Labyrinthitis

Labyrinthitis refers to inflammation of the bony labyrinth of the inner ear, including the semicircular canals, vestibule (middle section) and cochlea. The inflammation is usually attributed to a viral upper respiratory tract infection. 

Rarely labyrinthitis can be caused by a bacterial infection. This may be an inflammatory response to a nearby infection or the result of bacteria or bacterial toxins entering the labyrinth. It is usually secondary to otitis media or meningitis.

 

Presentation

Labyrinthitis presents with acute onset vertigo, similarly to vestibular neuronitis.

Unlike vestibular neuronitis, labyrinthitis can also be associated with:

  • Hearing loss
  • Tinnitus

 

Patients may have symptoms associated with the causative virus, such as a cough, sore throat and blocked nose.

 

Diagnosis

A clinical diagnosis is based on history and examination findings. It is important to exclude a central cause of the vertigo.

The head impulse test can be used to diagnose peripheral causes of vertigo, resulting from problems with the vestibular system (e.g., vestibular neuronitis or labyrinthitis).

 

Management

Management is the same as with vestibular neuronitis, with supportive care and short-term use (up to 3 days) of medication to suppress the symptoms. Options for managing symptoms are:

  • Prochlorperazine
  • Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

 

Antibiotics are used to treat bacterial labyrinthitis. The underlying infection (e.g., otitis media or meningitis) needs appropriate treatment.

Patients rarely have lasting symptoms, including permanent hearing impairment. This is more common after bacterial labyrinthitis, particularly associated with meningitis. 

TOM TIP: Remember hearing loss as a key complication of meningitis. All patients with meningitis are offered audiology assessment as soon as they are recovered to assess for hearing impairment. This complication comes up often in exams and is worth remembering.

 

Last updated July 2021
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