Labyrinthitis

Ears are one of our sense organs. They not only aid in hearing, but also help in equilibrium and body positioning. Ear comprises of many structures and inner ear structure is known as labyrinth. Labyrinthitis is the inflammation of the labyrinth. In some cases, the name labyrinthitis may also be referred to other causes of inner ear conditions which have no inflammation, as these conditions also produce similar symptoms. Human ears have a labyrinth in each of inner ears which are covered in dense bone near the base of the skull. As the name indicates, the labyrinth is a network of interconnected fluid-filled channels. About half of the labyrinth (the cochlea) is formed like a snail's shell. It is responsible for sending information regarding various sounds to the brain. The other half comprises of 3 semicircular canals connected to an open cavity or vestibule. The vestibule portion of the labyrinth is responsible for sending information to the brain regarding the movement and position of the head. Any irritation of the vestibule causes defective information going to the brain. Eyes are also one of the sense organs that help in sending positioning information to the brain and if the information from the labyrinth and the eyes don't correspond, then the brain has trouble translating what is actually occurring. This misinterpretation makes the patient feel as if he is spinning. This sensation is termed as vertigo. It can be followed by feelings of nausea and vomiting. Some patients may also experience hearing loss or abnormal sounds (tinnitus).

Labyrinthitis or Inner Ear Infection

Labyrinthitis is commonly caused by a virus. Other causes for labyrinthitis can be bacterial infection, head trauma, severe stress, allergy or a reaction to any medication. Bacterial and viral labyrinthitis can cause permanent hearing loss; however, this is rare. Labyrinthitis is frequently preceded by an upper respiratory tract infection (URI).

Usually labyrinthitis resolves on its own in one or a few weeks, depending upon the severity of the infection. Antibiotics are required if the infection is bacterial. However viral infections are the most common cause of labyrinthitis.

Antihistamines help in reducing the swelling from the infection and reduce the severity of symptoms.

Classification and Types of Labyrinthitis or Inner Ear Infection

Types of Bacterial Labyrinthitis or Inner Ear Infection

  • Syphilitic Labyrinthitis: Bacterial infections of this type can be present at time of birth or it may be acquired. Symptoms gradually develop and vary. They usually progress to complete imbalance as well as hearing. Sudden onset of dizziness or deafness may occur. There are other symptoms in congenital syphilis like chronic inflammation of eye (Interstitial Keratitis) along with swelling of forehead and saddle shaped nose.
  • Toxic Labyrinthitis: Infection of this type occurs when bacterial agents in middle ear pass to inner ear resulting in loss of balance as well as hearing loss. This is treated with antibiotics or by making incision in eardrum.
  • Acute Suppurative Labyrinthitis: Infection of this type is quite rare. Symptoms are sudden vertigo. It is usually a result of chronic infection of middle ear causing solid bulk of debris. This mass may wear off surrounding bone within inner ear, thus further exposing it to infections. Meningitis may also cause suppurative labyrinthitis.

Viral Labyrinthitis:

This is also called vestibular neuritis. This often results from viral infections. Symptoms are gradual onset of vertigo with vomiting and nausea. Symptoms are acute within first 24 hours and then gradually subside over the ensuing few days. Patients generally completely get cured within a month and a half. Vestibular suppressant like diazepam, plenty of hydration, and vestibular exercises are first line of treatment.

Pathophysiology of Labyrinthitis or Inner Ear Infection

The labyrinth is a membranous structure surrounded by dense bone which is formed in utero by intramembranous and enchondral ossification. Infections occurring in the middle ear (otitis media) may spread to inner ear and then from there inflammation can spread from inner ear into internal auditory canal. Meningitis can also spread to inner ear through cochlear aqueduct. Labyrinthitis usually results in a substantial inflammatory response causing intraluminal fibrosis. If it results in ossification, it is termed as labyrinthitis ossificans. There is a significant risk of hearing loss with bacterial meningitis. More than 20% of children suffer from auditory or vestibular symptoms with meningitis.

Signs and Symptoms of Labyrinthitis or Inner Ear Infection

Common Symptoms of Labyrinthitis or Inner Ear Infection Are:

Vertigo, nausea, vomiting, loss of balance. Other symptoms which may occur are headache, tinnitus and hearing loss.

These symptoms can be triggered or worsen by upon moving the head, sitting up, rolling over or looking upward. Depending on the cause and severity, symptoms may last for days or weeks. Patients should avoid doing activities such as driving, working at heights, or operating heavy machinery for a minimum of one week after the symptoms have stopped, as the symptoms have a chance of recurring. In rare situations, this condition may be permanent with tinnitus, hearing loss and vertigo and can be very debilitating.

Life Threatening Symptoms of Labyrinthitis or Inner Ear Infection Are:

  • If the patient cannot eat, drink or take medications because of vomiting.
  • The hearing gets increasingly worse.
  • Severe headache.
  • Lethargy or weakness.
  • Fever.
  • Ear pain.
  • Recent injury to head or ear.
  • Progressively worsening dizziness.
  • Double vision.
  • Speech problems.
  • Numbness or weakness in arms or legs.
  • Facial paralysis or weakness.
  • Change in gait.

Etiology and Risk Factors of Labyrinthitis or Inner Ear Infection

The cause of labyrinthitis cannot be determined easily. It usually follows a viral illness such as a cold or the flu leading to inflammation and resulting in labyrinthitis.

Common Causes of Labyrinthitis or Inner Ear Infection Are:

  • Trauma or injury to the head or ear.
  • Bacterial infections in the nearby structures like middle ear.
  • Allergies.
  • Alcohol abuse.
  • A benign tumor of the middle ear.
  • Some medications taken in high doses like furosemide (Lasix), aspirin etc.
  • Benign paroxysmal positional vertigo.
  • Some serious causes of vertigo produce symptoms like labyrinthitis such as tumors at the base of the brain or strokes.

Treatment for Labyrinthitis or Inner Ear Infection

Usually labyrinthitis resolves on its own in one or a few weeks, depending upon the severity of the infection. Antibiotics are required if the infection is bacterial. However viral infections are the most common cause of labyrinthitis.

Antihistamines help in reducing the swelling from the infection and reduce the severity of symptoms.

Conservative Treatment for Labyrinthitis or Inner Ear Infection Include:

  • Resting in a comfortable position.
  • Reducing salt and sugar intake.
  • Drinking lot of water.
  • Avoiding chocolate, coffee and alcohol.
  • Quitting smoking.
  • Keeping a stress free environment.
  • Epley maneuver.

Medical Treatment for Labyrinthitis or Inner Ear Infection Include

Medicines such as meclizine (Antivert), diazepam (Valium), promethazine (Phenergan), dimenhydrinate (Dramamine), antibiotics, and antihistamine such as diphenhydramine (Benadryl) are beneficial.

Surgery for Labyrinthitis or Inner Ear Infection Include

Some patients require surgery to drain the inner and middle ear.

Investigations for Labyrinthitis or Inner Ear Infection

  • Medical questionnaire
  • Physical examination
  • Neurological examination.
  • CT scan of the head.
  • MRI of the head.
  • Dix-Hallpike test.
  • Nylen-Barany test.
  • Hearing test
  • Laboratory culture (ear discharge).

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 21, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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