Dr. Aleman Lopez is a specialist in Otorhinolaryngology in Alicante. He has been dedicated to otoneurology for more than 15 years, and is an expert in ear and all the neurological pathology that affects it. In his office he has a Vestibular Exploration Unit and Computerized Dynamic Posturography that allows him to perform vestibular rehabilitation.
Vestibular neuritis is the prototype of acute vestibular lesion, which presents with an intense, disabling vertiginous crisis, with a sensation of spinning objects, accentuated vegetative symptoms (nausea, vomiting, sweating, pallor, digestive alterations) and difficulty in ambulation without help, especially at the beginning of the picture.
How does vestibular neuritis progress?
Given the intensity of the symptoms and the prolonged nature of the process, the patient often goes to the emergency department for appropriate care. The natural evolution of this pathological condition is towards gradual resolution in a period ranging from weeks to months, depending on the degree of lesion of the affected vestibular nerve, the initial treatment, the patient’s ability to compensate and the rehabilitation treatment indicated immediately after the crisis.
It is considered that the origin of the lesion may be a viral involvement or a microvascular dysfunction that acutely affects one of the vestibular nerves (nerves that carry signals from the balance system to the central nervous system). On some occasions, when lesions in the vestibular nerve are very severe, a certain degree of residual symptomatology may remain, which manifests with a sensation of dizziness triggered by head movements and a slight perception of instability. This symptomatology is minimized with the passage of time, when adequate vestibular rehabilitation is performed, usually at home.
Diagnosing vestibular neuritis
Accurate diagnosis of vestibular neuritis requires a thorough clinical otoneurological evaluation, including audiometric study, videonystagmoscopy (recording with an infrared video camera of eye movements in search of nystagmus), video-controlled impulsive cephalic test and dynamic functional evaluation of balance by posturography. With the information obtained from these studies, it is possible to determine the affected ear, the level of affectation, the degree of compensation and the functional situation of the balance. These data will allow the design of an individualized rehabilitation plan for each patient which, except in very severe cases, the patient will be able to carry out at home.
The otoneurological study of the patient will also make it possible to rule out other diagnostic possibilities, especially in elderly patients with cardiovascular risk factors, who can sometimes present pictures of vascular origin affecting the central nervous system in its posterior territory; these episodes can cause a clinical picture, very similar to vestibular neuritis, but much more serious, from the medical point of view. For this reason, on some occasions, these pictures will lead us to request complementary imaging studies. In general terms, the prognosis of vestibular neuritis is excellent in the medium term, provided that the management is adequate.