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  • Acute (or recurrent) peripheral vestibulopathy

  • Vestibular hypofunction or loss

  • Vestibular neuronitis


  • 386.12 Vestibular neuronitis

  • 386.53 Hypoactive labyrinth unilateral

FIGURE 263-1

The vestibular reflex pathways. (Reproduced by permission from House EL. A Systematic Approach to Neuroscience. New York, NY: McGraw-Hill, 1979.)


  • H81.20 Vestibular neuronitis, unspecified ear

  • H81.21 Vestibular neuronitis, right ear

  • H81.22 Vestibular neuronitis, left ear

  • H81.23 Vestibular neuronitis, bilateral


  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion (ROM), or Reflex Integrity, Secondary to Spinal Disorders

  • 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling

  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury


A 44-year-old woman was referred to physical therapy secondary to insidious episodes of severe vestibular symptoms. She reports that she often feels like things in her vision are “jumping up and down” and she feels like she is spinning when she looks up. The symptoms don’t subside right away when she stops looking up but rather take several days to lessen. When she doesn’t feel like she is spinning, she feels somewhat disoriented and off-balance and has had several episodes of “near falls.” She has not been treated with any antibiotics in several years, nor has she experienced any injury to her head. She does not have any change in her hearing. In addition to the sensations of moving and spinning, she has been forced to stop driving because she struggles to read signs and to turn her head quickly enough to drive safely.



  • Disorder of the peripheral vestibular system (part of the inner ear)

  • The peripheral vestibular system of each ear is made up of five sensory organs (hair-cell receptors contained within the superior, posterior, and horizontal semicircular canals as well as within the utricle and saccule) and the vestibular nerve.

  • The vestibular sensory organs detect head position and head motion to provide input for gaze stability, orientation, and balance.

  • Reduction or loss of function of one of the systems causes an imbalance of neural activity between the two inner ears, which causes the central nervous system to interpret the aberrant sensory input as head rotation.

  • Results in a spontaneous, severe attack of rotary vertigo (the illusion of spinning motion of the room or self) that lasts from 48 to 72 hours.

Essentials of Diagnosis

  • Physical examination normal

  • Audiogram normal

  • Neurotologic examination abnormal

  • Thorough and detailed history is essential to distinguish vestibular neuritis from other vestibular disorders and central pathology

FIGURE 263-2

Principal vestibular pathways superimposed on a dorsal ...

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