Labyrinthitis

Labyrinthitis is an inflammation of the labyrinth of the inner ear (which controls both hearing and balance). Labyrinthitis typically produces severe vertigo with head movement and sensorineural hearing loss. Vertigo begins gradually but peaks within 48 hours. Because it may last :3 to 5 days, causing loss of balance and falling in the direction of the affected ear, it often incapacitates the patient. Symptoms gradually subside over 3 to 6 weeks. Prevention is possible through early and vigorous treatment of predisposing conditions, such as otitis media and any local or systemic infection.

Causes

Many times, you cannot determine the cause of labyrinthitis. Often, the condition follows a viral illness such as a cold or the flu. Viruses, or your body’s immune response to them, may cause inflammation that results in labyrinthitis.

Other potential causes are these:

• Trauma or injury to your head or ear
• Bacterial infections: If found in nearby structures such as your middle ear, such infections may cause the following:
  
  
  • Fluid to collect in the labyrinth (serous labyrinthitis)
  • Fluid to directly invade the labyrinth, causing pus-producing (suppurative) labyrinthitis
• Allergies
• Alcohol abuse

Signs and Symptoms

The patient with labyrinthitis may complain of severe vertigo from any movement of the head, nausea and vomiting, and a unilateral or bilateral hearing loss. Questioning may uncover a recent upper respiratory tract infection. Tinnitus may not be present.

On inspection, note spontaneous nystagmus, with jerking movements of the eyes toward the unaffected ear. The patient may also demonstrate excessive giddiness. To minimize these symptoms, he may assume a characteristic posture -lying on the side of the unaffected ear and looking in the direction of the affected ear. Examination of the affected ear may reveal purulent drainage.

Diagnostic tests

Evaluation of labyrinthitis relies on culture and sensitivity tests to identify the infecting organism if purulent drainage is present, audiometric testing to reveal any sensorineural hearing loss, computed tomography scanning to rule out a brain lesion, and tympanometry and electronystagmography.

Treatment

Treatment measures are based on relieving the patient's symptoms and include bed rest with the head immobilized between pillows, meclizine given orally to relieve vertigo, and massive doses of antibiotics to combat diffuse purulent labyrinthitis. Oral fluids can prevent dehydration from vomiting; I. V. fluids may be needed for severe nausea and vomiting.

When conservative management fails, treatment necessitates surgical excision of the cholesteatoma and drainage of the infected areas of the middle and inner ear. A labyrinthectomy or vestibular nerve section may be done in some patients.

Prevention

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