Viral Neuronitis & Labyrinthitis

At a glance

Symptoms: Sudden severe vertigo, nausea, and imbalance; hearing loss in labyrinthitis
Common causes: Viral inflammation of the vestibular nerve or the inner ear
How it's diagnosed: Bedside head impulse testing, VNG, and hearing tests
Treatment: Short-term symptom relief, steroids for some, and vestibular rehabilitation

Overview

Viral Neuronitis and Labyrinthitis are conditions characterized by an infection of the inner ear, usually caused by a virus, leading to inflammation and irritation. These conditions impact the vestibulocochlear nerve—responsible for balance, equilibrium, and hearing—resulting in symptoms such as vertigo, dizziness, imbalance, nausea, and sometimes changes in hearing.

These conditions occur when a virus affects the inner ear, causing an immune response that leads to inflammation. If the inflammation is limited to the vestibular nerve, it's termed viral neuronitis. If both the cochlear and vestibular nerves are inflamed, it's called viral labyrinthitis. Symptoms often include severe vertigo, nausea, vomiting, and, in some cases, hearing loss or a sensation of fullness in the ears.

Symptoms

Acute Phase: Sudden onset of severe vertigo, possibly lasting hours to days, accompanied by nausea and vomiting.
Chronic Phase: Persistent disequilibrium that gradually improves over weeks to months.

Diagnosis

Early evaluation is crucial. Diagnostic steps include:

Detailed symptom history.
Observation of nystagmus using infrared video oculography.
Comprehensive audiogram for asymmetric hearing loss.
MRI and CT scans to exclude other pathologies.
Further testing like videonystagmography (VNG) during the chronic phase.

Treatment

Prompt treatment is advised for the best outcomes:

Acute Phase: Anti-viral medication (e.g., Acyclovir, Valacyclovir) and steroids to reduce inflammation.
Chronic Phase: Vestibular rehabilitation to retrain the brain to process signals from the damaged vestibular system and practice VOR exercises.

Living with Viral Neuronitis & Labyrinthitis

With timely and effective treatment, most patients make a full recovery. Vestibular rehabilitation may be recommended for lingering symptoms of disequilibrium and imbalance.

Testing that can help

Testing is chosen from your history and examination. These are the tests most often used here.

DizzyDoctor Vertigo Recording GogglesHigh-resolution infrared video goggles used to document eye movements during dizziness and positional vertigo evaluation.Videonystagmography (VNG)A comprehensive eye-movement test battery used to evaluate vestibular and oculomotor function.

Vestibular Evoked Myogenic Potentials (VEMP)Measures reflex responses from the otolith organs (saccule and utricle) to sound or vibration.

Specialty care: Viral Neuronitis / LabyrinthitisThese conditions involve inflammation of the inner ear or the nerves that connect the ear to the brain, often due to a viral infection.Vestibular RehabilitationVestibular rehabilitation is an exercise-based therapy that retrains the brain to compensate for inner ear problems, reducing dizziness and improving balance.DizzinessDizziness can mean spinning (vertigo), lightheadedness, or unsteadiness, and each points toward different causes.Benign Paroxysmal Positional Vertigo (BPPV)Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo: brief spinning set off by changes in head position, caused by loose crystals in the inner ear.

When to seek urgent care

Call 911 or go to the nearest emergency department if dizziness or imbalance starts suddenly together with any of the following, since these can be signs of a stroke or another emergency:

Weakness or numbness of the face, arm, or leg, especially on one side
Trouble speaking or understanding speech
Double vision or sudden loss of vision
A sudden, severe headache
Inability to walk or stand
Chest pain, fainting, or a seizure