Recallab › Question bank › ENT › Ear › #50297
Vestibular neuritis and labyrinthitis
A 40-year-old woman develops severe continuous vertigo with vomiting three days after an upper respiratory infection. It has persisted for two days. There is horizontal nystagmus beating to the right, and the head impulse test is abnormal on the left. Hearing is normal on both sides and there is no tinnitus. What is the diagnosis?
- correctA. Left vestibular neuritis
- B. Left labyrinthitis
- C. Benign paroxysmal positional vertigo
- D. Meniere's disease
Explanation
Key fact
Neuritis spares hearing; labyrinthitis does not. Both give an acute peripheral vestibular syndrome after a viral illness.
Left vestibular neuritis. The vestibular nerve alone is affected, so hearing is untouched.
Why
An abnormal head impulse test means a peripheral vestibular lesion.
Nystagmus beats away from the affected side, so beating right means a left lesion.
The onset days after a viral illness fits a post-viral neuritis.
The vestibular nerve is inflamed; the cochlear nerve and labyrinth are not.
So hearing is normal and there is no tinnitus.
Involvement of the cochlea as well would make it labyrinthitis.
Same illness, two names, decided by hearing
Why not the others
- B. Left labyrinthitis — is the same illness with the cochlea involved as well, so there would be hearing loss and tinnitus. Hearing is normal.
- C. Benign paroxysmal positional vertigo — gives brief episodes of seconds triggered by head position, with a normal head impulse test.
- D. Meniere's disease — gives episodic vertigo lasting minutes to hours with fluctuating hearing loss, tinnitus and aural fullness, not two continuous days.
Remember
Ask about the hearing. It is the only thing that separates neuritis from labyrinthitis, and it takes one question.
Go deeper
Vestibular sedatives such as prochlorperazine relieve symptoms but must be stopped within 2 to 3 days - they delay central compensation if continued.
Vestibular rehabilitation exercises speed recovery and are the mainstay after the first days.
A short course of corticosteroid is sometimes used; antivirals have not been shown to help.
Always apply the HINTS reasoning first: a normal head impulse test in this setting would mean a stroke, not a neuritis.
Dhingra PL, Dhingra S. Diseases of Ear, Nose and Throat, 9th ed. (Elsevier, 2025).