Vestibular Neuronitis
NICE CKS Vestibular neuronitis. Last revised: Jan 2023.
Guidelines
Management
Conservative Management / Self-Care Advice
Counsel the patient that:
- Symptoms will usually settle over 2-6 weeks, even without treatment
- Bed rest may be necessary – but activity should be resumed ASAP
In the acute phase of vestibular neuritis, patient must stop driving and not resume driving until fully recovered.
Reporting to the DVLA is only required if symptoms are prolonged and recurrent.
Symptomatic Management
1st line: short course (take regularly for up to 3 days) of oral
- Prochlorperazine, or
- Antihistamine (e.g. cyclizine, promethazine, cinnarizine)
For rapid relief of severe symptoms:
- Buccal prochlorperazine, or
- IM prochlorperazine / cyclizine
Advise the person to return if symptoms deteriorate or not fully resolved after 1 week.
Referral to Secondary Care
Admit the patient if there is severe nausea and vomiting and cannot tolerate oral fluids / treatment.
Refer to balance specialist (audiovestibular physician / neurologist) for further assessment or consideration of vestibular rehabilitation if
- Symptoms persist without improvement for >1 week despite treatment (urgent referral)
- Symptoms persist for >6 weeks
- Symptoms are not typical of vestibular neuronitis (e.g. additional neurological symptoms)