Approach Considerations
There is no standard treatment for vestibular neuritis. In most cases, the brain rapidly compensates and adjusts to the new vestibular deficit, or the inflammatory process resolves.
Multiple oral medicines that can help with dizziness and nausea are available (see Medication).
Evidence indicates many sedating medicines commonly used for this condition may slow recovery. Thus, medical treatment may reduce symptoms but prolong recovery.
Vestibular rehabilitation therapy (VRT), which includes balance exercises, appears to be equally as effective as corticosteroids in patients with vestibular neuritis. [4, 5]
Emergency Department Care
ED physicians must first distinguish true vertigo from other types of dizziness. Then, after determining that the patient truly has vertigo, central vertigo must be ruled out through a careful history, physical examination, and, if still uncertain, imaging studies.
Regardless of the vertigo's etiology, ED physicians should attempt to alleviate patient suffering. An intravenous (IV) line often is started to rehydrate the patient, who should be allowed to lie still in bed as desired. Parenteral medicines then are administered.
Consider admission for patients who have persistent vomiting despite treatment and for patients unable to walk satisfactorily.
In cases of vestibular neuritis refractory to acute medical treatment, ED physicians may wish to consult with a neurologist or otolaryngologist.
