İşitmeAtölyesiAt a glance
Isolated inflammation of the balance nerve (neuritis; hearing preserved) or inflammation involving the inner ear too (labyrinthitis; hearing loss + tinnitus added).
Sudden-onset, days-long severe vertigo, intense nausea-vomiting, imbalance, nystagmus.
Sudden continuous vertigo can be confused with stroke; EMERGENCY if there is a neurological sign. Bacterial labyrinthitis is urgent.
Short-term symptom control + early mobilisation; the main treatment is vestibular rehabilitation.
Medical disclaimer. This content is for informational purposes only and does not replace a physician’s examination, diagnosis or treatment; it should not be used as medical advice. For your complaints or personal situation, always consult an ear, nose and throat physician and an audiologist.
If you have sudden-onset severe dizziness lasting hours-days with intense nausea-vomiting, see a physician. If dizziness is accompanied by double vision, difficulty speaking or weakness in an arm/leg, this may be a stroke sign; go to the emergency department without losing time. If hearing loss is added on a background of ear infection (labyrinthitis), emergency assessment is needed.
Definition and epidemiology
Vestibular neuritis is isolated inflammation of the balance nerve (vestibular nerve) and hearing is not affected. Labyrinthitis is a picture in which the inflammation also involves the inner ear, adding sensorineural hearing loss and tinnitus to the dizziness. In current literature the term ‘acute unilateral vestibulopathy’ (AUVP) is also used for vestibular neuritis (Strupp et al., 2022).
Vestibular neuritis is among the most common causes of peripheral dizziness after BPPV; it is often seen in middle age and no clear sex difference has been reported.
Sudden-onset severe vertigo lasting days is the typical presentation.
Symptoms and signs
The clinical picture is characterised by sudden-onset severe spinning sensation, intense nausea-vomiting and imbalance. The patient usually becomes bed-bound because of symptoms that increase with movement.
In vestibular neuritis hearing is preserved; in labyrinthitis, sudden hearing loss and tinnitus are added to the picture. This distinction is important for diagnosis and follow-up.
Symptoms are most severe in the first 1-2 days, then decrease gradually over days-weeks. Nystagmus (involuntary eye movement) is an important sign detectable on examination.
Causes and risk factors
The most commonly proposed mechanism is viral/postviral inflammation due to reactivation of herpes viruses lying dormant (latent) in the vestibular ganglion. It can often follow an upper respiratory infection.
In labyrinthitis, viral or bacterial agents affect the inner ear too; bacterial labyrinthitis (especially on a background of middle-ear infection or meningitis) is more serious and requires urgent treatment.
In a patient presenting with sudden, severe, continuous vertigo, the priority is to distinguish it from a central cause such as stroke (Jeong et al., 2013).
Audiological and clinical assessment
The most critical step in emergency assessment is to distinguish a peripheral picture from central causes (especially stroke). The bedside HINTS examination is valuable for this; findings favouring peripheral are reassuring, while central signs require further investigation.
- HINTS examination (head-impulse test, nystagmus direction, eye skew): central/peripheral distinction in acute vertigo.
- vHIT: shows a reduced vestibulo-ocular reflex gain and corrective saccades on the affected side.
- Caloric test: documents unilateral vestibular weakness (canal paresis).
- VEMP: distinguishes involvement of the superior and inferior vestibular nerve branches.
- Pure-tone audiometry: distinguishes labyrinthitis (hearing loss present) from vestibular neuritis (hearing normal).
Imaging is planned when a central cause is suspected or the course is atypical.
| Feature | Vestibular neuritis | Labyrinthitis |
|---|---|---|
| Involvement | Balance nerve only | Balance nerve + inner ear |
| Hearing | Preserved | Sensorineural loss |
| Tinnitus | Not expected | Often accompanies |
| Severe form | — | Bacterial labyrinthitis (urgent) |
| Main treatment | Vestibular rehabilitation | + cause-directed treatment |
Treatment and audiological rehabilitation
In the acute, severe period, short-term vestibular suppressants can be used to ease nausea and dizziness; however, they should not exceed 2-3 days, because long-term use delays the brain’s adaptation process.
Although some studies report that corticosteroids contribute to recovery of vestibular function in the early period, current systematic reviews emphasise that the evidence is insufficient to support routine use; the decision rests with the physician (Fishman et al., 2011). Bacterial labyrinthitis requires appropriate antibiotic treatment.
The most effective, evidence-based approach is vestibular rehabilitation: early mobilisation and regular exercises accelerate central compensation. For a permanent hearing loss after labyrinthitis, a hearing aid; and in selected cases at risk of inner-ear ossification (labyrinthitis ossificans), a cochlear implant should be considered in a timely manner.
Impact on quality of life and advice
Although the acute period is quite distressing, most patients improve markedly. However, in some patients, despite physical recovery, persistent imbalance and dizziness (persistent postural-perceptual dizziness, PPPD) can develop; anxiety and excessive attention play a role.
To speed recovery, it is important to move early, continue exercises and avoid sedatives that suppress balance. Feeling mild dizziness during exercise is normal and shows that adaptation is developing.
If you used this review, you can cite it as follows (APA 7):
İşitme Atölyesi. (2026). Vestibular Neuritis and Labyrinthitis. Hearing & Balance Health Guide. https://www.isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/vestibuler-norit-labirentit/Permanent link: isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/vestibuler-norit-labirentit/ · Last reviewed: July 2026 · License: CC BY-NC-ND 4.0
References
- Fishman, J. M., Burgess, C., & Waddell, A. (2011). Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database of Systematic Reviews, 5, CD008607.
- Jeong, S. H., Kim, H. J., & Kim, J. S. (2013). Vestibular neuritis. Seminars in Neurology, 33(3), 185-194.
- Strupp, M., Bisdorff, A., Furman, J., et al. (2022). Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. Journal of Vestibular Research, 32(5), 389-406.
- Strupp, M., Zingler, V. C., Arbusow, V., et al. (2004). Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. New England Journal of Medicine, 351(4), 354-361.
Frequently asked questions
Will my dizziness be permanent?
In most patients the brain re-establishes balance over time and symptoms recede markedly. Moving early and doing vestibular rehabilitation exercises regularly speed this recovery. Some patients may have persistent imbalance; in that case too, exercises and, where needed, support help.
Is there hearing loss with every dizziness?
No. In isolated vestibular neuritis hearing is fully preserved; only in labyrinthitis, because the inflammation also affects the inner ear, do hearing loss and tinnitus occur. This distinction is important for the diagnostic and treatment plan.
Can this be confused with a brain haemorrhage or stroke?
Sudden, severe, continuous dizziness can rarely be confused with a brainstem/cerebellar stroke. That is why physicians carefully make this distinction with methods such as the HINTS examination. If the dizziness is accompanied by double vision, difficulty speaking or arm/leg weakness, emergency assessment is needed.
Should I stop if I get dizzy during exercise?
No. Feeling mild dizziness during exercise is a sign that the brain is re-learning balance, and this ‘challenge’ is necessary for recovery. It is recommended to continue the exercises gradually under expert guidance.
Should I use continuous dizziness medication?
Dizziness-suppressing drugs should be used only in the first few days, during the most severe period, for a short time. Long-term use delays the brain’s adaptation and slows recovery. That is why it is recommended to start movement and exercise as early as possible.
Scales that can be used to monitor balance complaints and rehabilitation benefit: