Vestibular neuritis (VN), also termed acute unilateral vestibulopathy (AUVP), is a peripheral vestibular disorder marked by sudden onset vertigo, nausea, and gait disturbances. These symptoms stem from inflammation of the vestibular nerve, although its exact pathophysiology remains unclear. Hypotheses suggest viral reactivation, such as herpes simplex virus (HSV), vascular dysfunction, or immune-mediated processes as potential causes (Chowdhury & Chowdhury, 2024; Maniaci et al., 2024; Oussoren et al., 2023).
Evidence supporting a viral etiology includes findings of HSV-1 latency-associated transcripts in vestibular ganglia and genetic variants linked to HSV-1 replication. Vascular factors, like microvascular dysfunction and pericyte impairment, may also exacerbate inflammation and neuronal damage, resembling mechanisms seen in sudden sensorineural hearing loss (Maniaci et al., 2024; Oussoren et al., 2023).
Systemic triggers, such as immune or inflammatory responses following COVID-19 vaccination, have recently been explored as contributors to VN pathogenesis (Chowdhury & Chowdhury, 2024).
The superior vestibular nerve’s anatomical features, including its length and vulnerability to inflammation, may explain the sparing of the posterior semicircular canal in some cases. While corticosteroids are effective in acute management, novel therapeutic approaches targeting viral replication, vascular integrity, and immune modulation offer promise for future treatment (Maniaci et al., 2024).
Despite strong indications of a multifactorial etiology encompassing viral, vascular, and systemic influences, definitive proof of VN’s inflammatory or viral origin remains elusive. VN symptoms can mimic those of anterior vestibular artery infarction, underscoring the importance of accurate diagnosis. Advances in diagnostic tools, such as the video head impulse test (vHIT), have improved differentiation of VN from other vestibular disorders, enhancing clinical management (Ross et al., 2024).
References
- Chowdhury, S., & Chowdhury, N. S. (2024). Association of vestibular neuritis following
COVID-19 vaccination. Discoveries, 12(3), e195. Link - Maniaci, A., Briglia, M., Allia, F., Montalbano, G., Romano, G. L., Zaouali, M. A.,
H’mida, D., Gagliano, C., Malaguarnera, R., Lentini, M., Graziano, A. C. E., & Giurdanella,
G. (2024). The role of pericytes in inner ear disorders: A comprehensive review. Biology,
13(10), 802. Link - Oussoren, F. K., van Leeuwen, R. B., Schermer, T. R., Poulsen, L. N. F., Kardux, J. J., &
Bruintjes, T. D. (2023). Cerebral small vessel disease in elderly patients with sudden
sensorineural hearing loss. Otology & Neurotology, 44(3), e171–e177. Link - Ross, A., Leemeyer, A.-M. R., Bruintjes, T. D., Cals, J. W. L., Bronstein, A., van
Leeuwen, R. B., Lissenberg-Witte, B., van Vugt, V. A., Rutgers, S., & Maarsingh, O. R. (2024). Prospective diagnostic accuracy study of history taking and physical examination for adults with vertigo in general practice: Study protocol. BMJ Open, 14(4), e085715. Link - Strupp, M., Bisdorff, A., Furman, J., Hornibrook, J., Jahn, K., Maire, R., Newman-Toker,
D., & Magnusson, M. (2024). Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic
criteria. Consensus document of the committee for the classification of vestibular disorders
of the Bárány Society.