Vestibular Neuritis — what it feels like and what to do first

Sudden, violent spinning that leaves you nauseous and off-balance is often vestibular neuritis. It’s an inflammation of the vestibular nerve (the balance nerve in your inner ear) that typically causes intense vertigo for hours to days, plus nausea and trouble walking. Hearing usually stays normal — that’s a useful clue that it’s neuritis, not a middle-ear problem.

If you’re in the middle of an attack: sit or lie down, keep your head still, and avoid driving. Ask someone to help you get to urgent care if the vertigo won’t settle. Don’t ignore warning signs like sudden hearing loss, weakness, slurred speech, double vision, or a severe headache — those need immediate emergency evaluation because they could be a stroke.

How doctors diagnose it

Your clinician will use a focused exam: bedside eye-movement tests, a head-impulse test, and checking balance and gait. They’ll rule out stroke or other causes. Sometimes an MRI is ordered if symptoms or exam findings suggest a central (brain) cause. Hearing tests help confirm that your hearing is normal — a key difference from labyrinthitis, which affects hearing too.

Treatment you can expect and home steps that help

Early treatment usually focuses on symptom control and helping the brain regain balance. Short-term vestibular suppressants like meclizine or a benzodiazepine can ease nausea and spinning but shouldn’t be used long-term — they slow the brain’s ability to compensate. Doctors sometimes prescribe a short course of oral steroids if started early; some studies show steroids can improve recovery of vestibular function when given quickly.

Anti-nausea meds such as ondansetron or promethazine can be useful for severe nausea. Hydrate, rest, and avoid alcohol or sedating meds while you recover. Start moving as the vertigo eases — gentle walking helps the brain relearn balance.

Vestibular rehabilitation therapy (VRT) is the most reliable way to speed recovery once the worst vertigo passes. A physical therapist will give specific exercises that retrain your balance system. You can start simple Brandt-Daroff style movements at home: sit upright, quickly lie down on one side and hold until symptoms drop, sit up, then repeat on the other side for several reps—do this a few times a day. If exercises make symptoms much worse, stop and check with your therapist or doctor.

Most people improve over weeks to months. If symptoms linger beyond a few months, persistent imbalance or motion sensitivity should be reviewed — targeted rehabilitation or further testing can help. Follow up with ENT or neurology if your symptoms don’t steadily improve, or if new symptoms appear.

Bottom line: rest and symptom relief at first, then active rehab to recover balance. Get immediate care for stroke-like signs or sudden hearing loss.