Vestibular neuritis is inflammation of the vestibular nerve, which carries balance signals from the inner ear to the brain. It typically causes sudden, severe spinning vertigo that lasts for a day or more, with nausea and unsteadiness but usually no change in hearing. Once the acute phase settles, vestibular rehabilitation — gaze stabilization, balance and habituation exercises — is strongly supported by clinical practice guidelines to help the brain compensate. At McKelvie Physiotherapy in Pickering, we measure how your balance system is working with infrared video goggles and build a one-on-one exercise program around what we find.
At a glance
- What it is
- Inflammation of the balance (vestibular) nerve on one side, causing sudden vertigo and imbalance
- Key symptom
- Sudden, constant vertigo lasting at least a day, with nausea and unsteadiness
- Hearing
- Usually unaffected — new hearing loss points to labyrinthitis or another cause
- Recovery
- The severe vertigo usually eases over several days; balance often keeps improving over the following weeks, though some people have lingering symptoms
- Treatment
- Vestibular rehabilitation once the acute phase settles — strongly supported by clinical practice guidelines
- At McKelvie
- 60-minute vestibular assessment with infrared video goggles ($180) in Pickering; no referral needed
What is vestibular neuritis?
Vestibular neuritis — also called acute unilateral vestibulopathy — is inflammation of the vestibular nerve on one side. This nerve carries information about head movement from the inner ear to the brain.
When one side suddenly stops sending normal signals, the brain receives mismatched information from the two ears. The result is a sudden, intense sense of vertigo that doesn’t stop when you keep still, along with nausea and difficulty standing or walking.
Unlike BPPV, where spinning comes in short bursts triggered by position, vestibular neuritis causes constant vertigo that typically lasts a day or more and then slowly eases.
What causes vestibular neuritis?
The exact cause is often unknown. Vestibular neuritis is most often thought to be viral — possibly the reactivation of a virus that has been dormant in the nerve — and some people notice it after a cold or flu-like illness.
Once the acute inflammation settles, the nerve may recover fully, partly or not at all. Even when it doesn’t, the brain can learn to compensate for the weaker side. That process of compensation is what vestibular rehabilitation is designed to support.
What are the symptoms of vestibular neuritis?
- Sudden, constant spinning or swaying vertigo lasting a day or more
- Nausea and vomiting, especially in the first few days
- Imbalance, veering or unsteadiness when walking
- Blurred or “jumping” vision when you move your head
- Hearing that is usually unchanged
- In the weeks afterward, dizziness with quick head turns, in busy places such as grocery stores, or when you’re tired
Some people also develop BPPV after an episode of vestibular neuritis, which a vestibular assessment can check for.
When to get urgent medical help
If vertigo comes on suddenly with a severe headache, trouble speaking, facial drooping, weakness, numbness or loss of vision, call 911 — these can be signs of a stroke.
A new, constant, severe vertigo should be assessed by a doctor the same day, even without those signs. Some strokes can look like vestibular neuritis, and only a medical assessment can tell them apart. New hearing loss, ear pain or a rash around the ear also needs prompt medical attention.
How is vestibular neuritis treated?
Treatment happens in two stages, and different clinicians lead each one.
The acute phase is a physician’s job. Your doctor will confirm the diagnosis, rule out stroke and other causes, and may prescribe medication to ease nausea and vertigo for the first few days. Corticosteroids (steroids) are sometimes prescribed early, although a Cochrane review found insufficient evidence that they improve long-term recovery (Fishman et al., 2011). Medications that suppress dizziness are generally intended for short-term use only.
Recovery is where physiotherapy comes in. Once the worst of the vertigo has settled, vestibular rehabilitation helps the brain compensate for the weaker side. The clinical practice guideline from the Academy of Neurologic Physical Therapy strongly recommends vestibular rehabilitation for people with peripheral vestibular hypofunction such as vestibular neuritis (Hall et al., 2022). A program typically includes:
- gaze stabilization exercises to keep your vision clear while your head moves
- balance exercises to rebuild steadiness when standing and walking
- habituation exercises to reduce sensitivity to the movements and environments that provoke dizziness
Assess
A full vestibular assessment with infrared video goggles to look at your eye movements, confirm how your balance system is working on each side, and check for other problems such as BPPV.
Rebuild
A personalized program of gaze stabilization, balance and habituation exercises, matched to your symptoms and how much you can tolerate.
Progress
Regular re-testing as you improve, with exercises stepped up to prepare you for work, exercise and the places that still bring on dizziness.
If you’re still dizzy or unsteady weeks or months after an episode, it isn’t too late — vestibular rehabilitation can still help with longer-lasting symptoms.
Why choose McKelvie Physiotherapy for vestibular neuritis?
- Advanced vestibular expertise — our lead physiotherapist is an Advanced Vestibular Physical Therapist (AVPT), and dizziness is our clinical focus, not a sideline.
- Advanced diagnostic technology — we use infrared video goggles (video-oculography) to record eye movements the naked eye can’t see, so your diagnosis is based on evidence, not guesswork.
- Accurate, one-on-one assessment — in a private room, with time to get to the bottom of your symptoms.
- Connected care — we work closely with local ENT specialists when you need medical input.
- Care that comes to you — in person in Pickering, at home across the GTA, or virtually anywhere in Ontario.
- Direct billing to many major insurers — and no referral needed.
Sources
- Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. Journal of Neurologic Physical Therapy (Hall CD, et al.), 2022.
- Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. Journal of Vestibular Research (Strupp M, et al.), 2022.
- Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database of Systematic Reviews (Fishman JM, et al.), 2011.