Vestibular Neuritis and Labyrinthitis
Vestibular neuritis causes an acute vestibular syndrome of prolonged vertigo, nausea and imbalance without hearing loss; labyrinthitis adds hearing loss and/or tinnitus, but both diagnoses are made only after urgent assessment for posterior-circulation stroke and other dangerous causes.
Definition
Vestibular neuritis is an acute vestibular disorder causing continuous vertigo, nausea and imbalance without hearing loss or tinnitus. Labyrinthitis refers to a similar acute vestibular illness with hearing loss and/or tinnitus because the inner-ear hearing apparatus is also involved.
First principles
Acute continuous vertigo is a syndrome, not a diagnosis
Sudden-onset vertigo with nausea or vomiting and gait unsteadiness is acute vestibular syndrome. A peripheral pattern can be caused by vestibular neuritis, but posterior-circulation stroke can look similar. The first job is therefore a trained bedside assessment and urgent stroke-pathway escalation when the pattern is central, the patient cannot be safely assessed, or no trained HINTS examiner is available.
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