Labyrinthitis

What Is Labyrinthitis?

Labyrinthitis means inflammation of the labyrinth. The labyrinth is the part of the ear also known as the inner ear. It is made up of the cochlea (for hearing), the vestibule (for equilibrium) and the semicircular canals (for orientation). When inflammation occurs in the labyrinth, you doctor can diagnose the condition of labyrinthitis.

What Symptoms Are Experienced in Labyrinthitis?

Patients will experience varying degrees of hearing loss, vertigo, and imbalance. This is because within the inflamed labyrinth, specialized cells of hearing and balance are compromised. These cells are called hair cells. Inflammation may cause temporary dysfunction or irreversible damage depending on the severity. It typically starts suddenly with hearing loss, vertigo, and even nausea with vomiting. Nausea improves first, then the vertigo decreases over a period of days. After the vertigo is gone, subtle disequilibrium (an “off” feeling) persists for weeks to months. Hearing loss tends to last longer and may not improve.

What Causes Labyrinthitis?

Most commonly it is caused by a virus and is called viral labyrinthitis. Viruses that cause cold sores, upper respiratory infections, stomach viruses, etc may cause viral labyrinthitis. However, infection with these viruses may even be asymptomatic (except for ear symptoms). Sick contacts, sharing food and drink, poor hand hygiene, and public travel are risk factors.

Less commonly a bacterial labyrinthitis may occur. Spread occurs from a bacterial ear infection or rarely meningitis. Bacterial labyrinthitis is more severe and may cause profound hearing loss.

Autoimmune labyrinthitis may be associated with other autoimmune diseases like lupus or rheumatoid arthritis. Head trauma can cause a post-concussive labyrinthitis. Certain antibiotics, diuretics or high dose aspirin may cause labyrinthitis as well.

How Is Labyrinthitis Treated?

Treatments can be divided into early treatments and late treatments. Early treatments aim to reduce inflammation, treat infection, and alleviate severe vertigo. The most common treatment is a corticosteroid. It is useful for viral or autoimmune labyrinthitis. It can also be used in meningitis to prevent labyrinthitis before it occurs. Corticosteroid treatment can be given orally, as an ear injection, or both.

Severe vertigo can be alleviated with vestibular suppressants such as Valium, Meclizine, or Dramamine. These are used for a few days until the severe symptoms dissipate.

If you have a bacterial ear infection treatment may be more complex and include antibiotics, ear tube placement (to drain the infection), and possible mastoidectomy (to prevent abscess formation or meningitis). Meningitis may require hospitalization in the intensive care unit in addition to antibiotics and steroids.

Late treatments aim to rehabilitate permanent damage sustained during labyrinthitis. If hearing does not improve, a hearing aid can be fitted. If the hearing loss is profound in one ear only, a bone anchored hearing aid or a contralateral routing of sound hearing aid can be offered. If hearing loss is profound in both ears such as after meningitis, cochlear implantation is an option.

Persistent vertigo or disequilibrium should be treated with vestibular rehabilitation and balance exercises. This allows the patient to adapt and is typically very effective. The exercises strengthen balance reflexes between the damaged ear, the brain, the eyes, and the extremities. They may be performed by the patient at home or under the direction of a physical therapist depending on the needs and severity.