Labyrinthitis is a disorder associated with inflammation of the inner ear. The labyrinth is a fluid-filled compartment that consists of the cochlea and the vestibular organs. The cochlea is the hearing organ and the vestibular organs are responsible for balance and spatial orientation.
Labyrinthitis has several potential causes, and patients of any age and gender may be affected. Patients with labyrinthitis can experience hearing loss in the affected ear, imbalance, dizziness, and nausea. When the balance organ’s input to the brain is suddenly changed, patients experience vertigo, feeling like you are spinning or moving when you are still. Severe symptoms may limit activities of daily living, the ability to work, and restrict recreational activities.
Labyrinthitis is a self-limiting illness that usually gets better in several weeks. Symptom can begin suddenly and gradually worsen over the course of hours to days before improvement is noticed. Failure to seek treatment may put patients at higher risk for permanent hearing loss and imbalance. Although uncommon, it is possible to have some permanent hearing loss despite treatment. While most patients with imbalance and mild dizziness with head movement recover, sometimes it may take months to years to fully recover. Patients with substantial balance issues may benefit from physical therapy, specifically vestibular physical therapy.
The symptoms of labyrinthitis can include:
· Hearing loss, often in high frequency pitch range
· Decreased ability to understand speech
· Tinnitus, or ringing or buzzing sensation in the ear
· Imbalance and unsteadiness, falling or swaying to one side while walking
· Vertigo, or feeling like you are spinning when you are still
· Involuntary twitching or jerking of the eyeball, called nystagmus
· Nausea and vomiting
Viral infection—Viral infections of the inner ear or activation of a virus that is normally inactive and stays within nerve endings are thought to be the most common cause of labyrinthitis. The specific virus that causes this is usually unknown in most cases. A unique type of labyrinthitis may be caused by reactivation of the varicella-zoster virus, called Ramsay Hunt syndrome, or herpes zoster oticus. This is like shingles of the ear and can occur with labyrinthitis in addition to ear pain, facial weakness, and blisters around the ear, ear canal, and eardrum.
Bacterial infection—A bacterial infection of the middle ear (the space behind the ear drum) can spread to the inner ear and cause bacterial labyrinthitis. Children with inner ear deformities are at a higher risk for bacterial labyrinthitis either from a middle ear infection or from the spread of bacterial meningitis to the inner ear. Severe bacterial labyrinthitis can occur with ear pain, ear infection, drainage of pus from the ear, fevers, or chills. Patients may require hospitalization. This type of infection has a higher risk for permanent hearing loss and may also lead to labyrinthitis ossificans, where there is bone formation in the inner ear after the infection.
Autoimmune—Autoimmune labyrinthitis is a rare cause of labyrinthitis and may come and go. It is often associated with other autoimmune disorders such as systemic lupus erythematosus, inflammatory bowel disease, rheumatoid arthritis, or other autoimmune disorders.
Trauma and surgery—Inner ear trauma puts patients at risk for developing labyrinthitis. Fractures involving the inner ear, concussion of the head and inner ear, or bleeding in the inner ear can cause labyrinthitis.
A tumor of the nerves supplying the inner ear, such as a schwannoma (acoustic neuroma), may also involve hearing loss, vertigo, or labyrinthitis. Your ENT (ear, nose, and throat) specialist, or otolaryngologist, may order an MRI to rule out this condition.
Other potential risk factors include allergies, stress, alcohol and tobacco consumption, and certain medications.
What are the Treatment Options?
Treating most cases of labyrinthitis includes observation, bed rest, and hydration. Steroids, such as prednisone, are typically prescribed to minimize inner ear inflammation. In some cases, steroids may be injected through the eardrum into the middle ear space. Antivirals may also be prescribed. Severe nausea and vomiting may be treated with anti-nausea medications. Vertigo may be treated with antihistamines or sedatives, such as benzodiazepines, although long-term use will impair the recovery of balance function.
The treatment of bacterial labyrinthitis is to control the primary infection, which is usually a middle ear infection. This may require antibiotics, placement of an ear tube, or more advanced ear surgery. Treatment for autoimmune labyrinthitis addresses the underlying autoimmune condition with steroids or other immune modulating medications usually directed by the rheumatologist.
A multidisciplinary team involving your ENT specialist, audiologist, and vestibular therapist is important to evaluate your hearing, minimize the potential long-term effects of labyrinthitis, and discuss options for possibly restoring your hearing. For severe hearing loss, the patient may be a candidate for a bone-conduction hearing aid or a cochlear implant. When the balance organs are damaged, the brain needs time to adjust to improve balance function again. Vestibular therapy and balance exercises help many patients regain their balance.
Although labyrinthitis is not life-threatening, vertigo may rarely be a sign of a more serious disorder such as a stroke or brain tumor. Patients with sudden, persistent vertigo or additional worsening symptoms such as double vision, slurred speech, facial droop, limb weakness, or numbness should seek immediate medical attention.
1. What are my treatment options?
2. When should I get a repeat hearing evaluation?
3. What tests should I have performed?
4. Do I need an MRI?
5. What are the options for hearing restoration?
6. Should I seek vestibular therapy?
With permission of the American Academy of Otolaryngology–Head and Neck Surgery Foundation,
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