The terms labyrinthitis and vestibular neuritis are often used interchangeably; both describe any inflammation along the pathway from the labyrinth (the inner ear) to the vestibular nerve (which connects the inner ear to the brain) to the vestibular nuclei, explains Sujana S. Chandrasekhar, MD, a partner at ENT and Allergy Associates in New York City. There are two kinds of labyrinthitis: viral labyrinthitis and bacterial labyrinthitis. Viral labyrinthitis — which is also called serous labyrinthitis or serous or viral neuritis — is much more common, says Dr. Chandrasekhar. “Viral labyrinthitis can occur in clusters, like other viral diseases can,” she explains. “Viral labyrinthitis is usually not associated with hearing loss (unless there’s a middle ear infection along with the inner ear infection, which will resolve).” Bacterial labyrinthitis, which is also called suppurative labyrinthitis, is quite rare and much more dangerous, says Chandrasekhar. “This is a catastrophic occurrence because there is bacteria and therefore pus in the inner ear and the inner ear becomes destroyed,” she says. “It causes hearing loss that persists even after the vertigo and dizziness are gone. Because the damage to the inner ear is so bad, the inner ear can fill up with scar tissue and calcium.” Both forms of labyrinthitis usually only affect one ear, adds Chandrasekhar. The onset of symptoms (known as the acute phase) is usually very sudden, with severe dizziness developing abruptly in the middle of the day. (2) In other cases, you experience symptoms when you first wake up in the morning. After the initial phase of spinning vertigo, there will be some disequilibrium or imbalance, says Chandrasekhar. Other symptoms of labyrinthitis include: (1)
Your eyes moving on their own, making it difficult to focus them.Loss of balance — you may fall toward one side.Dizziness that leads to nausea and vomiting.Ear symptoms including ringing in the ear (tinnitus) or hearing loss in the affected ear.
An ear infection can also cause labyrinthitis. Less commonly, labyrinthitis is caused by bacteria. Rarely, bacterial meningitis or a head injury may cause labyrinthitis. (3) Having a viral infection that can cause labyrinthitis increases your risk for the disorder. Your child’s risk may increase if they haven’t had recommended vaccines. People who are born with certain congenital abnormalities of the inner ear may also be at a higher risk of getting labyrinthitis, adds Chandrasekhar. Anyone can get labyrinthitis, but it’s more of a problem among elderly people, notes Chandrasekhar, because they are more at risk for balance issues and may already be on multiple medications, which can complicate the disorder. It also may take older people longer to recover.
You may have one or more of the following tests to rule out other conditions: (1)
Electroencephalogram (EEG), which measures the electrical activity of the brainElectronystagmography (ENG), which is used to determine whether vertigo symptoms are caused by an inner ear problemCaloric stimulation, in which the inner ear is warmed and cooled with air or water to test eye reflexesCranial computed tomography (CT scan of your head)Hearing testsMagnetic resonance imaging (MRI) of your head
Prognosis of Labyrinthitis
Viral labyrinthitis usually resolves completely with supportive measures, says Chandrasekhar. The longer and more severe the initial symptoms, the longer it will take for recovery. Older people may have a bit of underlying weakness in their balance system, so their recovery may take longer than it does for young people. Bacterial labyrinthitis is very rare, and the prognosis is less clear. The vertigo goes away with time, but most people will be left with some degree of permanent hearing loss. However, a cochlear implant or hearing aid can help. In very rare cases, some hearing loss is permanent in viral labyrinthitis. (1) Some people have chronic dizziness, but this is more common in older patients, says Chandrasekhar. After the initial phase of spinning vertigo is over, and there is still some disequilibrium or imbalance, people with labyrinthitis should not take vestibular suppressants, as this will delay their recovery, Chandrasekhar says. Instead, they should start doing vestibular (balance) exercises and resuming as many normal activities as possible. Bacterial labyrinthitis cases require strong antibiotic treatment along with supportive treatments including intravenous hydration and anti-vertiginous and anti-nausea medications, says Chandrasekhar. As quickly as possible after recovery, people with bacterial labyrinthitis should have a CT scan and MRI of the ear and, if they wish, undergo cochlear implantation quickly, before the inner ear calcifies and becomes hard and difficult or impossible to implant. This is likely to restore hearing, she notes.
Medication Options
Your doctor may prescribe the following medications, depending on your symptoms: (1)
AntihistaminesMedicines to control nausea and vomiting, such as prochlorperazineMedicines to relieve dizziness, such as meclizine or scopolamineSedatives, such as ValiumCorticosteroidsAntiviral drugs
Alternative and Complementary Therapies
Self-Care for Labyrinthitis The following can help you manage vertigo: (1)
Stay still and restAvoid sudden movements or position changesRest during severe episodes, and slowly resume activity. If you lose your balance, you may need help walkingAvoid bright lights, TV, and reading during attacksAfter the nausea and vomiting have passed, ask your healthcare provider about balance therapy. Chandrasekhar typically recommends labyrinthitis exercises or vestibular (balance) exercises like looking up and down and side to side while keeping the head still; head movements like bending the head forward and backward and side to side; arm and body movements like shrugging and circling the shoulders; standing exercises like moving from sitting to standing; and moving exercises like walking across the room and around a chair.Avoid driving, climbing, or operating heavy machinery until your symptoms have not occurred for at least one week.
Prevention of Labyrinthitis
Avoiding the common cold and flu and other viruses by practicing good hand hygiene and protective social behaviors can help prevent labyrinthitis, according to Chandrasekhar. Ten to 15 percent of patients who have had viral labyrinthitis will develop delayed benign paroxysmal positional vertigo (BPPV), says Chandrasekhar. A person who has BPPV is fine overall, but turning their head in a certain position causes severe spinning vertigo. The vertigo lasts for a few seconds, but is sudden and scary, and the patient can feel like they are spinning for several minutes. BPPV is treatable for the vast majority of cases by relatively simple physical therapy maneuvers called canalith repositioning procedures, says Chandrasekhar. Persistent postural-perceptual dizziness (PPPD) is a new diagnostic syndrome of non-spinning vertigo and unsteadiness, which combines chronic dizziness, vertigo, and other related disorders. (4) A study published in October 2017 in the Journal of Vestibular Research found PPPD in 25 percent of individuals who were followed 3 to 12 months after experiencing vestibular disorders like labyrinthitis. The disorder is diagnosed in an estimated 6 percent of patients who visit emergency departments in the United States complaining of dizziness. (4) Labyrinthitis has no gender preference and usually affects people in middle age, although anyone can get it. Children almost never get labyrinthitis — unless it’s bacterial, from meningitis, says Chandrasekhar. Ramsay Hunt syndrome (herpes zoster oticus) is caused by shingles, also known as zoster or herpes zoster. Shingles is a viral infection caused by the varicella-zoster virus, the same virus that causes chicken pox. After chicken pox clears up, the virus still lives in your nerves, according to the Mayo Clinic. (6) Years later, it may reactivate, and it can affect your facial nerves. Ramsay Hunt syndrome occurs when shingles affects the facial nerve near one of your ears. Along with the painful shingles rash, the syndrome can cause facial paralysis and hearing loss in the affected ear. Ramsay Hunt syndrome can also include labyrinthitis in addition to the other symptoms, according to Chandrasekhar. Other viruses that have been associated with labyrinthitis include: (3) Measles Rubella Mumps Polio Hepatitis Epstein-Barr virus MedlinePlus is a service of the National Library of Medicine (NLM), which is part of the National Institutes of Health (NIH). MedlinePlus offers useful information about labyrinthitis, including causes, symptoms, and treatment. VeDA The Vestibular Disorders Association (VeDA) provides information about balance, dizziness, and vestibular disorders; diagnosis and treatment; vision and hearing challenges with vestibular disorders; and psychological aspects of vestibular disorders and coping strategies.
