Vestibular Neuritis & Labyrinthitis

How are they different? Can they re-occur?

By Lauren Wootton, PT

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Vestibular Neuritis and Labyrinthitis are two similar conditions. Both begin with a viral or bacterial infection in the inner ear. Symptoms of both are similar, but the main difference is the location of the infection. Vestibular Neuritis is an infection of the vestibular nerve inside the inner ear. Labyrinthitis is an infection of the labyrinth, which includes the vestibular system and the cochlea. The cochlea is your hearing organ, and it is also in the inner ear.

The infection is usually viral, due to something that is affecting the whole body such as the flu, herpes, or hepatitis.  Many of my clients remember having had a cold or flu around the time, or just before, their vertigo began. There is even some speculation that the Covid-19 virus can invade the inner ear causing Vestibular Neuritis or Labyrinthitis, but so far there is not yet enough evidence know for sure. Bacterial inner ear infections are much less common, but can also occur. Bacterial ear infections are much more commonly found in the middle ear.

Both conditions cause a sudden onset of moderate to severe vertigo that lasts for at least one day, up to several days.  The vertigo sensation can be a sense that you or the room is spinning, pulling or even tilting when you are not moving at all. The biggest difference is that Labyrinthitis includes one sided hearing loss as a symptom.

Both conditions cause nausea and vomiting in the initial stages and then once the infection resolves, dizziness and imbalance often remain a problem long term.

Key Clue to Diagnosis: It is quite RARE for either condition to cause multiple vertigo attacks.  After the initial 1-4 day attack subsides, constant dizziness and imbalance are the main symptoms. 

If you have been diagnosed with Vestibular Neuritis or Labyrinthitis, and get recurrent vertigo attacks, there are two possibilities:

  • You were mis-diagnosed, and did not have Neuritis or Labyrinthitis. Something like BPPV, Vestibular Migraine or Menieres disease are more likely.
  • You ORIGINALLY had Vestibular Neuritis or Labyrinthitis, but your subsequent vertigo attacks are being caused by another vestibular condition such as BPPV or Vestibular Migraine.

Both scenarios are common. In fact, you are at a higher risk of developing BPPV or Vestibular Migraine after recovering from Vestibular Neuritis or Labyrinthitis. Read this past blog to find out WHY these conditions cause vertigo.

Diagnosis:

There are no specific tests that can identify Vestibular Neuritis or Labyrinthitis.  A thorough medical examination is necessary to rule out other causes of dizziness and vertigo.  The diagnosis is often given based on your symptoms and a physical examination. Your doctor may send you for a VNG (video-nystagmography) test which can help to determine if there has been damage to nerves that connect to the inner ear.

Note that vertigo is sometimes a symptom of a stroke.  Call 911 immediately if your symptoms are accompanied by:

  • Double vision
  • Slurred speech
  • Weakness
  • Numbness or tingling

Treatment:

In the initial stages of the illness, medications for nausea and dizziness may be prescribed. Sometimes corticosteroids are also given to reduce the inflammation.  Antibiotics or anti-viral medication may also be given to clear the infection, however this is not always done as the body's immune system often does a great job. 

If symptoms of dizziness, imbalance and/or hearing loss persist beyond a couple of weeks, there may have been damage done to the nerves in the inner ear. These nerves are responsible for balance, visual focus (particularly while you and/or the object is moving) and hearing.

In cases of mild nerve damage, your body and brain are often able to adapt and compensate for the loss of nerve function as you get back to doing your normal routine. 

Your body may not fully compensate on its own if:

  • nerve damage is more severe
  • vestibular suppressant medications are being taken for a prolonged amount of time
  • the person has not been able to slowly resume normal activities due to symptoms, fear, anxiety, or other medical reasons

Even in these cases, recovery from Vestibular Neuritis and Labyrinthitis is still possible!

Vestibular rehabilitation exercises can help to re-train the brain and create new connections from the inner ear to the brain to re-route around the damaged area of the nerve. 

A vestibular physiotherapist can carefully select, teach and progress vestibular exercises in order to:

  • improve your balance and walking ability
  • improve your ability to see things more clearly while you or the object is moving
  • eliminate your dizziness and/or motion sensitivity
  • give you strategies to overcome other challenges such as brain fog, fatigue, or returning to work

It is never too late to get started. Find a local vestibular therapist to set up a consultation or contact The Vertigo Therapist using the form below if you are in Ontario to get set up with a virtual vestibular therapy program. Find balance and dizziness relief!

Are You Ready To Get Rid Of Your Vertigo And Dizziness?

Book a Free Consult if you live in Ontario AND you:

  • Need someone to listen to you (really listen!) and provide the best course of action
  • Want to explore more treatment options for your symptoms besides medications
  • Want to get rid of your vertigo/dizziness or prevent future attacks

Lauren Wootton, MScPT, Vestibular Physiotherapist

Lauren is the founder of The Vertigo Therapist and has developed an effective method of assessment and treatment of vestibular conditions using virtual appointments and various technology. 

Lauren has found that the most effective way to help someone with vertigo is to tailor treatment not only to the specific condition but to the individual person in order to meet their goals (big and small) at a pace that is right for them.

Contact her through booking a free consult or e-mailing: Lauren@thevertigotherapist.com

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