Vestibular Neuritis and Labyrinthitis
Vestibular neuritis and labyrinthitis are inner ear problems that often happen after a virus. They can cause sudden, strong vertigo. Vertigo feels like you or the room is spinning or tilting.
These conditions usually affect one inner ear. Symptoms may feel scary and intense, but most people improve over time.
What is the difference?
Vestibular neuritis affects the balance nerve in the inner ear. It causes vertigo, nausea, vomiting, and balance problems. It does not usually cause hearing loss.
Labyrinthitis affects the inner ear balance and hearing system. It can cause vertigo, nausea, vomiting, balance problems, hearing loss, or ringing in the ear.
Viral infections are the most common cause. Bacterial infections are less common, but they can be more serious.
What is Happening In My Body?:
Vestibular neuritis and labyrinthitis are inner ear conditions that can make your balance system send uneven signals to your brain.
Think of your inner ears like two sides of a balance scale. When both inner ears are working evenly, the scale is level. Your brain gets matching information from both sides and can tell where your head is moving. This also helps your eyes stay focused when you turn your head.
When one side of the inner ear is irritated or weakened, the scale tips. One side is sending a weaker or mixed-up signal, while the other side is still sending a normal signal. Your brain may read this uneven information as movement, even when you are still.
This can cause sudden vertigo, dizziness, nausea, trouble walking, or a feeling that your vision takes a moment to “catch up” when you move your head.
Because of this you may feel:
- Sudden strong vertigo
- Nausea
- Vomiting
- Unsteadiness or trouble walking
- Hearing loss or ringing , mainly with labyrinthitis
It is important to know:
- These symptoms can occur after a cold, flu or other viral infections
- Symptoms are often worse with head and body movement
- Rest may help during the first day or two, but too much rest can slow recovery
- Symptoms can look like a stroke, so prompt medical attention is important
- Most people improve over days to weeks
- Some people have longer lasting dizziness, motion sensitivity, or balance problems
- Medicine may help with nausea and vertigo at first
- Vestibular Therapy is helpful in recovery of balance and function
How Are Vestibular Neuritis and Labyrinthitis Diagnosed?
A trained provider will check your eye movements, balance, walking, and hearing. There is no single test that proves you have vestibular neuritis or labyrinthitis. The diagnosis is usually based on your symptoms, exam, and whether your hearing has changed.
Tests may include:
- Head impulse test: Checks how your eyes respond when your head moves.
- vHIT: Uses goggles to measure how well each inner ear responds to quick head movements.
- VNG or ENG: Records eye movements to look for signs that one inner ear is weaker.
- Caloric testing: Uses warm or cool air or water in each ear to compare the right and left inner ear balance systems.
- Hearing test: Checks for hearing loss, which can help tell the difference between vestibular neuritis and labyrinthitis.
Most people do not need an MRI, but it may be ordered if symptoms are unusual or there is concern for stroke or another cause.
What Your Provider May Ask:
- When did your symptoms start?
- Did they start slowly or suddenly?
- Does it feel like the room is spinning?
- Are you having hearing loss or ringing in your ear?
- Are you having trouble walking?
- Are you having nausea or vomiting?
- Did you recently have a cold, flu or virus?
- Do you have any weakness, numbness, double vision or trouble speaking?
How Are Vestibular Neuritis and Labyrinthitis Treated?
Your provider may suggest medicine to help with:
- Nausea
- Vomiting
- Vertigo
These medicines are usually used only for a short time. Taking them for too long may slow your brain’s ability to adjust to the balance changes.
During the early stage, it is okay to rest and move carefully. If you feel unsteady, use support when walking and avoid activities that may be unsafe.
As your symptoms calm down, gentle movement becomes important. Vestibular therapy can help your brain relearn balance. Therapy may include:
- Balance exercises
- Walking practice
- Eye and head movement exercises
What Can I Expect Over Time?
Will I get better?
Most people improve over time.
How long will it take?
Strong symptoms often improve over a few days to a few weeks. Balance may take longer to fully return.
Can I live a normal life?
Yes. Most people return to their normal activities. Some people need vestibular therapy to help their brain and balance system recover.
When Should I Get Urgent Medical Care?
Seek urgent medical care right away if you have:
- New weakness or numbness
- Trouble speaking
- Face drooping
- Double vision
- A severe or “worst ever” headache
- Fainting
- Chest pain
- Trouble walking without help
- Repeated vomiting that does not improve
- New or sudden hearing loss
- Vertigo that gets worse after it had started to improve
- A fall with a head injury
Questions to Ask Your Provider
Which ear is affected?
Do I have vestibular neuritis or labyrinthitis?
Is my hearing affected?
Will my hearing get better?
Do I need vestibular therapy?
When can I return to work, driving, or exercise?
What should I do if symptoms come back?
Key Takeaways/Key Points to Remember
- Vestibular neuritis and labyrinthitis can cause sudden, strong vertigo, nausea, and trouble walking.
- Vestibular neuritis affects balance only.
- Labyrinthitis can affect both balance and hearing.
- Sudden hearing loss needs prompt medical attention.
- These symptoms can look like a stroke, so medical evaluation is important.
- Most people improve over time.
- Vestibular therapy can help with recovery.
Additional Resources
- Cleveland Clinic- Vestibular Neuritis: Symptoms, Causes & Treatment
- Cleveland Clinic- Labyrinthitis: Symptoms, Causes & Treatment
- NHS UK – Labyrinthitis and vestibular neuritis