What is vestibular neuritis?
Vestibular neuritis is an inner-ear condition caused by inflammation of the vestibular nerve — the nerve that carries balance and spatial orientation signals from the inner ear to the brain. It is one of the most common causes of acute, prolonged vertigo.
The inflammation is most often triggered by a viral infection, though in many cases the exact cause is never identified. When the vestibular nerve becomes inflamed, it disrupts the balance signals on one side, creating a mismatch between what the left and right inner ears are telling the brain. This mismatch produces intense vertigo, nausea, and difficulty with balance that can last days to weeks.
Vestibular neuritis affects the balance portion of the inner ear only. If hearing loss is also present, the condition is typically classified as labyrinthitis, which involves inflammation of both the vestibular and cochlear (hearing) nerves. In either case, vestibular therapy plays a central role in recovery.
Common symptoms
- Sudden, severe vertigo — a continuous spinning sensation that can last hours to several days
- Nausea and vomiting during the acute phase
- Difficulty walking or standing due to significant balance disruption
- Nystagmus — involuntary, rhythmic eye movements
- Blurred vision or difficulty focusing, especially during head movement
- Lingering unsteadiness and dizziness that may persist for weeks or months after the initial episode resolves
Unlike BPPV, which causes brief episodes of positional vertigo, vestibular neuritis produces continuous symptoms that are not tied to specific head movements. The acute vertigo gradually subsides over the first few days, but many patients are left with ongoing imbalance, motion sensitivity, and visual disturbance that can significantly affect daily life.
How we diagnose it
At Burlington Vestibular Therapy, your physiotherapist will conduct a thorough vestibular assessment to determine the nature and severity of your condition. This includes:
- Head impulse test — a quick, small head turn to evaluate how well each inner ear detects movement. A corrective eye movement (catch-up saccade) after the turn indicates reduced function on one side.
- Nystagmus assessment — observation of your eye movements at rest and during gaze to identify patterns consistent with a unilateral vestibular loss.
- Balance and gait testing — standardized assessments to measure how the vestibular deficit is affecting your stability during standing and walking.
- Symptom history — a detailed review of the onset, duration, and behaviour of your symptoms to distinguish vestibular neuritis from other conditions such as BPPV, Meniere's disease, or central causes of vertigo.
If your therapist suspects a central nervous system cause or your presentation is atypical, they will refer you to your physician or an appropriate specialist for further investigation.
How vestibular neuritis is treated
Unlike BPPV, vestibular neuritis cannot be resolved with a single repositioning manoeuvre. Recovery depends on vestibular compensation — the brain's ability to recalibrate and adapt to the changed signals from the inner ear. Vestibular rehabilitation therapy (VRT) is the most effective way to promote this process.
At Burlington Vestibular Therapy, your treatment programme will be tailored to your specific deficits and may include the following components:
Gaze stabilization exercises
These exercises train the vestibulo-ocular reflex (VOR) — the system responsible for keeping your vision clear during head movement. You will practise focusing on a stationary or moving target while turning your head at progressively faster speeds. Over time, the brain learns to produce accurate eye movements again, reducing blurred vision and visual discomfort during daily activities.
Balance retraining
Structured balance exercises challenge your postural control under increasingly difficult conditions — narrowing your base of support, standing on unstable surfaces, reducing visual input, and adding head movements. This progressive approach retrains the brain to rely on accurate sensory information and improves your confidence and stability in real-world situations.
Habituation exercises
If specific movements or visual environments trigger dizziness (for example, busy supermarkets or scrolling screens), habituation exercises involve controlled, repeated exposure to those provocative stimuli. With consistent practice, the brain learns to reduce its abnormal response, and the movements or environments that once caused symptoms become tolerable.
Walking and functional mobility
As your balance and gaze stability improve, your therapist will progress you through functional movement tasks — walking with head turns, navigating obstacles, changing direction, and managing uneven terrain — to ensure your recovery translates to the activities that matter in your daily life.
Recovery timeline
Recovery from vestibular neuritis varies from person to person, but most patients follow a general pattern:
- First 1–3 days: The acute vertigo is at its most severe. Medical management (anti-nausea medication, vestibular suppressants) may be appropriate during this phase, prescribed by your physician.
- First 1–2 weeks: The continuous spinning sensation typically resolves, but significant unsteadiness, motion sensitivity, and fatigue remain. This is an appropriate time to begin vestibular rehabilitation.
- Weeks 2–8: With consistent therapy and a home exercise programme, most patients see meaningful improvement in balance, gaze stability, and overall function.
- 3–6 months: The majority of patients achieve a good functional recovery. Some may experience mild residual symptoms in demanding situations, which continue to improve over time.
It is important to note that vestibular suppressant medications (such as meclizine or dimenhydrinate) should be limited to the first few days of the acute phase. Prolonged use of these medications can actually slow the brain's compensation process and delay recovery. Early initiation of vestibular rehabilitation is consistently supported by the evidence as the most effective approach.
When to seek vestibular therapy
If you have experienced an episode of sudden, severe vertigo lasting more than 24 hours — especially following a cold or viral illness — vestibular neuritis is a likely cause. You should seek vestibular therapy if:
- Your acute vertigo has settled but you continue to feel unsteady, off-balance, or dizzy
- Head movements provoke dizziness or blurred vision
- You feel worse in visually busy environments (grocery stores, traffic, screens)
- Your balance has not returned to normal weeks or months after the initial episode
- You have been avoiding activities due to dizziness or fear of falling
No physician referral is required to see a vestibular physiotherapist in Ontario. Book your vestibular assessment at Burlington Vestibular Therapy and take the first step toward recovery.
This page is for informational purposes only and does not constitute medical advice. If you are experiencing sudden vertigo with hearing loss, slurred speech, difficulty swallowing, or weakness on one side of the body, seek emergency medical attention immediately.
Learn more about vestibular therapy and the full range of conditions we treat.