Vestibular neuritis is typically a very memorable event in someone’s life with unrelenting horrible vertigo lasting for 2-3 days, possibly requiring emergency care.
Once the acute vestibular neuritis event clears up (with or without the use of medications), people can still experience uncomfortable symptoms afterwards for awhile.
Lingering or recurring symptoms after vestibular neuritis are usually from any resulting hypofunction, recurrent BPPV in the affected ear, and vestibular decompensation of any resulting hypofunction.
Also, one commonly overlooked cause of vestibular neuritis is the herpes virus that causes cold sores around the mouth. I commonly hear of people who have a cold sore break out around their mouth or lips just prior to getting acute vestibular neuritis.
For people who are prone to cold sores, taking medications or supplements to suppress the herpes virus that is dormant in that area can reduce viral activity that may precede vestibular neuritis.
Other viruses that can cause vestibular neuritis may come from a stomach bug or upper respiratory infection. Vestibular neuritis can be bacterial or viral, but is most often thought to be viral.
For that reason, medical doctors will sometimes prescribe anti-viral medications or antibiotics for suspected cases of vestibular neuritis. Your medical doctor will make the decision about what medication(s) to prescribe for you.
There is some evidence that the use of steroid anti-inflammatory medication (like a prednisone pack) early on during a case of acute vestibular neuritis may reduce the likelihood of permanent damage (hypofunction) in that inner ear.
However, dizziness and vertigo (spinning sensation) are common side effects of prednisone, so beware!
Sometimes people do not need any physical therapy after vestibular neuritis is cleared up, if the inflammation did not cause permanent damage to the inner ear, or hypofunction.
Hypofunction = reduced function or low function
Other times vestibular neuritis can cause a vestibular hypofunction if the inflammation caused damage to the inner ear, which can predispose people to future episodes of recurrent BPPV in that ear and balance problems.
Vestibular physical therapy would seek to resolve those issues through targeted exercises like habituation and adaptation, to drive “compensation in the central nervous system” which is the brain. There are a number mechanisms of central compensation that our brains can employ to recover from a vestibular hypofunction.
The idea is that the brain compares the input from the right vestibular system to the left vestibular system. Due to a hypofunction, they will not match so that creates the symptoms dizziness, vertigo, and imbalance.
Just like the BPPV causes a mismatch due to erroneous input and triggers a spinning feeling…
Before vestibular neuritis and hypofunction, the brain used to interpret 100% input on the right = 100% input on the left. Everything matched so no vertigo, dizziness or imbalance.
After the hypofunction, we can train the brain to “compensate” for a hypofunction by interpreting 50% input on the damaged side as proportional to 100% on the intact side, thereby eliminating symptoms of dizziness, vertigo and imbalance caused by the hypofunction.
I used the example of 50% input to illustrate the point about how central compensation works; however, damage to the inner ear causing a hypofunction can be as minor as 5 or 10%, as major as 100%, or any percentage in between.
After they have achieved central compensation through vestibular physical therapy, people who have a vestibular hypofunction must maintain a “lifetime of active head motions” to maintain a baseline that is free of dizziness and imbalance.
If they have a period of inactivity after a full recovery from a vestibular hypofunction has been achieved, they could experience a recurrence of symptoms called “vestibular decompensation.”
Some people are active enough in their daily lives (playing racquetball, swimming, dancing, etc) to have sufficient head motion to drive the central compensation of the vestibular system without vestibular physical therapy exercises. However, many people need a targeted exercise program instructed by a Vestibular Physical Therapist with certain training parameters that have been well established through vestibular research to facilitate a full recovery.
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Disclaimer
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
This is a great and informative summary of something most folks know very little about even if they have experienced the very bothersome symptoms of neuritis and subsequent hypofunction. Most Doctors don’t explain it nearly as accurately and explicitly. Excellent.
Very helpful insightful and encouraging thank you
Excellent summary of this often misunderstood condition. Very helpful.
Great explanations, specially the symptoms in the recovery process. I am also in the recovery phase and i was confused with some of the recurring dizzy spells.
Did it eventually get better. I started in September and still getting the dizziness.
Are you both better now? Thanks
I have been admitted for vertigo a month ago, and the diagnosis was bbpv. However, towards the recent 2 weeks, I have fullness in left ear and I am constantly being pulled to the left. No spinning anymore related to head movement but it feels like the gravity and equilibrium has shifted towards my left.
I can still carry on with daily works but it is very bothersome and impact my quality of life a lots!
As if I need to keep guard my movement not to fall on to my left but in fact it appears that I am constantly compensating to stay balance.
I am not sure what to do and who to see now. Did MRI on brain and MRA on both brain and neck and both were normal. No hearing loss. I am helpless and in deep depression now…
Hi Ivan,
It sounds like you need to find someone who can treat you for BPPV, since you were diagnosed with BPPV.
You can use this blog, this blog, this blog, and this blog to help you learn more and find a vestibular provider.
I hope you feel better soon!
Also, talk to your doctor about the depression if it lasts for more than 2 weeks or it gets any worse.
Best wishes,
Kim Bell, DPT
I started with severe vertigo in September 2021. Vestibular neuritis not BPPV. I eventually went to a phenomenal PT (who only does balance therapy). Took 3 months but I was fine. I had a return of the vertigo after a rough airplane ride 7 months later. Not as bad but keeps coming on and off. I am a very active 56 year old man. I am back with the PT, had a VNG with almost 100% unilateral vestibular loss, no CNS involvement. I have been doing very aggressive PT at home via my PT. (Example Turning 180 degrees walking 4 steps, turn again… and the like— slow or it puts me in a spin). I felt pretty good. I went water skiing, only going a short distance. I did very well. Then the next day mild vertigo returned. The following day it was almost debilitating. Then poof it was fine again. Waited 10 days (doing PT exercises) and tried again. I was fine, until the next day. And the second day again was close to debilitating. I’m now three days post ski and still not doing great. My PT is away on vacation two weeks, and ENT has said it is what it is. Any ideas?
Hi Tom,
I am sorry to hear about all this!
It sounds like you are definitely on the right track with your vertigo treatment plan and your team of providers.
Unfortunately, plane travel is notorious for flaring up vertigo!
I have four blog articles on travel tips for people with dizziness, two articles are on this website and the other two articles are on VertigoDetective.com.
Although you have shared a very interesting narrative of the ups and downs of your journey – and tugged on my heart strings – I suggest a different approach to seeking advice.
My suggestion is that you communicate the information I suggest in this blog regarding your vertigo flare ups. That information will allow for root cause analysis.
In general, if you state (1) the circumstances including time of day of the onset of vertigo, (2) the potential trigger of vertigo symptoms – what you were doing, and (3) the duration of your symptoms, then a skilled vestibular provider can assess the root cause of dizziness.
The recommendation about specifically what to do will depend on the root cause of the vertigo.
This blog explains more about how recommendations may differ, depending on root cause.
This blog has some vertigo home remedies that may help until your vestibular PT gets back from vacation.
It is very fortunate and wonderful that you have found a vestibular PT nearby to help you!
While your vestibular PT is away, you could try to mask your symptoms in the short term by taking medication for vertigo. Your ENT should be able to help you with that.
This blog may interest you for further reading now that you have established that you have a unilateral vestibular loss.
Best wishes,
Kim Bell, DPT
I suggest you avoid arginine foods. Also eat high lysine foods and take lysine supplements. I went through the same nightmare. This will be a lifelong dietary adjustment. Be strict otherwise you can retrigger it.
Hello Ivan, have you fully recovered?
I have the exact same symptoms from a vertigo episode in Dec 21. No dizziness now just can only describe as a doll on a dashboard of a car with a wobbly head. All to the left also. Full left ear, but no pain. So debilitating. I have not driven for 3 months. Have seen a vestibular physio and doing exercises. Fingers crossed as I have had enough.
I have been having severe vertigo for years. It will come about every 30 days, last a week then go away. It is a week of hell. After being told so many different things I figured it out for myself. I noticed that I was not getting cold sores anymore. They would usually come once a month. This corresponded with the vertigo spells. Then I remember a nurse telling me I had Herpes simplex virus. I said I know I get cold sores like a lot of people. She said it is my blood work and thought I should be upset in some way. This it me why am I not getting cold sores after 15 years and now I have this. Plus my ears fill full. This virus has moved to my ears. I was tested and ENT said you have vertigo go to a balance clinic. What is that going to help? I didn’t go. Two years later. I asked my doctor for an antiviral for cold sores. It seemed to help with the vertigo for awhile. Went a year ago to urgent care and begged for steroid and anti inflammatory. I couldn’t take this anymore. 90 min after I took it I was fine. Didn’t last a week. Now I can’t find a doctor to believe me. Still they think I don’t know what I am talking about. I can’t get steroids’ when this flairs up. I don’t know what to do. I can’t take it much longer. I have to drive and work like this for a week or so every month. Help please.
Hi Jo Ann,
I am not sure if you are still menstruating, but sometimes the herpes virus can break out at certain points in the menstrual cycle due to hormonal effects on the immune system.
I suggest for you to find a doctor who understands your condition and is willing to prescribe the medications that you need to prevent flare ups.
I highly recommend this doctor for telehealth, since I have been working closely with him for over 15 years on thousands of cases.
You can also use this blog to find other providers in your area.
Keep going! You must find the right provider so you can get this under control.
You can also take the approach of natural ways to support your immune system, like certain mushrooms or elderberry.
Best wishes,
Kim Bell, DPT
This is a very informative write up on what exactly happens with vestibular neuritis. This scary event hit me last week. I’m past the acute phase and improving well daily, but can forward this information to friends and family who are concerned about my trip to the emergency room and worry I may not fully recover an active lifestyle soon.
Thank you!
I was diagnosed with vestibular neuritis (viral) about 5 weeks ago, I immediately went to vestibular PT and felt great after about 2 weeks, then symptoms retuned all the while I continued the exercises at home and with the therapist. I again became asymmetric after 4 weeks for several days (thinking I’m out of the woods) to again become symptomatic. My PT says she’s not seen the on again off again and typically sees patients who improve continue to improve and not go back again. Can you tell me your thoughts and suggestions? Do you think I’m going to have to live with this indefinitely? I’m highly functional, can work, exercise, play golf……..but miserably uncomfortable. My brain scans are all normal. Thank you.
Hi Stuart,
It’s great that your brain scans are normal.
I think it might be a good idea to examine the risk factors for BPPV and figure out if something caused you to shed more crystals.
In this blog, I discuss things BPPV is commonly associate with which could be considered risk factors.
Some risk factors are modifiable like dehydration and stress. Other risk factors are unavoidable like dental work. While still other risk factors are not modifiable like normal aging.
It’s also possible that some of your BPPV crystals converted to another canal. You can learn about that here.
Either way, the key is to get assessed and treated for whatever you currently have presenting.
If you want to look for another vestibular PT who has more diverse experience, you can use this blog to search for other providers.
This article on dizziness with head turns may also shed some light on other possible root causes that may have been entirely overlooked thus far.
I hope that helps!
Sincerely,
Kim Bell, DPT
I’ve discovered that watching my salt intake to reduce fluid retention has helped my situation. I have had VN symptoms off and on for almost 2 years. I also believe that it is caused by the cold sore virus.. The first episode with the dizziness and nausea sent me to urgent care. I could not take the steroids….nausea meds stopped the vomiting. Maybe one day the specialists can come up with a definite treatment or cure for this condition. From what I have read…..it may never go completely away.
Hi,
Yes the cold sore virus can cause recurrent vestibular neuritis.
You may want to look into reducing foods with arginine like coconut, and taking a lysine supplement.
You can meet with a nutritionist who may be able to teach you about dietary changes to reduce the activity of the herpes virus.
You can also consider supplements to support your immune system.
Although the virus will never go away, you can hopefully get it under control.
I hope that helps!
Best wishes,
Kim Bell, DPT
Dr. Bell,
I was diagnosed in Sept 2020 with V.N. at the V.A. Hospital after a battery of tests including an MRI brain scan. Prescribed PT with a specialist and have done the exercises off and on at home since. Symptoms gradually seemed to improve until 4 weeks ago when the dizziness got much worse and my tinnitus nearly doubled in volume. Sitting still is okay but moving my head or riding in a car is hell. I’m careful about salt consumption, no alcohol, and only take a statin as far as meds. Any thoughts?
David
Hi David,
I suggest you seek care from a vestibular PT and get checked for BPPV.
BPPV can commonly occur after recovering from V.N.
You can search for a provider using this article.
If your neck is hurting or you slept funny, you may need to consult an orthopedic manual physical therapist. You can look for someone on this directory.
I hope that helps!
Best wishes,
Kim Bell, DPT
I had my Vestibular Neuronitis Attack on August 24, 2021 and I am about 98% better now (Feb. 22, 2022). I suffer fatigue easily. My ENT says that 6 weeks of Vestibular Therapy may help. Any suggestions for this lingering fatigue problem?
Hi Karin,
Many of my patients need extra sleep while they are recovering. You may even need to take an afternoon nap until your recovery is complete.
Take it easy. It’s a lot of work for your brain to re-calibrate.
Best wishes!
Hi, I was diagnosed with vestibular neuritis 2 weeks ago but I had the acute phase for 9 weeks, everything I have read as it should only last approximately 2-3 weeks. I have been given exercises by physio which don’t seem to be helping. I’m off work, unable to drive and feel horrendous. No hearing loss, CTBrain normal. Have you any suggestions as I’m struggling?
Hi Lee,
That is a tough one!
I would suggest that you get checked for BPPV, which can occur during or after vestibular neuritis.
You can use this blog to search for a vestibular provider who can perform “particle repositioning maneuvers.”
Also, you may want to talk to your doctor about assessing your immune system and gut function.
If the vestibular neuritis is from a virus or bacterial infection that is not resolving, then the question is why can’t your immune system fight it off?
If the vestibular neuritis is from inflammation in the inner ear, then the question is what is the cause of this chronic recurrent inflammation?
Maybe medications can help? Your doctor can advise you on that.
I hope you feel better soon!
Sincerely,
Kim Bell, DPT
Hello,
I have been dealing with vertigo and fullness in my right ear for four days now. I also have a cold sore that is healing on my lip. I went to my PCP, they assumed it was allergy related, but I believe it is viral due to the cold sore coincidence. I started taking Valacyclovir which I have an Rx for today (day 4). Do you believe this will speed my recovery? Vertigo comes on strong a couple times a day and lingers. Lying down helps.
Hi Steve,
For an acute viral vertigo attack, taking Valacyclovir daily is a good strategy.
Your doctor may also prescribe corticosteroids to reduce inflammation.
Both of these medications are usually prescribed for a limited period of time.
Viral vertigo may go away on its own, or it can cause an onset of BPPV.
After your body kicks the virus, then you may need to go to vestibular PT for any lingering dizziness, vertigo, or imbalance.
If needed, you can search for local vestibular PT using this article.
I was diagnosed with vestibular neuritis 2 years ago. I had acute vertigo for 1 week couldn’t stand up. Then balance issues and hearing loss on left ear. But the most debilitating symptom for me was during this time something happened to my eyes . My binocular vision was knocked off kilter and my right eye now looks upwards and with double vision . Over the last 2 years I have bought countless glasses with prism in to try and help. I have another private ENT appt this week and have tried ti see neuro ophthalmologist but NHS waiting list is 72 weeks ( from now) I work full time as an NHS nurse and this is taking over my life. I’ve just bought some llysine to see if that helps and vitamin D. I’m hoping to start vestibular rehab with physios. If anyone can suggest any help it would be greatly appreciated as it’s unbearable . Thanks in advance
Hi B.
I am sorry to hear about all this!
I suggest for you to consult with a Neuro-Optometrist.
You may need different glasses and you may need vision therapy (which is different than vestibular therapy).
This website COVD.org should help you learn more and you can use their Doctor Locator tool.
Viruses can attack the oculomotor nerves that control the eye. That may be what happened to you!
You can also travel somewhere to see a Neuro-Ophthalmologist with a shorter waiting period, instead of waiting over a year.
You may want to read this article on vestibular decompensation as well.
Also, I just purchased an electronic stethoscope due to my hearing loss in my left ear. It is awesome!
If I ever start wearing a hearing aide in my left ear, I may have to get a different stethoscope but this works for me for now.
I have weakness in my left vestibular nerve (symptoms began in 2020, diagnosis April 22). It’s a tilted feeling and like I need to readjust myself to feel centered.
I completed 12 weeks of PT and continue the home exercises. While there’s been technical improvement, I just miss feeling normal.
My head is so heavy and my neck is too. I’m keeping up with my exercises, just wish my brain would learn to adjust. So frustrating!