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.
To find a Vertigo Doctor in Your Area, click here.
Disclaimer
This blog is provided for informational purposes only. The content is 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 I 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.
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 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!