Vestibular Neuronitis

ByMickie Hamiter, MD, Tampa Bay Hearing and Balance Center

Reviewed/Revised Modified Oct 2025

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Vestibular neuronitis is a disorder characterized by a sudden severe attack of vertigo (a false sensation of moving or spinning) caused by inflammation of the vestibular nerve, the branch of the eighth cranial nerve that helps control balance.

The Ears

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The vestibule is a part of the inner ear. It contains organs that control balance (see also Overview of the Inner Ear). It is connected to the brain by the vestibular nerve. Vestibular neuronitis is usually caused by a virus that tends to affect the vestibular nerve of one ear.

Vestibular neuronitis may occur as a single, isolated attack of severe vertigo lasting 7 to 10 days, but many people have additional attacks of milder vertigo for several weeks thereafter. The first attack of vertigo is usually the most severe. Vertigo is a false sensation that people, their surroundings, or both are moving or spinning. Most people describe this unpleasant feeling as dizziness.

The attack of vertigo is accompanied by nausea, vomiting, and nystagmus (a rapid jerking movement of the eyes in one direction alternating with a slower drift back to the original position). The vertigo is severe at first, and gradually subsides over the course of several days, with residual imbalance lasting up to several months. People do not have tinnitus (ringing in the ears), and hearing is usually not affected.

Hearing tests

Tests for nystagmus

Gadolinium-enhanced magnetic resonance imaging (MRI)

The diagnosis of vestibular neuronitis involves hearing tests and , which help doctors diagnose the cause of vertigo.

Gadolinium-enhanced MRI of the head should be performed to make sure the symptoms are not caused by another disorder, such as a tumor.

Medications such as meclizine or lorazepam to relieve vertigo Medications such as meclizine or lorazepam to relieve vertigo

Medications such as prochlorperazine to relieve vomitingMedications such as prochlorperazine to relieve vomiting

Sometimes intravenous steroids (also called glucocorticoids or corticosteroids)

Intravenous fluids if vomiting persists

Physical therapy

In people with vestibular neuronitis, treatment of vertigo is usually reserved for relief of the symptoms it causes and consists of medications such as meclizine or lorazepam. Nausea and vomiting may be relieved by medications that relieve nausea (such as prochlorperazine). These medications should be used only for a short period of time because prolonged use may lengthen the duration of symptoms, particularly in older adults. Additionally, steroids are used briefly. If vomiting continues for a long time, a person may need to be given fluids and electrolytes by vein (intravenously). In people with vestibular neuronitis, treatment of vertigo is usually reserved for relief of the symptoms it causes and consists of medications such as meclizine or lorazepam. Nausea and vomiting may be relieved by medications that relieve nausea (such as prochlorperazine). These medications should be used only for a short period of time because prolonged use may lengthen the duration of symptoms, particularly in older adults. Additionally, steroids are used briefly. If vomiting continues for a long time, a person may need to be given fluids and electrolytes by vein (intravenously).

Although the vertigo often subsides relatively quickly (over several days), a feeling of dizziness may last for up to several weeks to months. During this time, doctors encourage people to stay active. A specialized form of physical therapy, called vestibular therapy, may be helpful.

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Copyright © 2025 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved.

Copyright© 2025Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved.