How does vestibular neuritis cause vertigo?

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Vestibular neuritis causes vertigo by disrupting the normal function of the vestibular nerve, which is responsible for transmitting balance and spatial orientation information from the inner ear to the brain. This inflammation or infection of the vestibular nerve leads to distorted or incomplete signals being sent to the brain, resulting in a mismatch of sensory input. This imbalance between the signals from the affected and unaffected vestibular system creates the sensation of vertigo, or a false sense of spinning or dizziness.

Here’s a closer look at how vestibular neuritis causes vertigo:

1. The Role of the Vestibular Nerve in Balance

The vestibular nerve is a key part of the vestibular system, which helps maintain balance and spatial orientation. This system includes the:

Semicircular Canals: Detect rotational movements.
Otolith Organs (Utricle and Saccule): Detect linear movements and changes in head position relative to gravity.

The vestibular nerve carries signals from the semicircular canals and otolith organs to the brain, allowing the brain to interpret the head’s movements and the body’s position in space. Normally, both ears send balanced, symmetrical information to the brain.

2. How Inflammation Disrupts Signals

Vestibular neuritis occurs when the vestibular nerve becomes inflamed, often due to a viral infection (such as the herpes virus or following an upper respiratory infection). This inflammation interferes with the nerve’s ability to transmit signals from the inner ear to the brain accurately.

When the vestibular nerve on one side of the head is impaired, it sends weakened or distorted signals to the brain, while the unaffected vestibular nerve continues to send normal signals. This creates a discrepancy between the two sides of the vestibular system, causing the brain to receive conflicting information about the body’s motion and position.

3. Mismatch of Sensory Input

The brain relies on three primary systems to maintain balance:

Vestibular System: Provides information about head movement and position.
Visual System: Provides visual cues about the environment and motion.
Proprioception: Provides information from muscles and joints about body position.

In vestibular neuritis, the brain receives abnormal input from the affected vestibular nerve. The mismatch between the information from the affected and unaffected sides, as well as between the vestibular, visual, and proprioceptive systems, leads to disorientation and the false sensation of movement, or vertigo.

4. Vertigo and Its Symptoms

Because the brain cannot reconcile the conflicting signals, the affected person experiences vertigo, which can manifest as:

A spinning sensation (either the environment appears to spin, or the person feels like they are spinning).
Dizziness and difficulty maintaining balance.
Nausea and sometimes vomiting, due to the disorientation caused by the vertigo.
Unsteady walking or difficulty coordinating movement.

5. Duration and Recovery

Acute Phase: The vertigo caused by vestibular neuritis can be severe and last for several hours to days during the acute phase. During this period, people may struggle with balance and coordination, and symptoms may be accompanied by nausea and vomiting.
Gradual Recovery: Over time, the brain compensates for the loss of input from the affected vestibular nerve, a process called vestibular compensation. As this occurs, the vertigo and balance issues gradually improve, although it may take weeks to months for full recovery.

6. Absence of Hearing Loss

Unlike labyrinthitis, which also affects hearing because it involves the entire inner ear, vestibular neuritis typically affects only the vestibular nerve and does not cause hearing loss. The primary symptom is vertigo, without additional auditory symptoms such as tinnitus or hearing impairment.

7. Treatment of Vestibular Neuritis

Treatment for vestibular neuritis focuses on managing symptoms and promoting recovery:

Medications: Anti-vertigo medications like meclizine or diazepam can help reduce dizziness and nausea during the acute phase, though they are usually used short-term because they can slow the brain’s ability to compensate.
Steroids: In some cases, corticosteroids may be prescribed to reduce inflammation of the vestibular nerve.
Vestibular Rehabilitation Therapy (VRT): This physical therapy focuses on exercises that help the brain adapt to the disrupted vestibular signals, improving balance and reducing dizziness over time.
Rest and Hydration: During the acute phase, rest and hydration are important, particularly if nausea and vomiting are present.

Conclusion

Vestibular neuritis causes vertigo by inflaming the vestibular nerve, which disrupts the signals sent from the inner ear to the brain about balance and spatial orientation. This results in a mismatch of sensory input, leading to the false sensation of spinning or dizziness. Over time, the brain can compensate for the loss of vestibular function, but during the acute phase, vertigo can be intense and disabling. With proper treatment and rehabilitation, most people recover from vestibular neuritis, although some may experience lingering balance issues.

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