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Vestibular Neuritis

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About the Disease

Vestibular Neuritis, also known as Vestibular Neuronitis, occurs when a viral infection triggers inflammation in the vestibular nerve. This nerve is crucial for maintaining balance, and its impairment can result in dizziness and imbalance. Common viral infections, such as a cold, flu, or sore throat, can lead to this inflammation.

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Symptoms

  1.  Dizziness or Vertigo: Intense spinning sensations, particularly severe in the first few days.
  2.  Nausea and Vomiting: Accompanying the vertigo, these symptoms can be debilitating.
  3.  Difficulty in Focusing: Especially during head movements, making daily activities challenging.

Labyrinthitis and Vestibular Neuritis share similar characteristics. In Vestibular Neuritis, only the vestibular portion of the vestibulocochlear nerve is inflamed, affecting balance. In contrast, Labyrinthitis affects both parts of the vestibulocochlear nerve, leading to balance and hearing issues.

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Diagnosis

Diagnosis involves several tests to evaluate the function of the vestibular system:

  • Videonystagmography (VNG): Detects horizontal spontaneous nystagmus, which reduces with optic fixation.
  • Video Head Impulse Test (vHIT): Identifies deficits in the vestibulo-ocular reflex on the affected side.
  •  Subjective Visual Vertical (SVV) Test: Measures misinterpretation of the vertical plane, typically shifted to the damaged side by more than 10°.
  •  Craniocorpography (CCG): Reveals rotation to the affected side during the Unterberger test.
  •  Dynamic Visual Acuity (DVA): Assesses any reduction in visual acuity during movement.
  •  Audiogram and Impedance Measurements: Ensure no cochlear or middle ear impairment.

 

A normal neurological examination is typical, and over a few days, vestibular symptoms usually subside, reducing sensations of spinning. Neurovegetative symptoms like nausea and vomiting also reduce, although imbalance may persist for some time. If vertigo is accompanied by unusual headaches or neurological symptoms, a brain MRI is recommended to rule out central pathology.

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Treatment

Treatment consists of managing the symptoms of Vestibular Neuritis and initiating vestibular rehabilitation as early as possible.

Managing Symptoms

  •  Medication: Oral drugs are prescribed to control nausea and vomiting. In cases of severe nausea, IV fluids may be administered to prevent dehydration.
  •  Vestibular Suppressants: These medications help control vertigo and dizziness but should not be used for more than three days to avoid delayed or incomplete recovery.
  •  Steroids: Used within the first five days of infection onset to reduce nerve swelling and inflammation.

Vestibular Rehabilitation
Vestibular rehabilitation aims to retrain the brain to adapt to changes in balance function, a process known as vestibular compensation. This includes evaluating and targeting specific balance functions:

  •  Vestibulospinal System: Assesses balance maintenance during standing and walking.
  • Vestibular Ocular System: Evaluates vision stabilization at rest and during head movement.
  • Posture and Center of Gravity Control

Based on the evaluation, customized vestibular rehabilitation exercises are recommended to the patient.

Balance Exercises
Balance exercises help the brain adjust to new circumstances and maintain stability despite confusing signals from the dysfunctional balance system. These exercises are tailored to the patient’s condition and progress, performed 2-3 times a day. Specific instructions on how to perform the exercises and home safety tips are provided to prevent falls. In cases where home-based exercises are ineffective, rehabilitation under a therapist’s guidance is necessary.

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