Vestibular Inflammation: Symptoms, Diagnosis, and Treatment

Q: Vestibular Inflammation: Symptoms, Diagnosis, and Treatment

To： Zeng Zhao-Rong Since the CT scan of the brain is normal, the symptoms should be related to the inner ear balance, such as vestibular neuritis or benign paroxysmal positional vertigo, among others. <br>If there are recurrent episodes or if symptoms persist, it is recommended t

Please help?

Two weeks ago, I suddenly felt very dizzy.
When I lay down to rest, I felt like the world was spinning, and then I started to vomit.
These symptoms persisted for a while; every morning when I got out of bed, I couldn't get up.
Changing positions would make the dizziness worse, followed by vomiting.
After vomiting, I felt somewhat better, but then the dizziness would return, and I would vomit again.
This continued for some time.
I then went to the emergency department at a hospital (Zhongxing Hospital), where the doctor suggested it might be an inner ear issue.
After receiving IV fluids, I felt better and went home, but the same situation occurred again the next morning, and it became increasingly severe.
I went to the emergency department at (Taipei Chang Gung Memorial Hospital), received IV fluids again, and went home.
The next day, I visited the ENT department at Chang Gung for an examination (only a consultation without any instrumental tests), and they also suggested it was an inner ear problem, so I went home with medication.
However, there was no improvement, and last night the same symptoms reappeared.
This time, I went to the emergency department at (Linkou Chang Gung Memorial Hospital), where the outcome was the same: IV fluids.
This time, I consulted both the ENT and neurology departments, but they only asked questions and said there was no problem.
They advised that medication would help.
However, my condition did not improve; in fact, I felt worse.
I then went to the emergency department at (En Chu Kong Hospital) in Sanxia, where the doctor immediately ordered a CT scan to check for any brain issues.
A neurologist was consulted and said there was no problem and it should not be a brain issue.
Then, an ENT doctor was called for an examination, including hearing and balance tests.
However, during the balance test, I couldn't tolerate it and vomited, which halted the examination.
The ENT doctor said my ears should be fine and that it was likely a neurological issue.
Finally, I went to the outpatient department at Kaohsiung Veterans General Hospital, where the doctor immediately recommended hospitalization for further examination.
After listening to my issues and conducting tests, the doctor diagnosed me with vestibular neuritis, stating that I just needed to rest and manage it with medication.
● My symptoms and related questions:
○ What is my occupation? Digital camera repair engineer.
○ Is there a family history? No.
○ Do I take any long-term medications? No.
○ Have I had a cold recently? Have I been to the mountains, the sea, or on a plane? No cold, but I had been to the mountains previously.
○ What is the nature of the dizziness? Is it spinning, floating, rolling back and forth, or swaying? It spins in a clockwise and counterclockwise direction; when I walk, my head feels heavy and my legs feel light.
○ Do I lean to one side while walking? Which side? Have I fallen suddenly? I lean to the left.
○ How long do the dizziness episodes last? How often do they occur? During the day or night? The episodes last only about ten seconds but occur continuously over several days.
○ Is the dizziness related to a specific position? Does changing positions worsen or alleviate the dizziness? Dizziness occurs when I turn my head or change angles.
○ Are there any symptoms like nausea, vomiting, cold sweats, pale or flushed face, shoulder pain, neck stiffness, headache, heavy head, or pain in the occipital region? Nausea, vomiting, cold sweats, shoulder pain, neck stiffness, headache, heavy head.
○ Do I have hearing loss, tinnitus, a feeling of ear fullness, sensitivity to loud sounds, ear pain, or ear discharge? Tinnitus occurs in the right ear but only for a short time.
○ Do I have numbness in my limbs or around my mouth? Blurred vision or temporary blindness? Difficulty with speech or swallowing? Weakness in both legs and arms...
At night, I see double vision (vertical diplopia).

Doctor, what kind of condition might this be, and how should I treat it? Should I see a specialist, or is medication sufficient? Should I consider neurological issues? Please help me with these questions.
Thank you.
My contact number: 0920-199-161
EMAIL: [email protected]
Zeng Zhao-Rong

Zeng, 20~29 year old female. Ask Date: 2001/05/13

Dr. Ye Boshou reply Neurology

To: Zeng Zhao-Rong Since the CT scan of the brain is normal, the symptoms should be related to the inner ear balance, such as vestibular neuritis or benign paroxysmal positional vertigo, among others.
If there are recurrent episodes or if symptoms persist, it is recommended to consult a neurologist.

Reply Date: 2001/05/13

More Info

Based on your detailed description of symptoms and the medical evaluations you've undergone, it appears that you are experiencing vestibular inflammation, likely related to a condition known as vestibular neuritis or labyrinthitis. This condition typically arises from inflammation of the inner ear structures that are responsible for balance and spatial orientation.

Symptoms and Diagnosis
Your symptoms of severe dizziness (vertigo), nausea, and vomiting, particularly when changing positions or upon waking, are classic signs of vestibular dysfunction. The fact that you have experienced these symptoms repeatedly, along with the need for intravenous fluids, indicates a significant impact on your daily life. The dizziness that worsens with head movements and the associated nausea suggest that the vestibular system is not functioning properly.

The evaluations you've undergone, including CT scans and consultations with various specialists, have ruled out serious neurological conditions, which is reassuring. The diagnosis of vestibular inflammation was made after thorough assessments, including hearing and balance tests. It's important to note that while imaging studies like CT scans are useful, they may not always reveal inner ear issues, which are often diagnosed based on clinical symptoms and specialized tests.

Treatment Options
The treatment for vestibular inflammation typically involves a combination of medication and vestibular rehabilitation therapy. Here are some common approaches:
1. Medications:
- Antihistamines (e.g., meclizine) can help reduce dizziness and nausea.

- Antiemetics (e.g., ondansetron) may be prescribed to control vomiting.

- Corticosteroids may be used in some cases to reduce inflammation.

2. Vestibular Rehabilitation Therapy (VRT):
- This is a specialized form of physical therapy aimed at helping your brain adapt to the changes in balance and reduce dizziness. A physical therapist can guide you through exercises that promote balance and coordination.

3. Rest and Hydration:
- Adequate rest is crucial, especially during acute episodes. Staying hydrated is also important, particularly if you are experiencing vomiting.

4. Follow-Up Care:
- Regular follow-ups with an ENT specialist or a neurologist may be necessary to monitor your condition and adjust treatment as needed.

When to Seek Further Evaluation
If your symptoms persist or worsen despite treatment, or if you experience new symptoms such as severe headaches, visual disturbances, or neurological deficits (like weakness or numbness), you should seek immediate medical attention. These could indicate a more serious underlying condition that requires further investigation.

Conclusion
In summary, your symptoms are consistent with vestibular inflammation, and while the initial treatment may involve medications and rest, vestibular rehabilitation could significantly improve your quality of life. It is essential to maintain open communication with your healthcare providers and report any changes in your condition. If you have concerns about the effectiveness of your current treatment or if you feel your symptoms are not improving, do not hesitate to seek a second opinion or further evaluation. Your health and well-being are paramount, and addressing these symptoms promptly can lead to better outcomes.

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