Labyrinthitis and Vestibular Neuritis (Vestibulopathy)

What are Labyrinthitis and Vestibular Neuritis?

These are inner ear conditions that cause a delicate structure deep inside your ear (the labyrinth) to become inflamed, usually caused by a virus. This may be after another illness or for no apparent reason. Usually only one ear is affected.

Limit the time you spend resting on the sofa or bed in the daytime and the amount of time you spend on screens such as TV, phones, tablets, computers, etc. Aim for 30 minute breaks daily.

Labyrinthitis or vestibular neuritis

The vestibular nerve carries information from the inner ear about head movement. When one of the two vestibular nerves or labyrinths is affected, there is an imbalance between the two sides, and vertigo occurs.

This can vary in severity from very mild unsteadiness, to more violent vertigo (spins), dizziness, difficulties with balance and walking, nausea and vomiting. Difficulty with vision and occasionally hearing loss may result.

It may come on abruptly and affect your walking or ability to go outside. Usually the situation starts to improve over a few days; occasionally medication helps in the early stages if you are vomiting or very nauseous, but should be avoided long term.

The majority of patients are completely free of symptoms within a few weeks. However, a small number will have chronic dizziness if there is nerve damage or they avoid movements that make them feel dizzy.

The balance system

Balance is part of everyday activities from the minute we get out of bed, bend to put on our socks, walk down the street, turn our head to talk or read, and take part in social and sport activities. It is controlled by very complex sensory balance system where we coordinate information from the eyes, inner ears, joints, feet and brain.

Associated problems

The vestibular system is closely linked to parts of the brain involved with migraine and headaches, anxiety and nausea.

Common other complaints seen are:

• Frequent headaches, even vestibular migraine
• Reduced concentration
• Discomfort in busy places, typically shopping centres
• Increased fatigue as well as often becoming quite emotional
• Difficulty reading especially computer screens.

Generally, as the balance improves, these associated problems will naturally reduce, but at times you may need some specific help to address these varied problems.

Diagnosis

Diagnosis is usually made by listening to you describe symptoms. There are many other medical conditions which can bring on vertigo so you will be asked questions to help exclude all of these. Very rarely do patients need further investigations such as MRI scan.

Vestibular rehabilitation exercises

These may be suggested to retrain the brain’s ability to adjust to the vestibular imbalance, known as compensation and adaptation.

To enable this to work fully, patients need to be dedicated to doing exercises regularly through the day for several months, even though initially these may seem to increase your dizziness.

Common exercises

Place a small card or target on the wall at eye level. Standing, keep your eyes fixed on this target whilst you turn your head to the left and right and build up to repeating for one minute.

Progress as able, to performing the same exercise faster of for longer. Thirty seconds to one minute (max) five times a day is usually enough.

Within a few weeks of doing this, aim to do the above as you walk forwards and backwards, still moving your head (stay close to the kitchen units or wall for safety).

Practise standing with your feet together, progressing to balancing on one leg, building up to 20 seconds as you improve. When this gets easier, repeat but try to challenge your balance by closing your eyes.

Make sure you are safe when doing these, stand close by the table or something to hold onto.

Walking

One of the best exercises is simply going out for a walk every day. Initially you may feel as if you are staggering but with daily practice, this will improve gradually over a month.

As you regain the ability, you will regain confidence to go outside the house alone, cross roads, and resume many of the activities you have been unable to do since the problem began. Look around, move your head and target your vision in all different directions.

Physiotherapy

Milder balance problems can continue for several months despite the above advice. If this is the case, you may be referred for physiotherapy or a balance clinic.

Will it happen again?

Whilst this is very unlikely, you may experience symptoms in the future. There is a two percent recurrence rate within two years and it usually affects the other ear.

This is often triggered by:

• Times of stress
• Marked tiredness
• Following a different illness or period of prolonged inactivity.

It may leave you feeling more unsteady so it is important that you restart any exercises and advice you were previously given, and your symptoms will typically settle again over several weeks. This does not mean you need to be seen again, although your GP will re-refer you to physiotherapy if it is needed.

Further information Patients have found the following websites helpful:

• nhs.uk/Vertigo
• dizziness-and-balance.com
• Vestibular.org
• labyrinthitis.org.uk

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Mersey Care NHS Foundation Trust listens and responds to patients and their carers to help improve the services we deliver.

If you have any comments,compliments or concerns you can speak with a member of staff or contact our Patient Advice and Liaison Service (PALS) and Complaints Team:

Telephone: 0151 471 2377
Freephone: 0800 328 2941
Email: palsandcomplaints@merseycare.nhs.uk

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