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Labyrinthitis

Labyrinthitides

Labyrinthitis is a disease of the inner ear, characterized by development of inflammation and irritation of the affected area. Such a type of condition can give rise to vertigo and can also lead to hearing loss.


Presentation

Development of severe vertigo is the classical symptom of labyrinthitis. In many cases, vomiting and nausea also accompany vertigo. Hearing loss is yet another important marker of labyrinthitis. Many individuals also suffer from tinnitus, a condition characterized by ringing sensation inside the ears. Affected individuals also have difficulty in focusing their eyes.

Labyrinthitis, in many cases can cause permanent damage to the ear leading to permanent hearing loss if the cochlea is affected. The individual’s sense of balance can also get disrupted for prolonged period even after the inflammation gets corrected.

Pain
  • The severity of pain makes the patient to seek early treatment. Other uncommon symptoms include inner ear dyfunctions such as vertigo and tinnitus.[ncbi.nlm.nih.gov]
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  • Home remedies that may help relieve symptoms of labyrinthitis include warm compresses on the affected ear, saltwater gargle, not smoking , and over-the-counter (OTC) pain relievers.[medicinenet.com]
  • Acupuncture and physiotherapy in the treatment of myogenic headache patients: pain relief and EMG activity. Advances in Pain Research and Therapy, 1983, 5:571-576. Loh L et al.[clinic.acumedic.com]
Fever
  • Symptoms of purulent labyrinthitis include Severe vertigo and nystagmus Nausea and vomiting Tinnitus Varying degrees of hearing loss Pain and fever are common.[merckmanuals.com]
  • Symptoms and Signs Symptoms of purulent labyrinthitis include Severe vertigo and nystagmus Nausea and vomiting Tinnitus Varying degrees of hearing loss Pain and fever are common.[merckmanuals.com]
  • If people have symptoms of meningitis, such as confusion, stiff neck, or high fever, doctors do a lumbar puncture (spinal tap) and send samples of spinal fluid to the laboratory for culturing.[msdmanuals.com]
  • In glandular fever you will have fever, sore throat and nodular swelling in different parts of the body. 2 Know that bacterial infection is a cause, too. It is less common but more severe. Typically children are the sufferers.[wikihow.com]
Falling
  • This feeling may be associated with loss of balance to the point that the person walks unsteadily or falls.[onhealth.com]
  • Loss of balance -- you may fall toward one side. Nausea and vomiting. Ringing or other noises in your ears ( tinnitus ). Labyrinthitis usually goes away within a few weeks. Treatment can help reduce vertigo and other symptoms.[nlm.nih.gov]
  • Pain is associated with recurrent falls in community dwelling older adults: evidence from a systematic review and meta-analysis. Pain Med ; 2014:15:1115-1128. Tinetti ME, Kumar C. The patient who falls-“it’s always a trade off”.[vestibular.org]
  • Therefore, you should rest in bed to avoid falling and injuring yourself. After a few days, the worst of these symptoms should have passed and you should no longer feel dizzy all the time.[hse.ie]
Loss of Hair
  • There was loss of hair cells, "epithelialization" of the utricular maculae and semicircular canal cristae on the deafferented side, and reduced synaptic density in the ipsilateral vestibular nucleus (Baloh et al, 1996).[dizziness-and-balance.com]
Nausea
  • Nausea and vomiting. Ringing or other noises in your ears ( tinnitus ). Labyrinthitis usually goes away within a few weeks. Treatment can help reduce vertigo and other symptoms.[nlm.nih.gov]
  • Other medications are prescribed for easing symptoms of nausea and vomiting.[symptoma.com]
  • It may be associated with nausea, vomiting, and eye nystagmus. The cause is often not clear.[en.wikipedia.org]
  • It may cause vertigo, nausea, vomiting, imbalance, hearing loss and tinnitus. Recovery generally takes from one to six weeks but there may be some residual symptoms over a longer period.[curlie.org]
  • Acupuncture in the prevention of postoperative nausea and vomiting. Anaesthesia, 1997, 52 (7):658-661. Stein DJ et al. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.[clinic.acumedic.com]
Vomiting
  • If you have severe vomiting, you may be admitted to the hospital.[nlm.nih.gov]
  • Acupuncture and postoperative vomiting in day-stay paediatric patients. Anaesthesia and Intensive Care, 1996, 24(6):674-677. Liu SX et al. Magnetotherapy of neiguan in preventing vomiting induced by cisplatin.[clinic.acumedic.com]
  • Other medications are prescribed for easing symptoms of nausea and vomiting.[symptoma.com]
Tinnitus
  • Subjective assessment via the Speech, Spatial and Qualities scale (SSQ) and the Tinnitus Visual Analogue Scale was performed at preimplant and 12 months postimplant.[ncbi.nlm.nih.gov]
  • Other uncommon symptoms include inner ear dyfunctions such as vertigo and tinnitus. The diagnosis is established by clinical examinaion either by otoscopic evidence of the tick itself, or its fecal remnant.[ncbi.nlm.nih.gov]
  • It may cause vertigo, nausea, vomiting, imbalance, hearing loss and tinnitus. Recovery generally takes from one to six weeks but there may be some residual symptoms over a longer period.[curlie.org]
  • All patients exhibited acute onset dizziness, subjective performance deterioration, erratic impedance pattern, and two experienced worsening tinnitus.[ncbi.nlm.nih.gov]
  • Many individuals also suffer from tinnitus, a condition characterized by ringing sensation inside the ears. Affected individuals also have difficulty in focusing their eyes.[symptoma.com]
Otalgia
  • Aural tick usually menisfests as intolerable otalgia. The severity of pain makes the patient to seek early treatment. Other uncommon symptoms include inner ear dyfunctions such as vertigo and tinnitus.[ncbi.nlm.nih.gov]
  • Otalgia suggests herpes zoster oticus, especially if the tympanic membrane is not inflamed. Neck pain/stiffness suggests meningitis or vertebral artery dissection. Facial weakness is not a feature but may occur in herpes zoster oticus and stroke.[patient.info]
Hearing Impairment
  • Y.C....Park H.J. 2012 41 Maternal protein restriction regulates IGF2 system in placental labyrinth. ( 22201967 ) Gao H....Yallampalli C. 2012 42 Apoptosis of the fibrocytes type 1 in the spiral ligament and blood labyrinth barrier disturbance cause hearing[malacards.org]
  • These vestibular symptoms and signs occur in the absence of any significant hearing impairment, supporting the theory that the underlying pathology does not affect the entire labyrinth (inner ear) and is selective for the vestibular nerve.[doi.org]
Vertigo
  • Movement of the eye suggests a central cause of vertigo.[patient.info]
  • Treatment can help reduce vertigo and other symptoms.[nlm.nih.gov]
  • Such a type of condition can give rise to vertigo and can also lead to hearing loss. Development of severe vertigo is the classical symptom of labyrinthitis. In many cases, vomiting and nausea also accompany vertigo.[symptoma.com]
  • Prochlorperazine is another commonly prescribed medication to help alleviate the symptoms of vertigo and nausea.[en.wikipedia.org]
  • They may reduce symptoms of vertigo.[uofmhealth.org]
Dizziness
  • Older adults are more likely to have dizziness that lasts longer. In very rare cases, hearing loss is permanent. People with severe vertigo may get dehydrated due to frequent vomiting.[nlm.nih.gov]
  • All patients exhibited acute onset dizziness, subjective performance deterioration, erratic impedance pattern, and two experienced worsening tinnitus.[ncbi.nlm.nih.gov]
  • Improvement in dizziness can occur quickly for some, while others may need the therapy for years.[everydayhearing.com]
  • After a few days, the worst of these symptoms should have passed and you should no longer feel dizzy all the time. You can do several things to minimise any remaining feelings of dizziness and vertigo.[nhsinform.scot]
Meningism
  • Ten patients' charts (26%) were available for full review; 9 of these 10 patients had documented pneumococcal meningitis and the other patient had Haemophilus influenzae-type meningitis.[ncbi.nlm.nih.gov]
  • The most common risk factor for labyrinthitis ossificans was meningitis (19/24 or 79%). Eighteen (75%) patients had a history of bacterial meningitis.[ncbi.nlm.nih.gov]
  • , ascertaining likely routes for spread of infection from the meninges to the inner ear, and comparing the data from humans with those described in a rabbit model of meningogenic labyrinthitis.[ncbi.nlm.nih.gov]
  • PATIENTS: Forty-nine patients with hearing loss from bacterial meningitis who received cochlear implants from 1991 to 2011. Thirty-nine patients had adequate data for analysis.[ncbi.nlm.nih.gov]
  • MAIN OUTCOME MEASURES: Morbidity--labyrinthitis, meningitis; end point--death.[ncbi.nlm.nih.gov]
Nystagmus
  • Nystagmus type: Nystagmus is spontaneous. It is usually fine horizontal but may be mixed horizontal-torsional. It may be easier to see if sclera are exposed and the movement of scleral blood vessels can be followed.[patient.info]
  • Nystagmus which changes direction on eccentric gaze (i.e., right beating nystagmus with right gaze and left beating nystagmus with left gaze, with or without nystagmus with forward gaze) is suggestive of a central etiology (e.g., posterior fossa stroke[clinicaladvisor.com]
  • Her constant nystagmus disappeared within two weeks, and her hearing started coming back within a week.[complexchild.org]
Ataxia
  • Profound hearing loss, severe vertigo, ataxia, and nausea and vomiting are common symptoms of bacterial labyrinthitis.[emedicine.medscape.com]
  • Severe truncal ataxia, defined as the inability to sit upright without the use of arms to stabilize, is predictive of a central lesion.[clinicaladvisor.com]
  • Decreased ataxia and improved balance after vestibular rehabilitation. Otolaryngol Head Neck Surg . 2004 Apr. 130(4):418-25. [Medline] . Wei BP, Mubiru S, O'Leary S. Steroids for idiopathic sudden sensorineural hearing loss.[emedicine.medscape.com]

Workup

A preliminary physical examination of the ear would be carried out followed by neurological tests. Various other tests may also be required to rule out other underlying disease conditions that can mimic signs and symptoms of labyrinthitis. These include hearing tests, electroencephalography (EEG) and eye movement test. Blood tests and imaging studies such as CT scan and MRI would also be required to diagnose meningitis as the causative factor for labyrinthitis [8]. MRI can also be useful for diagnosing conditions such as acoustic neuroma, brain abscess, epidural hematoma and stroke.

Pseudomonas
  • Pseudomonas aeruginosa is the gram-negative bacterial rod which is often isolated from chronic aural discharge.[ncbi.nlm.nih.gov]

Treatment

Viral labyrinthitis can be effectively managed by medications and rest that would be necessary to ease the symptoms. In case of bacterial infections, antibiotics are the treatment of choice. Corticosteroids are recommended for reducing the inflammation. In addition, diazepam and other benzodiapines are also indicated. Individuals are advised to take adequate rest and avoid all those activities that would call for stress and sudden movement. Recent studies have pointed towards the beneficial role of antioxidant therapy as additional treatments [9].

Surgical intervention is the treatment of choice, if labyrinthitis has occurred due to otitis media. In such cases, ventilation tube is indicated along with surgical drainage followed by debridement. Hospital admission is necessary if the symptoms have turned severe and individuals show signs of slurred speech, numbness, weakness, diplopia and gait disturbance [10].

Prognosis

Individuals often do well with treatment and completely recover within few months. Severity of the symptoms lessens within the first week of initiation of treatment. About 10 to 20% of children with meningitis, who are also suffering from labyrinthitis, suffer from permanent hearing loss [7].

Etiology

Bacterial and viral infections can cause labyrinthitis. Infectious disorders like bacterial infection causing otitis media or meningitis, can favor the development of such a type of inflammatory disease [2]. In many cases, allergies, certain medications, head injury, trauma, stroke or ear injury can affect the inner ear increasing the risk of labyrinthitis. In addition to these, drinking excessive amounts of alcohol, smoking and stress also predisposes an individual to contract this condition. Individuals suffering from upper respiratory tract infections can also be affected by labyrinthitis.

Epidemiology

The exact incidence of labyrinthitis is unknown. However, from the available data, it has been estimated that viral labyrinthis is the most common form. Cases of sensorineural hearing loss that occur due to viral labyrinthitis are known to affect about 1 in 10,000 individuals. Of these, 40% of the affect individuals also complain of vertigo [3].

Individuals in the age group of 30 to 60 years are more prone to develop viral labyrinthitis. Such a type of condition, rarely strikes the children population [4].

Sex distribution
Age distribution

Pathophysiology

The inner ear is responsible for maintaining balance and is important for the function of hearing. In case of labyrinthitis, the various parts of the inner ear undergo inflammation and irritation. Such series of events can drastically affect the balance and hearing ability of the affected individuals. The resultant reaction is development of vertigo and hearing loss [5].

Several types of autoimmune processes can also give rise to labyrinthitis. The inner ear consists of various nerves that can also get inflamed, giving rise to a condition known as vestibular neuritis. Symptoms of this disorder often mimic the symptoms of labyrinthitis, making diagnosis of the condition difficult [6].

Prevention

So far there is no known way to prevent the development of labyrinthitis. However, complications can be kept at bay with initiation of treatment at the right time. In addition, affected individuals are advised against driving and other activities until symptoms resolve completely.

Summary

Various types of viruses, bacteria and infectious organisms may cause the development of labyrinthitis. This type of disorder of the inner ear disturbs the balance and the hearing function, causing hearing loss and vertigo. Labyrinthitis can affect one or both the ears. Patients often do well with treatment; however the condition cannot be prevented [1].

Patient Information

  • Definition: Labyrinthitis is a condition characterized by inflammation of the inner ear due to infections, allergic reactions or underlying disease conditions. Such a type of inflammatory disease causes dizziness and hearing loss. The inner ear is important for the function of hearing and maintenance of balance. Any activity or infection that affects the functioning of the inner ear disturbs the sense of balance and the hearing ability.
  • Cause: Viral infections are the most common cause of labyrinthitis. In addition, allergies, medications, disease conditions, trauma, stroke and bacterial infections can also predispose an individual to develop labyrinthitis. Drinking alcohol, smoking and stress also significantly increase the chances of labyrinthitis.
  • Symptoms: Symptoms of labyrinthitis include dizziness, hearing loss accompanied by nausea and vomiting. Affected individuals also have difficulty in focusing their eyes, and also develop tinnitus in the long run. Individuals also experience loss of balance.
  • Diagnosis: No single test is helpful in diagnosing labyrinthitis. A careful physical examination of the inner ear is done at the preliminary level. This is followed by neurological examination and tests to rule out other underlying disease conditions. Imaging studies such as CT scan and MRI are also indicated.
  • Treatment: Mild cases can be effectively treated with medications and adequate rest. In severe cases, hospital admission is indicated to resolve the symptoms and correct the inflammation of inner ear. Corticosteroids along with diazepam are required for treating the inflammation. Other medications are prescribed for easing symptoms of nausea and vomiting.

References

Article

  1. Jang CH, Park SY, Wang PC. A case of tympanogenic labyrinthitis complicated by acute otitis media.Yonsei Med J. Feb 28 2005;46(1):161-5.
  2. Nadol JB Jr. Hearing loss as a sequela of meningitis. Laryngoscope. May 1978;88(5):739-55.
  3. Byl FM. Seventy-six cases of presumed sudden hearing loss occurring in 1973: prognosis and incidence.Laryngoscope. May 1977;87(5 Pt 1):817-25.
  4. Gold DR, Reich SG. Clinical reasoning: a 55-year-old woman with vertigo. A dizzying conundrum. Neurology 2012; 79:e146.
  5. Kroenke K, Hoffman RM, Einstadter D. How common are various causes of dizziness? A critical review. South Med J 2000; 93:160.
  6. Baloh RW. Clinical practice. Vestibular neuritis. N Engl J Med 2003; 348:1027.
  7. Bohr V, Paulson OB, Rasmussen N. Pneumococcal meningitis. Late neurologic sequelae and features of prognostic impact. Arch Neurol. Oct 1984;41(10):1045-9
  8. Kopelovich JC, Germiller JA, Laury AM, Shah SS, Pollock AN. Early prediction of postmeningitic hearing loss in children using magnetic resonance imaging. Arch Otolaryngol Head Neck Surg. May 2011;137(5):441-7. 
  9. Strupp M, Zingler VC, Arbusow V, Niklas D, Maag KP, Dieterich M, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med. Jul 22 2004;351(4):354-61.
  10. Meyerhoff WL, Kim CS, Paparella MM. Pathology of chronic otitis media. Ann Otol Rhinol Laryngol 1978; 87:749.

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Last updated: 2019-07-11 22:16