CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Vestibular neuronitis - Management
How do I know my patient has it?
- Vestibular neuronitis often affects previously well, young or middle-aged adults, but can affect anyone.
- Enquire about symptoms indicative of vestibular neuronitis.
- Vertigo occurs spontaneously, may develop on waking, or may develop over the course of the day. Acute symptoms usually settle in a few days because vestibular compensation occurs.
- Nausea and vomiting occur, and balance may be affected. Gait apraxia is not a prominent feature.
- Hearing loss and tinnitus are not features of vestibular neuronitis (but may be present in labyrinthitis).
- There are no focal neurological symptoms.
- Look for signs of vestibular neuronitis.
- Nystagmus is present and is usually fine horizontal but may be mixed horizontal-torsional with the fast phase away from the affected ear. It always beats in the same direction, even if the head is rotated, and is reduced when the vision is fixed on a point.
- The head impulse test may be positive (but is less reliable than nystagmus as an examination finding, as it may also be positive for other peripheral causes of vertigo and so cannot be used to differentiate between them).
© NHS Institute for Innovation and Improvement