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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