Vestibular neuritis

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Classification according to ICD-10
H81.2 Vestibular neuropathy
ICD-10 online (WHO version 2019)

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

distribution

The incidence is 3.5 per 100,000 per year. After benign positional vertigo and Menière's disease , it is the third most common form of peripheral-vestibular vertigo. The maximum illness lies between the 3rd and 6th decades of life.

Pathogenesis

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

Symptoms

In the case of acute unilateral failure of the organ of equilibrium, vertigo , nausea and vomiting, sweating and involuntary pendulous eye movements occur. A horizontally rotating spontaneous nystagmus with the fast component towards the healthy ear is often observed (failure nystagmus). A tendency to fall to the sick side while sitting or standing ( trunk ataxia ) is also typical . There is no hearing impairment.

Clinical examination

During the clinical examination, there is a sideways deviation to the affected side when carrying out the Unterberger step test . The vestibulo-ocular reflex has failed. The spontaneous nystagmus increases when looking to the unaffected side. The diagnosis is confirmed by a caloric test of the inner ear by an ear, nose and throat specialist. Here there is a thermal underexcitability of the equilibrium organ when tested with cold or warm water or air.

therapy

Bed rest should be maintained in the acute situation, as dizziness increases with head movements. Symptomatic drugs can be used against vertigo for a short time.

Studies show that glucocorticoid methylprednisolone helps accelerate the healing process in the short term. The therapy should be carried out for about a week with a subsequent slow dose reduction ( tapering ). This results in a better restoration of the equilibrium nerve.

Long-term treatment success could not be proven in other studies.

Infusions with vasodilators ( vasodilating drugs ) or with rheological drugs , which are often used for other vestibulocochlear disorders, are scientifically unfounded . As soon as the acute symptoms have subsided, a special physiotherapy should always complement the medicinal therapy in order to train the balance organ.

forecast

The course is favorable. In the majority of patients, the sense of equilibrium is fully restored after 12 weeks, in a further proportion there is at least a partial improvement at this point in time. Another proportion still complain of dizziness after three months.

In up to 15% of cases, there is also a benign paroxysmal positional vertigo of the affected ear. The traumatic experience of persistent organic vertigo can also lead to phobic vertigo. Recurrences are rare and affect the other ear.

Special case of labyrinth failure on both sides

With chronic bilateral failure, standing and walking motor skills are disturbed when the eyes are closed or in the dark. This can lead to a loss of spatial orientation (risk sports or dangerous jobs can no longer be practiced). A bilateral labyrinth failure is very rare.

Differential diagnoses

literature

  • Klaus Poeck, Werner Hacke: Neurology . 12th, updated and expanded edition. Springer, Heidelberg 2006, ISBN 3-540-29997-1 , pp. 419, 420 .
  • Thomas Brandt, Marianne Dieterich, Michael Strupp: Vertigo - leading symptom dizziness . 2nd Edition. Springer, Heidelberg 2013, ISBN 978-3-642-24963-1 (with DVD).

Web links

Individual evidence

  1. ↑ M. Strupp, VC Zingler, V. Arbusow: Methylprednisolone, valacyclovir, or the combination for vestibular neuritis In: The New England Journal of Medicine. 2004, 351 (4), pp. 354-361.
  2. ↑ Fishman, JM; Burgess C; Waddell A (May 2011). "Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)". Cochrane Database Syst Rev (5): CD008607. doi: 10.1002 / 14651858.CD008607.pub2 . PMID 21563170 .
  3. ↑ thieme-connect.com