Vestibular neuronitis

The vestibular neuritis or vestibular neuropathy is an acute or chronic dysfunction of the vestibular system in the inner ear.

Dissemination

The incidence is 3.5 per 100,000 per year. After benign positional vertigo and Meniere's disease is the third most common peripheral vestibular vertigo. The disease maximum is 3 to 6 decades of life.

Pathogenesis

The cause of the disease is an inflammatory process of the vestibular nerve, for example, by a viral infection or reactivation ( " neuritis " ) or a circulatory disorder suspected. The exact causes of the disease are still unclear.

Symptoms

In acute unilateral loss of the vestibular system leads to dizziness, nausea and vomiting, sweating and involuntary oscillating eye movements. Often a horizontal rotary nystagmus with the fast component to the healthy ear is towards observed ( Ausfallnystagmus ). Typical is also a tendency to fall in the sitting or standing to the diseased side ( truncal ataxia ). A disturbance of the sense of hearing is not available.

Clinical examination

On clinical examination, there is a Seitabweichen the affected side when performing the Unterberger - Tretversuchs. The vestibulookuläre reflex has failed. The spontaneous nystagmus increases when looking toward the unaffected side. The diagnosis is made by a Kalorikprüfung of the inner ear by an ear, nose and throat specialist. Here you will find a thermal hyposensitivity of the vestibular system when tested with cold or warm water or air.

Therapy

In the acute situation bed rest should be adhered to, as the dizziness increases during head movements. Symptomatic possible to use drugs to relieve dizziness shortly.

The glucocorticoid methylprednisolone has proven effective in the treatment. The therapy should be carried out over about a week with subsequent slow reduction of dose ( Ausschleichung ). This provides a better restoration of the balance nerve is reached.

Scientifically unfounded are infusions of vasodilators ( vasodilator drugs) or with rheological drugs that are often used in other vestibulocochleären disorders. Once the acute symptomatology has placed a special physical therapy should always complement the drug to train the organ of balance.

Forecast

The course is favorable. After days, weeks later than is usually asymptomatic before by central compensation.

However, in up to 15% of cases, in addition to a benign paroxysmal positional vertigo of the affected ear. Also can be set by the traumatic experience of a persistent organic rotational vertigo a phobic postural vertigo. Recurrences are rare, this then affect the other ear.

Special case of two-sided maze failure

In chronic double-sided failure may cause problems of standing and Gehmotorik with eyes closed or in the dark. This can lead to loss of spatial orientation ( high-risk sports or hazardous occupations can no longer be exercised ). A two-sided maze failure is very rare.

Differential diagnoses

  • Meniere's disease
  • Benign paroxysmal positional vertigo
  • Stroke
  • Acoustic neuroma
  • Pseudoneuritis vestibular
  • Basilar
  • Vestibular paroxysm
  • Perilymph fistula
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