Vestibular Neuritis and Labyrinthitis – What are they, and how to manage?

 

Vestibular neuritis and labyrinthitis are some of the most common inner ear disorders that we see at Physiothérapie Avantex. In this article we’ll examine what vestibular neuritis and labyrinthitis are, the usual progression of vestibular neuritis and labyrinthitis, the differences between them,  and how these conditions are treated, both medically and in physiotherapy.

Vestibular Anatomy

Let’s start with a short anatomy lesson. The vestibular system is a small organ in our inner ear that gives us important information about our sense of balance, position and movement. It is connected to a snail-like organ called the cochlea, which helps us hear. The two pieces together are called the labyrinth. They are connected to the brain through the vestibulo-cochlear nerve. Thanks to sensory information collected by the vestibular system and cochlea and transmitted to the brain via the vestibulocochlear nerve, we are able to stay balanced, oriented and hear.

Vestibular Neuritis vs. Labyrinthitis

Vestibular neuritis is an inflammation of the vestibular portion of the vestibulocochlear nerve, most often due to a viral infection. This inflammation initially causes intense vertigo, which can last a number of hours. Patients with vestibular neuritis often report intense vertigo, vomiting and difficulty being able to even get to the bathroom. 

In labyrinthitis, the same type of viral infection causes inflammation of the whole labyrinth, inflaming the structures responsible for both balance and hearing. In addition to the vertigo noted above, patients with labyrinthitis will also experience hearing loss. 

In both cases, immediate treatment with anti-inflammatory medications is recommended to reduce the symptoms and limit damage to the labyrinth and vestibular nerve. Patients are most often transported to hospital where the above treatments are administered. 

What happens next?

Once the acute phase has been managed with the appropriate medications, patients will most often report that the intense vertigo has passed, but they will often experience dizziness, imbalance and in the case of labyrinthitis, hearing loss. In most cases, dizziness and associated balance difficulties can be improved with vestibular rehabilitation, and in our experience, most patients with these conditions will have complete symptom resolution in the weeks and months following infection, as long as the correct rehabilitation plan is followed. Return of hearing function can be more variable, and is often monitored by audiologists with hearing tests during the rehab process. 

Vestibular Rehabilitation for Vestibular Neuritis and Labyrinthitis

 

Once the acute phase is over and patients are back home, we recommend starting vestibular rehabilitation immediately. Vestibular rehabilitation for vestibular neuritis and labyrinthitis will involve balance exercises, exercises for gaze stability and habituation exercises to reduce dizziness. In our experience, many people with vestibular neuritis or labyrinthitis will also develop benign paroxysmal positional vertigo (BPPV), so we screen for that and treat it as required. We also encourage our patients to gradually get back to all of their usual daily activities, work and sports as soon as it is safe and tolerable for them. Any movement helps regain function and reduce dizziness after vestibular neuritis, so get out there!

In our clinical experience, outcomes after vestibular neuritis and labyrinthitis are very good, with complete recovery of the patient’s usual functional level. If you think you may have had vestibular neuritis or labyrinthitis and need help with your rehab, reach out! We would be happy to get you back on your feet.