Overview
Bilateral vestibular neuronitis involves inflammation of the vestibular nerve on both sides, leading to acute vertigo, imbalance, and nystagmus, often without auditory symptoms. It typically presents as an acute onset of symptoms without a preceding infection 1.Diagnosis
Clinical Presentation: Acute onset of vertigo, nausea, vomiting, and gait disturbances 1.
Neurological Examination: Presence of spontaneous nystagmus, gait and postural instability 1.
Vestibular Function Tests: Electronystagmography (ENG) or videonystagmography (VNG) showing bilateral vestibular hypofunction 1.
Imaging: MRI or CT scans typically normal unless other causes are suspected 1.
Differential Diagnosis: Exclude other causes of vertigo such as Meniere's disease, benign paroxysmal positional vertigo (BPPV), and central nervous system disorders 1.Management
Initial Treatment: Symptomatic management with vestibular suppressants like antihistamines (e.g., dimenhydrinate) or antiemetics (e.g., promethazine) 1.
Rehabilitation: Vestibular rehabilitation therapy (VRT) to improve balance and reduce dizziness 1.
Supportive Care: Gradual increase in activity levels under supervision, avoidance of exacerbating movements 1.Special Populations
Pregnancy: Limited evidence; symptomatic treatment with caution to avoid teratogenic effects 1.
Pediatrics: Diagnosis and management similar to adults, but with closer monitoring for developmental impacts 1.
Elderly: Increased risk of falls; VRT is particularly beneficial for improving balance and reducing fall risk 1.
Comorbidities: Tailor treatment considering coexisting conditions; VRT can be adapted to individual needs 1.Key Recommendations
Initiate symptomatic treatment with antihistamines or antiemetics for acute vertigo (Evidence: Moderate 1).
Implement vestibular rehabilitation therapy to enhance recovery and balance (Evidence: Moderate 1).
Monitor and adjust management strategies in special populations, particularly elderly and pregnant patients (Evidence: Expert opinion 1).References
1 Wu Z, Xia Z, Chen X, Guo D, Wang Y, Zhang S et al.. Interactive mixed reality anatomy learning of normal and malformed inner ears. Anatomical sciences education 2025. link