Vestibular neuritis is 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 afterward for a while.

Lingering or recurring symptoms after vestibular neuritis are usually from any resulting hypofunction, recurrent BPPV in the affected ear, and/or vestibular decompensation of any resulting hypofunction.

Identify the Causes of Vestibular Neuritis

Cold Sores and or Herpes

One commonly overlooked cause of vestibular neuritis is the herpes virus which causes cold sores or fever blisters around the mouth. I commonly hear of people who have a cold sore breaking out around their mouth or lips just before getting acute vestibular neuritis.

What to do

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.

Respiratory Infection

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.

Medical doctors will sometimes prescribe antiviral medications and/or antibiotics for suspected cases of vestibular neuritis. Your medical doctor will decide what medication(s) to prescribe for you.

What to do

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! Discuss the potential risks and benefits of medications with your doctor.


Since 2020, I have never seen more cases of viral vertigo. COVID-related dizziness should not be disregarded as a potential root cause of viral vestibular neuritis, especially in patients with waxing and waning symptoms.

What to do

To learn more about COVID-related dizziness and find out what to do, check out this article.

Vestibular Hypofunction: A Potential Long-Term Consequence

Vestibular neuritis can cause a vestibular hypofunction if the infection or inflammation causes damage to the inner ear. A peripheral vestibular hypofunction is an inner ear functioning at less than 100% after recovering from vestibular neuritis.

Not everyone develops a vestibular hypofunction as a result of vestibular neuritis, but this diagnosis can explain lingering dizziness and balance problems after neuritis clears up. A vestibular hypofunction may also predispose patients to future episodes of recurrent BPPV in that damaged ear.

What to Do

To recover from a vestibular hypofunction or BPPV that may occur as a result of vestibular neuritis, I suggest consulting a vestibular physical therapist.

A vestibular PT can assess and treat any post-neuritis BPPV that occurs or recurs.

Vestibular physical therapy would also seek to resolve the symptoms of any vestibular hypofunction through targeted vestibulo-ocular exercises and habituation exercises. The goal of the exercises is to drive “compensation in the central nervous system” which is the brain.

There are several mechanisms for central compensation that our brains can employ to recover from a vestibular hypofunction. Many physical therapists call this process “recalibration” of the vestibular system after injury.

How Does it Work?

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 which creates the symptoms of dizziness, vertigo, and imbalance.

Just like the BPPV causes a mismatch due to erroneous input and triggers a spinning feeling…

Before vestibular neuritis and resulting 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.

Does Everyone Need Vestibular PT to Recover from a Vestibular Hypofunction?

Some people are active enough in their daily lives (playing racquetball, pickleball, volleyball, surfing, swimming, swing 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.

How To Maintain Central Compensation

After achieving central compensation, 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.”

If vestibular decompensation occurs or is suspected, I recommend that those patients return to vestibular physical therapy for a re-evaluation and most likely another round of vestibular exercises.

To find a Vertigo Doctor or Vestibular PT in Your Area, click here.


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.

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