Questionnaire/history: Onset? Rotational vertigo (sensation of being on a merry-go-round)? Constant (even when head is still) (initial)? Exacerbated by changes of head position? Nausea/vomiting? Hearing loss? Tinnitus? Focal neurological symptoms (eg double vision, speech problems)? Recent viral illness (eg URTI)? Past medical history? Drug history? Drug allergies? Examination: Nystagmus? - Fine horizontal? - Mixed horizontal-torsional with the fast phase away from the affected ear? - Unidirectional? - Reduced when the vision is fixed on a point? Head impulse test (to differentiate vestibular neuronitis from a central lesion)? Hearing? Otoscopy? Management: Advised: - Acute symptoms usually settle in a few days and gradual recovery occurs over 2 weeks - Factors such as alcohol, tiredness or intercurrent illness may have a greater than usual effect on the balance - May be periods during their recovery when their symptoms appear to be worsening again - Bed rest may be necessary if symptoms are particularly severe during the acute phase, but activity should be resumed as soon as possible (even if vertigo becomes more prominent during movement) - Not to drive when they are dizzy or if they are likely to experience an episode of vertigo while driving - To inform the employer if vertigo poses a risk in the workplace - Buccal prochlorperazine for up to 3 days if symptoms severe - To seek medical advice if symptoms deteriorate or have not subsided after 1 week Reference(s): NICE CKS: Vestibular neuronitis Information for patient/carer(s): NHS Health A to Z: Labyrinthitis and vestibular neuritis