Sudden, severe, continuous vertigo lasting days — caused by viral inflammation of the vestibular nerve. One of the most disabling vestibular conditions, but recoverable with early management.
Medical definition
Vestibular neuritis is an acute unilateral peripheral vestibular disorder caused by inflammatory damage to the superior branch of the vestibular nerve, usually following a viral illness. The hallmark is sudden onset of intense rotational vertigo — severe enough that most patients cannot stand or walk — accompanied by nausea, vomiting, and spontaneous nystagmus beating away from the affected side. Hearing is preserved, which distinguishes it from labyrinthitis (where both vestibular and cochlear branches are affected and hearing loss occurs). The acute phase lasts 24 to 72 hours. A subacute phase of several weeks follows, during which central compensation gradually reduces symptoms. Full recovery takes 3 to 6 months when vestibular rehabilitation is started early.
Why it matters for vertigo
Vestibular neuritis is the second most common cause of peripheral vertigo after BPPV. The danger is in the recovery phase. Patients often feel “almost better” after 2 to 3 weeks but then notice persistent unsteadiness, visual vertigo in crowded spaces, and difficulty on uneven ground. This residual phase is frequently misdiagnosed as anxiety, cervicogenic vertigo, or chronic sinusitis. Without vestibular rehabilitation, compensation is incomplete and PPPD can develop. The other risk is missing a central mimic — posterior fossa stroke can present identically in the first 24 hours. The HINTS exam (Head Impulse, Nystagmus, Test of Skew) is the bedside test that differentiates them.
Where I see this in clinic
I see vestibular neuritis most often as a second-opinion case. The patient had a severe vertigo episode 2 to 4 months ago, was told it was a “viral attack,” and was given anti-vertigo medication. The acute episode resolved but they have never felt fully steady since. On video consultation, the key questions are: did the vertigo start suddenly and last days (not seconds)? Was there nausea and vomiting? Is hearing normal? Was rehabilitation started? If the answers follow the vestibular neuritis pattern and no rehabilitation was done, that is the gap to fill — a structured home vestibular rehabilitation programme, not more suppressive medication.
Related terms
Nystagmus — the eye movement that confirms the affected side. VNG — shows reduced or absent caloric response on the affected side. PPPD — the chronic dizziness that can follow unresolved vestibular neuritis. Dix-Hallpike test — negative in vestibular neuritis (helps rule out BPPV).
Medical Disclaimer: This glossary entry is for educational purposes only. Consult Dr. Prateek Porwal directly. WhatsApp: 7393062200.