bubble_chart Overview

In 1909, Ruttin first proposed the term vestibular neuritis, also known as epidemic vertigo, epidemic neurolabyrinthitis, acute labyrinthitis, or vestibular paralysis. The inflammation is confined solely to the vestibular system, with the cochlea and central system remaining normal. It predominantly affects adults aged 20 to 60, often with a history of upper respiratory tract infection prior to onset. The condition can be classified into acute and chronic forms.

bubble_chart Etiology

(1) Viral infection: Serum tests after illness show significantly increased titers of herpes simplex and varicella-zoster viruses.

(2) Vestibular nerve stimulation: The vestibular nerve may be compressed by blood vessels or adhere to the arachnoid membrane, or even suffer hypoxic degeneration due to stenosis of the internal auditory canal, triggering nerve discharge and causing the disease.

(3) Focal factors: Autoimmune reactions may be involved.

(4) Diabetes: Schuknecht et al. (1972) reported that diabetes can lead to degenerative atrophy of vestibular neurons, resulting in recurrent vertigo attacks.

bubble_chart Pathological Changes

In some patients who underwent vestibular nerve section, pathological examination revealed isolated or scattered degenerative changes and regenerative phenomena in the vestibular nerve, including reduced nerve fibers, vacuolation of ganglion cells, and increased collagen deposits within the nerve.

bubble_chart Clinical Manifestations

(1) Acute Vestibular Neuritis 80% of patients experience sudden onset of vertigo, mostly upon waking at night, following respiratory or gastrointestinal infections. Symptoms peak within hours and are accompanied by nausea and vomiting, lasting for several days to weeks before gradually subsiding. Recovery is slower in the elderly, potentially taking months. The condition typically affects one ear, though cases of sequential bilateral involvement are rare. Spontaneous paralytic nystagmus toward the healthy side is observed. Familial clustering or small-scale outbreaks may occur. Notably, tinnitus and deafness are absent during the illness.

(2) Chronic Vestibular Neuritis This form predominantly affects middle-aged and older individuals, characterized by recurrent episodes of mild vertigo, more noticeable during upright walking. Symptoms may persist for years, with nausea and vomiting being uncommon. Patients often report prolonged unsteadiness.

bubble_chart Diagnosis

Simple peripheral vestibular vertigo, without cochlear involvement symptoms.

1. Caloric test shows partial or complete vestibular function loss, sometimes with a directional preponderance to the healthy side.

2. No headache or other neurological signs.

3. Leukocytosis may occur during the acute phase.

4. Spontaneous nystagmus is present during the attack stage.

bubble_chart Treatment Measures

During the acute phase, sedative medications such as diazepam and chlorpromazine should be administered, and hormones can also be effective. In the chronic phase, it is important to increase nutrition, engage in physical exercise, and eliminate the source of the disease. If the condition persists and does not improve with long-term treatment, vestibular neurectomy may be considered.