recuperation (2-3 months) may cause minor dizziness or imbalance in certain individuals.
• Stress, fatigue, and illness can increase symptoms.

Recovery Factors

• Age: Recovery may be slower for seniors.
• Nerve irritation severity: Severe instances slow healing.
• Early treatment: Corticosteroids and VRT enhance recovery.
• Lifestyle: Exercise and balancing activities speed brain adaptation.

Managing Recovery

• Vestibular suppressants and anti-nausea medications are used for acute symptoms.
• Balance and dizziness exercises are part of vestibular rehabilitation therapy (VRT).
• Walking and other gentle activities speed up compensation.
• Avoid overrest: Bed rest slows healing.

Key points

• Most recover in 4–8 weeks, although full recovery may take 3 months.
• Some imbalances last for months.
• Faster and more complete healing requires vestibular rehabilitation.
• A medical assessment is necessary to rule out stroke and other potential causes of vertigo.

Exercises for VN

Vestibular rehabilitation treatment (VRT) involves vestibular neuritis exercises that retrain your brain to respond to balance signals and reduce dizziness. Gaze stabilisation, balance training, and habituation exercises are most effective when performed daily for 20–30 minutes.

Main Exercise Types

1. VOR Training: Gaze Stabilisation

• Improve head-moving eye control.
• Sit or stand and gaze on a stationary object (such as a wall letter).
• Raise or lower your head while keeping your eyes fixed.
• Start slowly, then accelerate as tolerated.
• Benefit: Reduces head-movement blurring and dizziness.

2. Balance Exercises

• Increase stability and postural control.
• Stand with feet together, then one foot.
• Walk straight, heel-to-toe.
• Experiment with head-turning while walking.
• Keep yourself safe by performing near a wall or with assistance.

3. Practice Habituation

• Repeating symptom-causing movements reduces dizziness.
• Sit, rapidly lie down, and sit up (perform multiple times).
• Sit or stand with your head turned.
• Bend forward to grab something, then stand.
• Expect little dizziness to help the brain adapt.

4. Functions

• Daily walks: Even small ones improve balance.
• Walk with your head turned left/right.
• Walking while counting or carrying an object tests coordination.

The frequency and duration

• The frequency and duration should be two to three 20–30-minute sessions per day.
• Progress: Start with simple movements, then add speed and complexity.
• Recovery requires consistency: daily practice.

Safety Tips

• Mild dizziness is normal during adaptation.
• Don't overdo it: Exercise should challenge but not fatigue.
• Environment: Start in a safe place with someone nearby.
• For stability during standing activities, wear flat shoes or go barefoot.

Whom should I see for vestibular neuritis?

Vestibular neuritis specialists differ based on the stage of symptoms and the need for diagnosis or rehabilitation.

Consult Specialists

ENT Specialist (Otolaryngologist): Initial contact.

• Examines inner ear problems, ruling out labyrinthitis, Ménière's, and infections.
• The ENT specialist prescribes anti-nausea, vestibular suppressants, and corticosteroids.

Neurologist

• Consult a neurologist for severe or abnormal symptoms or to rule out stroke/neurological reasons.
• After conducting thorough neurological evaluations, the neurologist may order MRI/CT scans.

Audiologist: 

• The audiologist evaluates the function of hearing and balance.
• Labyrinthitis (hearing loss) may overlap, making this important.

Balance-specialised physical therapist:

• A balance-specialised physical therapist assists patients with vestibular rehabilitation.
• The treatment plan encompasses techniques such as gaze stabilization, balancing, and habituation exercises.
• This is crucial for promoting long-term healing and reducing symptoms of dizziness.

When to Get Help Now

• For sudden vertigo, weakness, slurred speech, double vision, or severe headache, seek emergency examination to rule out stroke.
• For persistent vomiting or inability to walk safely, seek medical attention immediately.

Conclusion

An inner ear illness called vestibular neuritis causes sudden vertigo, dizziness, and balance issues due to vestibular nerve irritation. Disrupted inner ear balancing signals are the issue, not brain damage. Some people may have an imbalance for months after 4–8 weeks of recovery. Gaze stabilisation, balance training, and habituation techniques can speed up recovery and help the brain adapt. Medical evaluation is needed to rule out stroke; most patients recover with careful care.