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Vestibular neuronitis (labyrinthitis) Causes, Symptoms and Treatment

Focus. There is confusion around the term labyrinthite . This word is often used, wrongly, to refer to vestibular neuronitis . Now, true labyrinthitis is another affection of the ear, much rarer. It is very similar to vestibular neuronitis but also causes a decrease in hearing and tinnitus. True labyrinthitis is a medical emergency.

The vestibular neuritis is characterized by the sudden onset of intense dizziness . The sufferer has the sensation that she is turning on herself or that the outside environment is turning around her. Dizziness is accompanied by nausea and sometimes vomiting.

The symptoms are so intense that bed rest is often necessary for 2 or 3 days, sometimes up to 1 week.

Then recovery is slow and gradual. Symptoms disappear within 6 weeks, on average. During the following months, some movements may cause loss of balance .

Although the symptoms may seem very disturbing, vestibular neuronitis is not a serious disease in itself. The vast majority of people will only have one crisis in their lifetime.

Prevalence

There are no accurate statistics on the prevalence of vestibular neuronitis . About 15% of vertigo is caused by this condition.

Vestibular neuronitis is usually seen in adults aged 20 to 60 years. It affects men as well as women in all regions of the world.

Causes of Vestibular neuronitis

The origin of this disease is not well known. Experts believe it would be a complication of a virus infection . They hypothesize that vestibular neuronitis usually occurs at the same time as a respiratory infection, such as influenza or sinusitis, or in the days that follow. Moreover, vestibular neuronitis is more common in winter and spring .

This infection would reach the vestibular nerve inside the ear. This nerve branches out and connects the organs involved in the balance (vestibule and semicircular canals) to the brain. Only one ear would be affected. As a result, the information about the body’s placement in space that reaches the brain would not be the same in both ears. This would give rise to vertigo .

In some cases, it is believed that reactivation of herpes simplex virus type(responsible for cold sores) or Epstein-Barr virus (responsible for infectious mononucleosis) may be the cause. But no association was found between vestibular neuronitis and otitis media.

Diagnostic of Vestibular neuronitis

It is important to consult a doctor in case of vertigo . He will carry out a general physical examination as well as an examination of the ears. Various simple examinations help the diagnosis, such as the Dix and Hallpike maneuver, in which the vertigo is tested by various movements of the body.

The doctor should rule out other possible causes of vertigo. He must also distinguish them from dizziness . Dizziness could be due to, for example, benign positional vertigo , Meniere’s disease, or “true” labyrinthitis. It should also exclude the possibility of more serious problems, such as a stroke or a brain tumor. Dizziness may also be triggered by taking high doses of certain medications, such as antibiotics.

An index that distinguishes vestibular neuronitis from other ear disorders is that it does not interferewith hearing and does not cause tinnitus.

The symptoms of vestibular neuronitis

The following symptoms occur intensively for 2 to 3 days. Their complete disappearance occurs in 4 to 6 weeks.

During the crisis:

  • strong vertigo  : the feeling that the objects of the environment move around you, or vice versa. Three times out of four, vertigo comes suddenly;
  • loss of balance ;
  • Of nausea and vomiting;
  • Some palpitations ;
  • The movements of the head aggravate the symptoms.
Warning. The following symptoms should be consulted urgently: persistent vomiting, vertigo with fever over 39 ° C, convulsions, fainting.

People at risk for Vestibular neuronitis

No predisposition is known.

Risk factors

  • A recent infection of the respiratory tract(flu, sinusitis, etc.).

Note . Ingestion of high doses of some drugs may cause dizziness, but not vestibular neuronitis.

Medical treatments of vestibular neuronitis (labyrinthitis)

There is no cure that brings healing. The symptoms usually resolve on their own with time.

The rehydration is very important in case of repeated vomiting. You must drink plenty of water , broths, soups or juices. During this period, it is better to take many small snacks of foods rather dry and low odor (eg, crackers with soup) that will increase less nausea than real meal.

Various medications can temper nausea .

pharmaceuticals

  • Against vertigo and nausea  : antiemetics such as anticholinergics (scopolamine) and antinauseants (such as those used to fight motion sickness, such as Gravol). Taking methylprednisolone can shorten the duration of the seizure. This medicine combines anti-inflammatory and anti-allergic actions;
  • To calm  : sedatives (benzodiazepine, etc.), lorazepam (Ativan), diazepam (Valium), anticholinergics or a psychotropic sedative (eg, prochlorperazine).

Note . Antiviral drugs are not widely used because their effectiveness is uncertain.

Rehabilitation exercises

A physiotherapist or occupational therapist can teach exercises at home to relearn the balance . It’s basically eye and neck movements. What is called vestibular rehabilitation consists of doing head and body movements to correct the sensation of loss of balance.

Brandt-Daroff exercises
  • Sit on the edge of the bed, towards the middle, legs hanging down to the floor;
  • Turn the head 45º to the left;
  • Quickly drop to the right side, keeping the head turned (the portion of the head behind the right ear touches the bed);
  • Hold this position for about 30 seconds;
  • Straighten the trunk, and sit on the bed for 30 seconds;
  • Turn the head 45º to the right;
  • Quickly drop to the left side, keeping your head turned;
  • Hold the position for 30 seconds;
  • Recover.

It is recommended to do these exercises 5 times in a row, 3 times a day (morning, noon and night). See the Sites of Interest section for an illustration of the Brandt-Daroff exercises.

Basic care

    • During the first days, at the height of the symptoms: keep the bed if necessary and move your head as little as possible. Sit or lie down as soon as you feel dizzy;
    • Find the positions of the head that do not trigger the sensation of vertigo. Turning your head quickly, for example, often provokes it;
    • After this initial period, it is better to gradually resume normal activities as much as possible so that the brain can “compensate” more quickly (that is to say, to ignore false movement signals) and thus correct the losses of equilibrium. However, avoid abrupt changes of position. At this stage, rehabilitation exercises are important;
    • Disclaimer temporarily certain risky activities and then resume slowly. This includes not driving (car, motorcycle, bike, etc.), climbing ladders, or operating heavy machinery;
    • Remove sources of stress because stress aggravates dizziness. For example, during periods of acute crisis, it is advisable to rest in a dark room while closing your eyes. Reduce as much noise as possible and do not try to read;
    • Be sure to have a light at night that allows you to get up safely. Clear the passageway to prevent falls;
    • If you are unstable when traveling , it is better not to be alone at home;
    • Refrain from smoking cigarettes;
  • Do not consume alcohol or caffeine-based drinks as this may worsen the symptoms.

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