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H81.2 – Vestibular Neuronitis: Causes and Treatment

H81.2 is the ICD-10 code for vestibular neuronitis, an inflammation of the balance nerve causing sudden, severe vertigo and unsteadiness.

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Things worth knowing about "H81.2"

H81.2 is the ICD-10 code for vestibular neuronitis, an inflammation of the balance nerve causing sudden, severe vertigo and unsteadiness.

What is H81.2 – Vestibular Neuronitis?

The ICD-10 code H81.2 refers to vestibular neuronitis (also called vestibular neuritis), an inflammatory or functional disorder of the vestibular nerve. This nerve is responsible for transmitting balance information from the inner ear to the brain. Vestibular neuronitis is one of the most common causes of acute, prolonged vertigo and typically has a sudden onset.

Causes

The exact cause of vestibular neuronitis is not fully established. The most widely accepted theory involves a viral infection, particularly by herpes viruses (e.g., herpes simplex virus type 1), which damages or inflames the vestibular nerve. Many patients report a preceding upper respiratory tract infection. Possible causes include:

Viral infections (especially herpes viruses)
Post-infectious immune-mediated reactions
Vascular compromise of the vestibular nerve (less common)

Symptoms

The hallmark symptom of vestibular neuronitis is a sudden onset of intense rotational vertigo that can persist for hours to several days. Common associated symptoms include:

Severe nausea and vomiting
Balance disturbances and unsteady gait
Nystagmus (involuntary, rhythmic eye movements)
A sensation of falling or swaying

Unlike labyrinthitis, vestibular neuronitis typically does not cause hearing loss or tinnitus, as only the vestibular branch of the eighth cranial nerve is affected.

Diagnosis

Diagnosis is primarily clinical. Key diagnostic steps include:

History and physical examination: Assessment of nystagmus (typically horizontal-torsional, beating in one direction)
HINTS examination (Head Impulse, Nystagmus, Test of Skew): A bedside test to differentiate peripheral from central causes of vertigo
Caloric testing: Demonstrates unilateral reduced function of the vestibular organ
Cranial MRI: To exclude central causes such as stroke or tumor

Treatment

Treatment of vestibular neuronitis is both symptomatic and, where possible, causal:

Acute Management

Antivertiginous agents (e.g., dimenhydrinate, meclizine) for short-term relief of vertigo and nausea
Antiemetics in cases of severe vomiting
Corticosteroids (e.g., methylprednisolone): May promote recovery of vestibular nerve function and are used in the acute phase

Long-Term Treatment and Rehabilitation

Vestibular rehabilitation: Physiotherapy-based balance exercises to promote central compensation are the most important measure for full recovery
Early mobilization and movement exercises are strongly encouraged

The prognosis is generally favorable. The majority of patients recover fully within weeks to a few months. However, some individuals may experience persistent balance difficulties.

References

Strupp M, Brandt T. Vestibular neuritis. Seminars in Neurology. 2009;29(5):509–519. doi:10.1055/s-0029-1241040
World Health Organization (WHO). ICD-10 Version 2019: H81.2 – Vestibular neuronitis. https://icd.who.int/browse10/2019/en#/H81.2
Bhattacharyya N, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology – Head and Neck Surgery. 2017;156(3_suppl):S1–S47.

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