What is vestibular neuritis?
Vestibular neuritis strikes when inflammation hits the vestibular branch of the eighth cranial nerves, unleashing a sudden storm of vertigo, nausea and unsteady steps. Vestibular neuritis isn't rare, striking between 3.5 and 15.5 per 100,000 people each year, with up to 1 in 10 adults and over 3% of children facing acute one-sided vestibular loss. While often self-limiting, vestibular neuritis can leave a lingering imbalance that disrupts daily life and erodes quality of living.
What causes vestibular neuritis?
Vestibular neuritis is often triggered when herpes simplex virus type 1 (HSV-1) reactivates in the vestibular ganglion, causing inflammation that scrambles balance signals. In some cases, microvascular ischemia or immune-driven nerve injury tips the scales, further wrecking vestibular function. The superior vestibular nerve, trapped in its long, narrow bony canal, is a prime target for swelling and compression. Together, these forces unleash the sudden, spinning storm of vertigo that defines the disorder.
Symptoms of vestibular neuritis
The symptoms of vestibular neuritis include:
- Sudden or severe vertigo (sensation of spinning)
- Dizziness and balance problems
- Nausea and Vomiting
- Motion sensitivity and visual problems
- Nystagmus (involuntary eye movements) without associated hearing loss.
Failing to detect vestibular neuritis risks more than dizziness. It can mask a stroke, prolong disability, and cost lives.
Diagnosis of vestibular neuritis
- Clinical diagnosis of hallmark symptoms:
- Sudden, severe, continuous vertigo lasting hours to days.
- Associated with nausea and vomiting.
- Spontaneous horizontal-torsional nystagmus toward the healthy ear.
- Imbalance without true hearing loss (hearing loss suggests labyrinthitis instead).
Typical course: Gradual improvement over days; near-complete recovery in weeks.
- Medical examination:
- Head Impulse Test (HIT) will show abnormality in the affected ear.
- Nystagmus characteristics are observed, especially the peripheral pattern is prominent (suppressed with visual fixation, constant direction).
- Gait assessment may reveal imbalances, but the patient can walk with support (severe falls suggest a central cause).
- HINTS Exam (Head impulse, Nystagmus, Test of Skew) to differentiate from stroke.
- Vestibular function tests
- Caloric testing: reduced or absent response in the affected ear; may normalize over time.
- VEMP (Vestibular Evoked Myogenic Potentials) is often reduced or absent.
- Imaging - only If “Red Flags” appear
- MRI brain (focus on brainstem and cerebellum)-preferred if stroke is suspected or symptoms persist >48hours.
- CT scan with thin slices-alternative if MRI unavailable.
EquifHIT in VOR testing
- EquifHIT from Taevas is a Functional Head Impulse Test (fHIT) device that analyses the vestibulo-ocular reflex (VOR), the key pathway often impaired in vestibular neuritis.
- It quantifies a patient’s ability to maintain sharp vision while moving by displaying optotypes during quick, erratic head motions.
- In vestibular neuritis, with canal-specific precision, EquifHIT detects the decreased VOR gain on the afflicted side of vestibular neuritis.
- This makes it a fast, reliable tool to confirm peripheral vestibular dysfunction and distinguish it from central causes of vertigo.
Call to Action
If you or your patients experience sudden, prolonged vertigo, insist on a targeted vestibular evaluation. Ask your clinician about vestibulo-ocular reflex testing with the EquifHit Functional Head Impulse Test. Visit Taevas website to explore our product details, or call <Taevas contact number> to book a live demonstration.
Early, objective detection of vestibular deficits means more accurate diagnosis and a faster path to recovery.
References
- Smith T, Rider J, Cen S, et al. Vestibular Neuronitis. [Updated 2023 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK549866/
- Bae CH, Na HG, Choi YS. Current diagnosis and treatment of vestibular neuritis: a narrative review. J Yeungnam Med Sci. 2022;39(2):81-88. doi:10.12701/yujm.2021.01228
- Erbek S, Luis L. Vestibular Neuritis. In: Neurotology Updates. Comprehensive ENT. Cham: Springer; 2024. p. 185–199.
- Musat GC, Preda MA, Tanase I, Anton AZC, Mitroi GG, Musat O, Oancea ALA, Mitroi MR. Inferior Vestibular Neuritis: Diagnostic Criteria, Clinical Features, and Prognosis—A Focused Review. Medicina. 2025; 61(2):361. https://doi.org/10.3390/medicina61020361
- Taevas Global. EquifHit Functional Head Impulse Test Device. Taevas Global. 2025 Aug 7 [cited 2025 Aug 10]. Available from: Taevas Global website