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Ask the Doctors: Vestibular neuritis causes mild to severe dizziness

In the most severe cases, vertigo can cause a constant spinning sensation that makes it difficult to stand or walk, and can cause headache, nausea and vomiting. | THINKSTOCK IMAGES

Dear Doctor: A neurologist diagnosed me with vestibular neuritis after an “event” a year ago that put me in the hospital for a week. My MRI was unrevealing, but I am still unbalanced and find it hard to get around. Besides physical therapy, can anything else be done?

Dear Reader: Vestibular neuritis is a condition that occurs when either the inner ear, or the nerves that connect the inner ear and the brain, become inflamed due to infection. This results in dizziness (vertigo) that can range from mild to severe. In the most severe cases, vertigo can cause a constant spinning sensation that makes it difficult to stand or walk, and can cause headache, nausea and vomiting.

What exactly is vestibular neuritis?

The word “vestibular” refers to the vestibular system. This is the portion of the inner ear and the brain that interprets the sensory information the body uses to regulate balance and control eye movements. Neuritis is a general term for diseases in which a nerve or a group of nerves becomes inflamed.

When the vestibular system is healthy, the signals to the brain from the left and right sides of the body match up. When the nerves on one side become swollen due to inflammation, the information sent to the brain gets scrambled. This results in the brain being unable to match up what the left and right sides of the body are saying, and the result is varying degrees of vertigo. Balance is affected, and vision or hearing may also be involved. Some people find it difficult to concentrate, and some experience tinnitus, which is the presence of a ringing sound with no outside source.

Most inner ear infections are viral in nature. Unfortunately, not a lot is known about how these infections are transmitted. In many cases, the viral infection runs its course over a period of weeks and symptoms go away. In some cases, if the vestibular nerves have been damaged, the dizziness can persist.

As you probably learned, there is no definitive test for vestibular neuritis. The MRI that you had was not to diagnose vestibular neuritis, but rather to rule out conditions with similar symptoms such as head injury or stroke. Other conditions with similar symptoms include allergic reactions, the side effects of certain prescription or nonprescription medications, a neurological disorder or anxiety.

In cases where dizziness persists, further testing may be appropriate. This is done to confirm that the diagnosis is correct, and to pinpoint the location of the problem within the vestibular system. In addition to a hearing test, a physician or audiologist may recommend electronystagmography or videonystagmography tests used to evaluate the vestibular system. A short course of steroids may be recommended to decrease the inflammation in the vestibular system. The hopeful news is that, over time and with the help of rehabilitation exercises, the brain adjusts to the altered signals and the dizziness can abate.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.