It is a disorder involving the peripheral vestibular system and is hence not sinister.. In vestibular neuritis attack is typically acute, over minutes to hours. Symptoms usually peak within 1—6 h and resolve slowly over 2—3 days, but may rarely continue for about a week. The course is usually benign, with complete recovery in 4—6 weeks.
Recovery of the presenting symptoms of vertigo with nausea and vomiting occurs spontaneously in most cases even when the unilateral loss of vestibular function is permanent because the brain compensates for the vestibular loss.
There are exceptions, particularly in older patients and in patients who take the symptom-relieving anti-vertigo drugs or CNS depressant drugs for a prolonged period, in which compensation may be slow or incomplete. Vestibular neuritis is thought to have a viral origin, but proof in an individual case is difficult. MRI with contrast enhancement occasionally reveals an inflammation of the 8th cranial nerve, but these findings are non-specific and have little diagnostic value.
Serological studies may show a viral infection but cannot prove that a virus has caused the inner ear damage. Vestibular neuritis is different from Ramsay Hunt syndrome, which is also a viral inflammation of the vestibulo—cochlear nerve that is caused by varicella zoster virus. In this disease, visible eruptions are quite often seen in the external auditory meatus along with facial paralysis and hearing loss, none of which are present in vestibular neuritis.
In Ramsay Hunt syndrome, patients typically have a deep burning pain in the ear sometimes with deafness and facial paraalysis, which is never seen in vestibular neuritis. The sudden onset of severe head spinning called acute vestibular syndrome that persists for more than a day without any ear related symptoms is usually caused by vestibular neuritis but it may not always be so. This may also be caused by a stroke cerebro-vascular accident in the cerebellum or in the brainstem.
