Labyrinthitis

Definition

Labyrinthitis is an ear disorder that involves irritation and swelling of the inner ear.

See also: Meniere's disease

Alternative Names

Bacterial labyrinthitis; Serous labyrinthitis; Neuronitis - vestibular; Vestibular neuronitis; Viral neurolabyrinthitis; Vestibular neuritis

Causes, incidence, and risk factors

The are likely many causes of labyrinthitis. It commonly occurs after an ear infection ( otitis media ) or an upper respiratory infection. It may also occur after an allergy, cholesteatoma, or taking certain drugs that are dangerous to the inner ear.

During labyrinthitis, the parts of the inner ear become irritated and inflamed. This interferes with their function, which includes the ability to keep your balance.

The following raise your risk for labyrinthitis:

• Drinking large amounts of alcohol
• Fatigue
• History of allergies
• Recent viral illness, respiratory infection, or ear infection
• Smoking
• Stress
• Use of certain prescription or nonprescription drugs (especially aspirin)

Symptoms

• Abnormal sensation of movement (vertigo)
• Difficulty focusing the eyes because of involuntary eye movements
• Dizziness
• Hearing loss in one ear
• Loss of balance, such as falling toward one side
• Nausea and vomiting
• Ringing or other noises in the ears (tinnitus)

Signs and tests

A complete physical and neurological exam should be done. An ear examination may not reveal any problems.

Usually, the diagnosis of layrinthitis does not require other tests. Tests will be done to rule out other causes for your symptoms. These may include:

• EEG
• Electronystagmography
• Evoked auditory potential studies
• Head CT scan
• Hearing tests (audiology/audiometry)
• MRI of the head
• Warming and cooling the inner ear with water (caloric stimulation) to test eye reflexes

Treatment

Labyrinthitis usually goes away within a few weeks. However, symptoms may need treatment. Your doctor may prescribe an antibiotic to treat the infection. Medications that may reduce symptoms include the following:

• Antihistamines
• Corticosteroids such as prednisone when symptoms are severe
• Medicines such as compazine to control nausea and vomiting
• Medicines to relieve dizziness such as meclizine or scopalamine
• Sedative-hypnotics such as Valium

To prevent worsening of symptoms during episodes of labyrinthitis, try the following:

• Keep still and rest when symptoms occur.
• Gradually resume activity.
• Avoid sudden position changes.
• Do not try to read when symptoms occur.
• Avoid bright lights.

You may need help walking when symptoms occur. Avoid hazardous activities such as driving, operating heavy machinery, and climbing until 1 week after symptoms have disappeared.

Expectations (prognosis)

If you have severe vomiting, you may be admitted to the hospital.

Severe symptoms usually go away within a week. Most patients are completely better within 2 to 3 months. Continued dizziness is more likely to last in older patients.

Hearing usually returns to normal.

Complications

• Injury to self or others during attacks of vertigo
• Permanent hearing loss (rare)
• Spread of inflammation to other ear areas or to the brain (rare)

Calling your health care provider

Call your health care provider if dizziness, vertigo, loss of balance, or other symptoms of labyrinthitis are present. Also call if hearing loss occurs.

Urgent or emergency symptoms include double vision, weakness or paralysis, slurring of speech, convulsions, fainting, persistent vomiting, or vertigo accompanied by fever of more than 101 degrees Fahrenheit.

Prevention

Prompt treatment of respiratory infections and ear infections may help prevent labyrinthitis.

References

Polensek SH. Labyrinthitis. In: Ferri FF, ed. Ferri’s Clinical Advisor 2008: Instant Diagnosis and Treatment. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008.