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Acute dizziness usually resolves spontaneously after a few hours (but may also persist for up to several days). however, it may recur in the coming days or weeks. In the future, residual vestibular dysfunction may persist, manifested by imbalance, especially pronounced when walking. Spontaneous nystagmus persists for 3-5 days, nystagmus when the eyes are turned towards the healthy ear in Frenzel glasses (that is, when the gaze is turned off) is observed for another 2-3 weeks. In many patients, rapid head movements can cause oscillopsia and mild short-term unsteadiness for a long time after suffering vestibular neuronitis. However, even in the absence or incomplete recovery of vestibular function, patients usually do not experience significant changes in daily activities due to vestibular compensation.
The timing of recovery of vestibular function depends on the degree of damage to the vestibular nerve, the rate of central vestibular compensation and the patient's performance of vestibular gymnastics. According to some data, in almost half of the cases, attacks recur after a few months or years, according to other authors, vestibular neuronitis rarely recurs - in 2% of cases. . in many patients who have had vestibular neuronitis, complaints of dizziness reflect an existing somatoform disorder.
Differential diagnosis is carried out with other conditions manifested by prolonged vestibular vertigo. Unlike vestibular neuronitis, acute labyrinthitis often occurs against the background of a systemic infection or acute otitis media and is accompanied by hearing loss. Perilymphatic fistula usually occurs after a cranial injury, barotrauma, severe coughing or straining, accompanied by hearing loss, confirmed by a fistula test. A stroke in the vertebrobasilar system is accompanied by other focal neurological disorders, central nystagmus, brain damage according to MRI. Vestibular neuronitis is often difficult to distinguish from a first attack of Ménière's disease, which is more likely if vertigo is accompanied by tinnitus, ear fullness, and hearing loss.
Symptomatic vestibulolytic agents are used - vestibular suppressants (dimenhydrinate * at a dose of 50-100 mg every 6 hours, metoclopramide, benzodiazepine ** tranquilizers and phenothiazines, with vomiting *** use the parenteral route of administration and / or the use of dosage forms in the form of suppositories) and treatment underlying disease. The duration of use of vestibular suppressants and antiemetics is limited by their ability to delay vestibular compensation. In general, it is not recommended to use these drugs for more than 2-3 days. The use of methylprednisolone a (at an initial dose of 100 mg followed by a dose reduction of 20 mg every three days) in the first three days of indocin pills leads to a higher frequency of recovery of vestibular function one year after the onset of the disease.
Benzodiazepines enhance the inhibitory effects of GABA on the vestibular system, which explains their effect in vertigo. Benzodiazepines, even in small doses, significantly reduce dizziness and associated nausea and vomiting. The risk of drug dependence, side effects (drowsiness, increased risk of falls, memory loss), and slowing of vestibular compensation limit their use in vestibular disorders. Lorazepam (Lorafen) is used, which at low doses (eg 0.5 mg 2 times a day) rarely causes drug dependence and can be used sublingually (at a dose of 1 mg) for an acute attack of dizziness. Diazepam (Relanium) at a dose of 2 mg 2 times a day can also effectively reduce vestibular vertigo. Clonazepam (antelepsin, rivotril) has been less studied as a vestibular suppressant but appears to be as effective as lorazepam and diazepam. Usually it is prescribed at a dose of 0.5 mg 2 times a day. Long-acting benzodiazepines, such as phenazepam, are not effective for vertigo.
Vestibular neuronitis is an inner ear disease characterized by inflammation of the vestibular nerve with severe attacks of dizziness. The increase in incidence is observed in late spring. Recently, there has been a trend towards an increase in the number of patients seeking medical attention for dizziness and balance disorders. In each case, it is important to correctly establish the cause of these symptoms and determine the form of the disease in order to prescribe adequate treatment in the future.
Sometimes the cause of the development of the disease remains unknown, which indicates indocin unidentified nature of vestibular neuronitis.
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