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The vestibular nerve is a large division of cranial nerve eight (CN VIII) that transfers the equilibrium information from the inner ear to the central nervous system. The cochlear nerve is the other large branch of the vestibulocochlear nerve that transports the sounds findings to the central nervous system. Inflammation of the vestibular branch of CN VIII (vestibulitis) is associated with the vertigo symptoms.
On the other hand swelling of both vestibular and cochlear nerve bundles (labyrinthitis) produce tinnitus and/or hearing problems moreover to vertigo.
Some consider this being the third most common cause of peripheral vestibular vertigo. It has an estimated annual incidence of 3.5 per 100,000 population and may account for 7% of patients at outpatient clinics specializing in the treatment of vertigo 7.
Vestibular neuritis is common between men and women aged 30-60 years old group and increased the incidence of it's with the aging regarding the decreased in the number of inner ears nerve cells and blood flow 1,2.
After recovery of the symptoms, balance and dizziness disorders can last for several months in some of the patients.
Viral infections are the commonest causes of the vestibular neuritis and bacterial infections are much less common.
Most common types of viral causes of vestibular neuritis include Herpes simplex (HSV-1) infection considered most common viral etiology 7), measles, rubella, mump, Epstein Barr, flu, herpes zoster, and chickenpox 3.
Some patients may give a history of prior gastrointestinal or upper respiratory tract infection especially in men and women aged 30-60 years old 1,2.
MRI with contrast is sometimes requested by clinicians in order to rule out of the other causes of sudden onset dizziness and vertigo such as stroke and brain tumors.
- T1 C+ (Gd): MRI with contrast can show enhancement of the vestibular nerve fibers within the internal auditory canal with the labyrinth of the inner ear often intact.
Treatment and prognosis
No standard treatment method for vestibular neuritis but antiviral or antibacterial therapy is usually prescribed for viral or bacterial causes. Supportive therapy also used for dizziness and nausea. In intractable cases, vestibular rehabilitation therapy may need it. Recurrence is rare and most patients will show full recovery 3.
- 1. Susan Herdman. Vestibular Rehabilitation. (2019) ISBN: 9780803613768
- 2. Strupp M, Brandt T. Vestibular neuritis. (2009) Seminars in neurology. 29 (5): 509-19. doi:10.1055/s-0029-1241040 - Pubmed
- 3. Shupert CL, et al. (n.d.). Labyrinthitis and vestibular neuritis. (see: https://vestibular.org/labyrinthitis-and-vestibular-neuritis)
- 4. E. Saraf Lavi and, Evelyn M. L. Sklar. Enhancement of the Eighth Cranial Nerve and Labyrinth on MR Imaging in Sudden Sensorineural Hearing Loss Associated with Human Herpesvirus 1 Infection: Case Report. (2001) American Journal of Neuroradiology. 22 (7): 1380. Pubmed
- 5. Park KM, Shin KJ, Ha SY, Park JS, Kim SE. A Case of Acute Vestibular Neuritis Visualized by Three-Dimensional FLAIR-VISTA Magnetic Resonance Imaging. (2014) Neuro-ophthalmology (Aeolus Press). 38 (2): 60-61. doi:10.3109/01658107.2013.874454 - Pubmed
- 6. Jeong S et.al . Vestibular neuritis. (2013) Seminars in neurology. doi:10.1055/s-0033-1354598 - Pubmed
- 7. Strupp M et.al. Vestibular neuritis. (2009) Seminars in neurology. doi:10.1055/s-0029-1241040 - Pubmed