By: Dr. John Conde DC, DACNB Special to the Boca and Delray newspaper
Vestibular neuritis is a condition characterized by the sensation of severe and violent spinning, nausea, vomiting, disequilibrium, blurred vision, and loss of mental clarity. It usually starts as a sore throat, flu, or cold with a viral origin. Measles, mumps, rubella, mononucleosis, and chicken pox can have a sequlae of vestibular neuritis. However, in some rare cases a bacterial infection is noted to be the cause as such in middle-ear infections and meningitis. The infection actually affects the middle-ear, specifically the vestibular nerve. Inflammation of the nerve ensues and normal conduction of information regarding balance that travels to your brain is short-circuited resulting in dizziness.
The standard of care concerning the treatment of vestibular neuritis all starts with accurate diagnosis. There are two main tests that should be administered which are the videonystagmography (VNG) and force plate posturography (CAPS) tests, along with a detailed case history to determine exposure to a virus or bacteria. The VNG is an exam which requires goggles and a computer and provides the clinician with very important information regarding voluntary and involuntary eye movements. There are certain types of dysfunctional eye movements that are noted with vestibular neuritis.Regarding the CAPS system, this is a platform that measure balance in a very detailed manner. Patients with vestibular neuritis score very low on this and exhibit large sway patterns. Lastly, blood work can be ordered as well to rule out bacterial causes of vestibular neuritis.
Once a diagnosis has been reached, treatment usually begins with medications to control the symptoms as well as treat the underlying disorder if due to a bacteria. Within the first 3-5 days the patient should notice some of the static symptoms improve such as malaise, nausea, blurred vision, mental clarity, and the violent vertigo. However, the dynamic symptoms that usually come with movement and entail vertigo and disequilibrium may take several weeks or months.
Patients often complain of feeling “off kilter” for quite some period after. This is due to the fact that with the irritation and inflammation of the vestibular nerve, the brain compensates and increases the machinery necessary to transmit balance information on the side of the infection. This creates a discrepancy between the right and left inner-ear systems and the brainstem. This asymmetric presentation creates a mismatch and thus dizziness. Vestibular rehabilitation is usually required to “re-calibrate” the balance system in the brain to allow for proper symmetry.
Vestibular rehabilitation should be very specific to the area that was noted to be dysfunctional in the exam. Treatment usually is more one sided and may involve activities such as prescribed eye exercises, head movements, laser tracing, digital iPad applications, balancing exercises, Dynavision D2 (64-LED digital board), Interactive Metronome (computer generated beat system), and nerve stimulation (repetitive peripheral somatosensory stimulation). The main objective of the treatment is to create symmetry in the brain and inner-ear. Patients that usually get over the static symptoms and have difficulty getting over the dynamic systems but choose not to seek treatment may develop chronic vestibular neuritis. Symptoms for this condition may go on for years. Seek treatment after any vestibular neuritis episode.
Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach and can be reached at 561-330-6096, firstname.lastname@example.org, www.thecondecenter.com