1.What is vestibular neuronitis? It is also called vestibular neuritis. It is incomplete damage to one side of the vestibule, and this partial damage only involves the superior vestibular nerve that senses horizontal semicircular canal and superior semicircular canal movements. Vestibular neuronitis occurs as a result of activation of occult herpes simplex virus in the vestibular ganglion. Clinical features are sudden onset, marked nausea and vomiting, balance disturbances, and visible horizontal or rotational nystagmus. The symptoms gradually decrease after a few days and full recovery takes 1 to 3 months. Due to vestibular compensation, recovery is possible even with total loss of function on one side. 2. What is the pathogenesis of vestibular neuronitis? The etiology of vestibular neuronitis is unclear, and the most authoritative study is a viral infection with lesions in the vestibular neurons. The disease is thought to be a neuronitis involving the vestibular branch of the 8th cranial nerve, because it occurs frequently and epidemically, and is particularly prevalent in adolescents and young adults, so the cause is thought to be viral. 3. What are the clinical manifestations of vestibular neuronitis? The first attack of vertigo is severe, accompanied by nausea and vomiting, and lasts 7 to 10 days. Persistent nystagmus toward the affected side appears. The disease usually resolves spontaneously and may develop as a single episode or several subsequent episodes after 12 to 18 months have passed; each subsequent episode is less severe and of shorter duration. No deafness or tinnitus accompanies the attack. (1) The disease most often occurs between 30 and 50 years of age, with no significant difference in incidence between the sexes. (2) The onset of the disease is sudden, with a history of fever, epiglottitis or urinary tract infection, which can be caused by mumps, measles and herpes zoster virus. (3) The clinical manifestations are most prominent in vertigo, which increases when the head is turned and reaches a peak in a few hours to a few days, and then gradually decreases. There is no tinnitus or deafness; in severe cases, there is dumping, nausea, vomiting and pale face. (4) At the beginning of the disease, there are obvious spontaneous nystagmus, mostly horizontal and rotational, fast phase to the healthy side, and the direction of nystagmus may change during the evolution of the disease. (5) Vestibular function examination shows unilateral or bilateral diminished response, some cases recover vestibular function after healing. (6) The course of the disease is from several days to 6 weeks, with gradual recovery, and a few patients may relapse. 4.What are the treatment measures for vestibular neuronitis? For acute attacks of vertigo, symptom suppression can be carried out according to the management of Meniere’s disease. For prolonged vomiting, it is necessary to administer intravenous rehydration and electrolytes as supplemental and supportive treatment. Anti-viral treatment is the main cause of vomiting, such as Ribavirin injection, and Chinese herbal medicine such as Banlangen and Shuanghuanglian are also effective. At the same time, hormones such as dexamethasone are used to reduce neuroinflammatory lesions. During the vestibular function recovery period, vestibular function rehabilitation training is necessary, and patients can do vestibular rehabilitation training to promote the recovery of vestibular function. 5.What does vestibular rehabilitation training include? Cawthorne-Cooksey exercises are preferred for general rehabilitation interventions for vestibular disorders. these exercises consist of a series of simple to complex head movements, such as ball tossing exercises. the main advantage of Cawthorne-Cooksey exercises is that they are cost effective. Patients should be seen regularly and will need to receive some instruction. Some non-specialized activities can also be used for vestibular rehabilitation. In principle, these activities should be performed with head and body movement as well as eye movement. Many non-specialized activities such as golf, bowling, and tennis require combined head, body, and eye action. The key is to find an activity that is safe and of interest. Walking around the house and looking around, and dancing are all good vestibular rehabilitative activities. Alternative balance activities such as yoga, tai chi, and martial arts are also good for rehabilitation. Tai Chi and yoga have relaxing properties and are beneficial for dizziness and balance disorders with anxiety. These activities are less costly than individualized treatment and are best suited for patients who have been instructed by a rehabilitator.