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Vestibular Neuronitis

NICE CKS Vestibular neuronitis. Last revised: Jan 2023.

Guidelines

Counsel the patient that:

Symptoms will usually settle over 2-6 weeks, even without treatment
Bed rest maybe necessary - but activity should be resumed ASAP

In the acute phase of vestibular neuritis, patient must stop driving and not resume driving until fully recovered.

Reporting to the DVLA is only required if symptoms are prolonged and recurrent.

1st line: short course (take regularly for up to 3 days) of oral

Prochlorperazine, or
Antihistamine (e.g. cyclizine, promethazine, cinnarizine)

For rapid relief of severe symptoms:

Buccal prochlorperazine, or
IM prochlorperazine / cyclizine

Advise the person to return if symptoms deteriorate or not fully resolved after 1 week.

Admit the patient if there is severe nausea and vomiting and cannot tolerate oral fluids / treatment.

Refer to balance specialist (audiovestibular physician / neurologist) for further assessment or consideration of vestibular rehabilitation if

Symptoms persist without improvement for >1 week despite treatment (urgent referral)
Symptoms persist for >6 weeks
Symptoms are not typical of vestibular neuronitis (e.g. additional neurological symptoms)

References

Author: Adams Lau
Reviewer:
Last edited: 12/07/25

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