August 16, 2019
Ear Canal Infections (Acute Otitis Externa)
This is a common cause of severe prolonged dizziness due to injury to the inner ear*.
It has many other names: vestibular neuronitis, viral neurolabyrinthitis, acute unilateral vestibular failure, acute unilateral peripheral vestibulopathy, acute vestibulopathy of unknown aetiology, acute unilateral peripheral deficit, epidemic vertigo & peripheral acute vestibular syndrome.
It is thought to be due to due to a reactivation of a latent herpes simplex virus type 1 infection (the virus of colds sores) of the superior vestibular nerve.
The patient complains of sudden rotatory vertigo lasting one to several days with sweating, nausea and vomiting. There is no hearing loss, no tinnitus, no rashes, no pain and no facial weakness.
The patient has severe horizontal spontaneous nystagmus (with a rotational component) toward the unaffected ear. There is a pathologic head-impulse test toward the affected ear and a deviation of the subjective visual vertical toward the affected ear.
Patients stagger towards the affected ear and want to lie still
The patient has no evidence of a stroke.
Treatment consists of medication to treat the symptoms of acute vertigo and nausea medication, prednisolone 60 mg for 5 days (with PPI and no contra-indications and side-effects).
If it recurs, then the antiviral Acyclovir 800mg 5 x day for 7 days is used on immediate onset of symptoms.
*A key issue is to make sure that the cause is not a stroke or “mini-stroke” (transient ischaemic attack) which can mimic vestibular neuritis.
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