What is vestibular neuritis and how does it cause dizziness

Author: Li Fei et al. Reviewer: Committee of Dizziness of the Neurology Branch of the Chinese Medical Doctor Association, Stroke and Dizziness Committee of the Chinese Stroke Association Curator: Gu Fuqi, Zou Wei Production/Organizational Information: Chinese Journal of Geriatric Medicine, Clinical Personalized Medicine.

Recently, a young man was admitted to the general ward after experiencing severe dizziness following a cold. He felt as if the entire room was spinning, and was plagued by relentless nausea and vomiting, making it difficult for him to walk. After resting in bed for a day and night without any improvement, his family became alarmed, wondering if it could be a stroke. They quickly called an ambulance for immediate medical attention. After examination, the doctor diagnosed him with vestibular neuritis. The family was puzzled about the condition. The doctor explained that it is inflammation of the vestibular nerve, responsible for balance—similar to a malfunctioning gyroscope in the body. Fortunately, timely medical attention and systematic treatment, along with rehabilitation training, led to significant improvements in the young man's symptoms within a month.

Vestibular neuritis refers to an acute condition characterized by damage to the vestibular nerve on one side, leading to clinical manifestations such as acute, persistent vertigo, accompanied by nausea, vomiting, and instability, with a tendency to tilt toward the affected side. It is a common acute peripheral vestibular syndrome and ranks third among peripheral vertigo conditions, following benign paroxysmal positional vertigo (BPPV) and Ménière's disease.

Current research indicates that the most likely cause is the activation of dormant viruses in the nerves, leading to inflammation and swelling; it may also be related to local circulatory issues. Common viruses include herpes simplex virus type 1 and varicella-zoster virus, which can remain dormant in nerve ganglia and may be activated when the immune system is compromised.

Vestibular neuritis is most commonly seen in individuals aged 30 to 60, with a peak incidence between 40 and 50 years old. Recent studies have found that incidence is also increasing among individuals over 70, with no significant difference in rates between men and women.

The symptoms of vestibular neuritis generally have an acute onset, peaking within 24 hours. They are mainly divided into two stages: the acute phase, which lasts up to 14 days from onset, and the recovery period, occurring from 14 days post-onset.

Many elderly individuals worry that dizziness could signal a stroke or brain tumor; however, dizziness can manifest differently depending on the underlying condition.

Important differentiating points: vestibular neuritis does not exhibit hearing issues (such as tinnitus or deafness), nor does it present symptoms like limb numbness or slurred speech, which distinguishes it from Ménière's disease and stroke.

The golden treatment period for vestibular neuritis is within 72 hours of onset.

It is often stated that the optimal treatment window for vestibular neuritis is within 72 hours post-onset, as early treatment significantly improves prognosis and reduces sequelae. Therefore, it is essential to seek medical attention promptly when experiencing severe dizziness and not to endure stubbornly.

Common treatment misunderstandings include the myth that one should remain still in bed when experiencing dizziness. This is not true, as vestibular neuritis cannot be cured by rest; prolonged immobility may worsen the condition by preventing the brain from adapting. Instead, while it is important to rest during acute dizziness, balance exercises should be practiced as soon as one feels better.

Another misconception is that motion sickness medication is conveniently effective for dizziness. In reality, motion sickness medications and anti-nausea drugs prescribed by doctors belong to the same class of drugs. While they provide short-term relief, prolonged use may hinder vestibular recovery. These medications should not be used for more than three days.

Additionally, stopping medication once symptoms improve does not mean that further treatment is unnecessary. Complete recovery of vestibular function takes time, so it is essential to complete the treatment as advised by the doctor and adhere to any recommended rehabilitation training to lower the risk of recurrence.

To prevent vestibular neuritis, enhance immunity by maintaining a regular schedule and ensuring adequate sleep; consume a balanced diet with plenty of fruits and vegetables, and engage in moderate exercise, such as walking or Tai Chi.

Focus on managing underlying diseases, such as hypertension, high cholesterol, and diabetes, through regular check-ups and timely treatment. Avoid smoking and excessive alcohol consumption.

Address discomfort promptly by resting during symptoms such as brief dizziness or head discomfort, especially during cases of cold or fever. Seek medical attention for unexplained dizziness and avoid self-medication.

Avoid triggers by keeping warm during seasonal changes to prevent colds, avoiding excessive fatigue and mental stress, and protecting the head during transport.

The prognosis for vestibular neuritis is generally good, with most individuals experiencing significant improvement within weeks through standardized treatment and rehabilitation, experiencing a low recurrence rate of approximately 2% to 11%. Symptoms gradually improve with compensation of vestibular function, typically recovering within 3 to 6 months. A minority may experience mild residual balance issues that do not affect daily activities.

In summary, while vestibular neuritis can occur suddenly, it should not be feared. With prompt medical attention, adherence to treatment protocols, and rehabilitation training, most patients can resume normal life. Middle-aged and elderly individuals experiencing sudden dizziness should not panic but should seek timely medical attention. Typical symptoms include spinning sensations, intact hearing, no limb numbness, and clear speech.

References: 1. Committee of Dizziness of the Neurology Branch of the Chinese Medical Doctor Association, and the Stroke and Dizziness Committee of the Chinese Stroke Association, Li Fei et al. Multidisciplinary Expert Consensus on the Diagnosis and Treatment of Vestibular Neuritis. Chinese Journal of Geriatric Medicine, 2020, 39(9): 985-994. DOI:10.3760/cma.j.issn.0254-9026.2020.09.001. 2. Gu Fuqi, Zou Wei. Advances in the Treatment of Vestibular Neuritis: Traditional Chinese and Western Medicine. Clinical Personalized Medicine, 2025, 04(3): 747-751. DOI:10.12677/jcpm.2025.43404. 3. Bae CH, Na HG, Choi YS. Current diagnosis and treatment of vestibular neuritis: a narrative review. J Yeungnam Med Sci. April 2022; 39(2): 81-88. doi:10.12701/yujm.2021.01228.