An infection of the labyrinth and both the vestibular and cochlear nerves by viral pathogens is termed viral labyrinthitis, a term rarely used in the literature because of its poorly understood etiology and pathogenesis [1] [2] [3]. It is distinguished from vestibular neuronitis, in which only the vestibular portion of the vestibulocochlear nerve is affected, thus a different clinical presentation is observed in the two syndromes [2] [3] [4]. So far, several viruses that have been identified as possible agents of labyrinthitis - herpes simplex virus (HSV) type 1, cytomegalovirus (CMV), adenovirus, strains of influenza A and B, as well as Epstein-Barr virus (EBV) [1] [5]. In addition, measles, mumps, and rubella viruses have also been implicated in the pathogenesis of viral labyrinthitis [6]. The main clinical features are vertigo and sensorineural hearing loss, developing as a consequence of cochlear and vestibular nerve damage, respectively [1] [2] [6]. Both symptoms appear in an abrupt fashion and are more frequently unilateral, while tinnitus is present in a number of patients [2] [5] [6]. Unlike bacterial infections of the inner ear, which are more common in the pediatric population, viral labyrinthitis is primarily encountered in adults between 30-70 years of life [2].

• Inflammation

  Otitis media — Inflammation of the middle ear. It can lead to labyrinthitis. [medical-dictionary.thefreedictionary.com]

  Nerve, Inflammations, Vestibular Nerve, Nerve Inflammation, Vestibular, Nerve Inflammations, Vestibular, Vestibular Nerve Inflammation, Vestibular Nerve Inflammations, Nerve Neuritides, Vestibular, Nerve Neuritis, Vestibular, Neuritides, Vestibular Nerve [fpnotebook.com]

  The Facts Labyrinthitis is an inflammation of the inner ear. The labyrinth is a structure of fluid-filled sacs and tubes just inside the skull. [medbroadcast.com]

  Labyrinthitis is a term denoting inflammation and infection of the labyrinth, the constitutive anatomical part of the inner ear. [symptoma.com]

• Falling

  After a few minutes, I tried standing up but felt as if I was about to fall over. The dizzy feeling continued for another hour, however I didn't feel anymore extreme dizziness. [raamdev.com]

  […] infection is common Presentation Symptoms acute onset of severe, contiguous vertigo nausea vomiting tinnitus hearing loss Physical exam horizontal nystagmus toward the unaffected ear Evaluation Diagnosis is clinical May have a positive Romberg test fall [step2.medbullets.com]

  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]

• Weakness

  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. [epainassist.com]

  The initial symptoms are deep, burning auricular pain followed by a rash inside of the auditory canal, vertigo, permanent hearing loss, and facial weakness . [iowaearcenter.com]

  Dizzy spells also occur if move too fast, and I am often unusually fatigued, suffereing from muscle weakness, and with sysmptoms such as confusion and a lack of concentration; I also feel rather "spaced out" fairly often. [medhelp.org]

  Weakness of arms or legs. Difficulty walking. Collapse, or periods of unconsciousness. Numbness in areas of your body. Chest pain. An abnormally slow or fast pulse. An irregular pulse. Any other symptom that you cannot explain. [patient.co.uk]

• Fatigue

  I am currently taking no medication, so what is causing the fatigue et cetera? Apologies for the length Thankyou 3 Responses Well things do not add up. [medhelp.org]

  It takes time until they break up and go on their way and the terrible dizziness, nausea & fatigue go away. I don't get any relief with the vertigo medicine nor valium that she prescribed last time.Glad you went. [arthritisinsight.com]

  Risk Factors for Labyrinthitis The following may increase your risk of developing labyrinthitis: Drinking too much alcohol Smoking Stress Fatigue Allergies Recent viral illness, respiratory infection, or ear infection Taking certain medications, such [everydayhealth.com]

  However, if the inner ear is permanently damaged by the infection and the brain does not adequately compensate, symptoms can develop into chronic dizziness, fatigue, disorientation, as well as tinnitus and hearing loss (if labyrinthitis is the cause). [eyeandear.org.au]

• Recent Upper Respiratory Infection

  Diagnosis Diagnosis of labyrinthitis is based on a combination of the individual's symptoms and history, especially a history of a recent upper respiratory infection. [healthofchildren.com]

  Bacterial labyrinthitis may produce a discharge from the infected ear. Diagnosis The diagnosis of labyrinthitis is based on a combination of the patient's symptoms and history—especially a history of a recent upper respiratory infection. [medical-dictionary.thefreedictionary.com]

• Nausea

  The Dr. at the walk in clinic did some tests, looked in my ears and said I have viral Labyrinthitis which is causing the dizziness, (not the plaquenil) and nausea, that she's seen 3 other's today with the same thing. [arthritisinsight.com]

  Zinziber officinalis, Hedychium spicatium, Cayophyllus aromatocus, Piper longum, and Terminalia arjuna are some of the herbs used to treat giddiness and nausea. [home-remedies-for-you.com]

  In some cases, your doctor may prescribe medications such as: corticosteroids to reduce inflammation in your inner ear vestibular suppressants for severe vertigo anti-nausea medications for nausea or vomiting. [healthdirect.gov.au]

  Medications are often prescribed to control nausea and to improve dizziness during the severe stage. If treated promptly, many inner ear infections cause no permanent damage. [hearinglink.org]

• Vomiting

  If you have severe vomiting, you may be admitted to the hospital. [medlineplus.gov]

  Outlook (Prognosis) If you have severe vomiting, you may be admitted to the hospital. Severe symptoms usually go away within a week. Most people are completely better within 2 to 3 months. [nicklauschildrens.org]

  However, initial treatment approach is always to control the symptoms such as nausea, vomiting, vertigo, and dizziness. [medindia.net]

• Loss of Appetite

  During the next few days I felt very sick, headaches, loss of appetite, more dizzy feelings (though none nearly as intense) and just overall sick. Then it went away and I figured that was the end of it. [raamdev.com]

• Hypotension

  Orthostatic hypotension This means your blood pressure drops when you sit up from lying, or when you stand up from sitting or lying. In particular, if you jump up out of bed after a night's sleep. [patient.co.uk]

• Blurred Vision

  Symptoms of Labyrinthisis include: Tinnitus Dizziness Vertigo Hearing Loss Ear pain Feeling sick Mild headaches Blurred vision Pressure inside the ear Imbalance Bacterial or viral infections cause the nerves connecting the inner ear to the brain to become [tinnitushearingsolutions.com]

  Other symptoms of labyrinthitis may include: mild headaches ringing or humming in your ear(s) ( tinnitus ) fluid or pus leaking out of your ear(s) ear pain changes in vision, such as blurred vision or double vision The symptoms of labyrinthitis can be [nhsdirect.wales.nhs.uk]

  Other symptoms of labyrinthitis may include: mild headaches ringing or humming in your ear(s) (tinnitus) fluid or pus leaking out of your ear(s) ear pain changes in vision, such as blurred vision or double vision The symptoms of labyrinthitis can be quite [nhs.uk]

• Tinnitus

  Vestibular neuritis Vertigo without postion changes Vertigo but no hearing loss or tinnitus (inflammation of vestibular portion of CN VIII) Meclizine Labyrinthitis Acute, self-resolving episode Vertigo Hearing loss Tinnitus Self-limited Meclizine + steroids [step2.medbullets.com]

  Both symptoms appear in an abrupt fashion and are more frequently unilateral, while tinnitus is present in a number of patients. [symptoma.com]

  Inner ear damage or dysfunction is a contributory cause of tinnitus. [tinnitushearingsolutions.com]

• Hearing Problem

  Prevention The most effective preventive strategy includes prompt treatment of middle ear infections, as well as monitoring of patients with mumps, measles, influenza, or colds for signs of dizziness or hearing problems. [healthofchildren.com]

  Left alone Meniere’s will generally ‘burn out’ but this can take several years with sufferers struggling with balance and hearing problems – leaving no useful hearing or balance function on the affected side. Webpage published: 2018 [hearinglink.org]

  Usually, labyrinthitis does not cause any problems. In rare cases, labyrinthitis permanently damages the eighth cranial nerve. This can cause lasting problems with balance, and partial or total hearing loss. You might need to use a hearing aid. [saintlukeskc.org]

  In case of labyrinthitis, cochlea and vestibule become inflamed and therefore patient experiences hearing problems, tinnitus (constant high or low pitched ringing sound in ear) and dizziness. [medindia.net]

• Fluctuating Hearing Loss

  Not to be mistaken for… Symptoms of labyrinthitis are similar to those of Menière’s disease, which causes intermittent episodes of vertigo, fluctuating hearing loss with a progressive, ultimately permanent loss of hearing, ringing in the ear (tinnitus [axappphealthcare.co.uk]

• Ear Discharge

  Hearing test Laboratory culture (ear discharge). [epainassist.com]

• Vertigo

  The main clinical features are vertigo and sensorineural hearing loss, developing as a consequence of cochlear and vestibular nerve damage, respectively. [symptoma.com]

  Vestibular neuritis Vertigo without postion changes Vertigo but no hearing loss or tinnitus (inflammation of vestibular portion of CN VIII) Meclizine Labyrinthitis Acute, self-resolving episode Vertigo Hearing loss Tinnitus Self-limited Meclizine + steroids [step2.medbullets.com]

  If your vertigo symptoms last more than a few days, staying active may be more helpful. There are also some exercises that your doctor may suggest once the vertigo has subsided. [hearingcentral.com]

  CONGENITAL and acquired deafness and acute and chronic vertigo are often attributed to viral infections of the inner ear. [jhu.pure.elsevier.com]

• Dizziness

  I don't get dizzy very easily; things such as spinning around or riding a roller coaster don't make me dizzy at all, so this came as a huge surprise. Following the dizzy spell, I felt very nauseous and wanted to throw up. [raamdev.com]

  Should I worry about dizziness? Dizziness due to a temporary infection is usually not harmful. [patient.co.uk]

  About 20% of all dizziness is due to BPPV The most common cause of BPPV in people under age 50 is head injury About 50% of dizziness in older people is due to BPPV In half of all cases, there is no known reason for the onset of BPPV Treatment is usually [hearinglink.org]

• Stroke

  Facial weakness is not a feature but may occur in herpes zoster oticus and stroke. Cardiovascular risk factors including smoking, diabetes, hypertension and previous stroke all increase the likelihood of the symptoms being due to a TIA or a stroke. [patient.info]

  Viral Labyrinthitis • Vertigo Lasts days to weeks • May have hearing changes Possible Treatments It is important for people suffering from such symptoms to be examined and diagnosed by an ENT (Ear Nose Throat) specialist since other conditions, such as stroke [hearingcentral.com]

  This can help to rule out other causes of your symptoms, such as stroke. You may have tests such as: MRI. This is done to rule out stroke. Electrocardiogram (ECG) or other cardiovascular tests. These can rule out cardiovascular causes. [saintlukeskc.org]

  If the main symptom you have is dizziness or vertigo, your doctor will want to eliminate other possible causes such as migraine, stroke, medications, and neurologic disease. [medbroadcast.com]

• Headache

  In particular, if you have other symptoms in addition to the dizziness, such as: Headache, especially if it is severe, or a different kind of headache to ones you usually get. Hearing or visual loss. Problems with speech. Weakness of arms or legs. [patient.co.uk]

  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. [epainassist.com]

  You have a severe headache or lethargy. You have a fever. You have ear pain. You recently injured your head or ear. Your dizziness doesn't stop after a few minutes. You develop double vision. You develop speech problems. [emedicinehealth.com]

  During the next few days I felt very sick, headaches, loss of appetite, more dizzy feelings (though none nearly as intense) and just overall sick. Then it went away and I figured that was the end of it. [raamdev.com]

• Nystagmus

  OBJECTIVE: To evaluate the dynamic properties of the horizontal vestibulo-ocular reflex (h-VOR) in the acute stage of two common labyrinthine diseases that provoke severe attacks of vertigo with spontaneous nystagmus: vestibular neuritis (vestibular loss [ncbi.nlm.nih.gov]

  On physical exam a horizontal nystagmus is observed. [step2.medbullets.com]

  Electronystagmography (ENG)- Used as a tool to evaluate the movement of eyes in relation to inner ear function, the ENG, frequently used in the form of a caloric reflex testing, has shown the ability to reveal nystagmus in patients with viral labyrinthitis [symptoma.com]

  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]

The diagnosis of labyrinthitis may not be easy to make without adequate clinical suspicion, which can only be created by a thorough physical examination and a detailed patient history. The simultaneous presence of vertigo and hearing loss should prompt the physician to perform a complete neurological examination and confirm lesions of both segments of the vestibulocochlear nerve. Furthermore, several tests are recommended to support the diagnosis [2] [3]:

• Audiometry - The sensorineural hearing loss is confirmed during audiometry, the principal test used for detection of hearing abnormalities.
• Electronystagmography (ENG)- Used as a tool to evaluate the movement of eyes in relation to inner ear function, the ENG, frequently used in the form of a caloric reflex testing, has shown the ability to reveal nystagmus in patients with viral labyrinthitis [2].
• Imaging studies - Computed tomography (CT), magnetic resonance imaging (MRI) and gadolinium-enhanced MRI are useful radiologic methods in visualizing pathological processes in the inner ear and may reveal an enhanced signaling of either nervous components [3]. Moreover, the middle ear is assessed during these procedures as well, where signs of otitis media, mastoiditis or even meningitis can be identified, thus pointing toward the diagnosis of a bacterial etiology.

Most commonly, treatment for viral infections includes drinking lots of fluids, getting rest, eating well and letting the illness run its course. [sharecare.com]

Once we've approved your claim, you'll get the private treatment you need. 3 And we’ll pay for treatment After you've been treated, send us your invoices. [aviva.co.uk]

With time and the right treatment, the prognosis is good. [hopkinsmedicine.org]

[…] for Vestibular Neuronitis Completed NCT00271791 Phase 2 Prednisone;Prednisone 5 Complementary/Alternative Medicine for Abnormality in the Vestibular (Balance) System Completed NCT00032383 Phase 1, Phase 2 6 Incremental Velocity Error as a New Treatment [malacards.org]

With time and the right treatment, the prognosis is good. [hopkinsmedicine.org]

If bacterial labyrinthitis is suspected then consider antibiotics Prognosis, Prevention, and Complications Lasts days to weeks Please rate topic. Average 5.0 of 1 Ratings Thank you for rating! [step2.medbullets.com]

Moreover, the middle ear is assessed during these procedures as well, where signs of otitis media, mastoiditis or even meningitis can be identified, thus pointing toward the diagnosis of a bacterial etiology. [symptoma.com]

[…] onset of severe, contiguous vertigo nausea vomiting tinnitus hearing loss Physical exam horizontal nystagmus toward the unaffected ear Evaluation Diagnosis is clinical May have a positive Romberg test fall to the side of the affected ear Rule out other etiologies [medbullets.com]

Etiology and Pathophysiology Acute inflammation and damage to the labyrinth, involving both the vestibular apparatus and cochlea. [unboundmedicine.com]

Pathology Labyrinthitis can be divided according to etiology. [radiopaedia.org]

Evidence that viral infections can cause deafness and vertigo in man is based largely on epidemiological observations and on a limited number of temporal bones examined months or years after the acute event. [jhu.pure.elsevier.com]

Epidemiology Data is lacking for labyrinthitis alone. [unboundmedicine.com]

Causative viruses and bacteria Little direct evidence suggests a viral cause for labyrinthitis; however, a wealth of epidemiologic evidence implicates a number of viruses as potentially causing inflammation of the labyrinth. [emedicine.medscape.com]

Vascular ischemic causes Pathophysiology: Anatomically labyrinth is composed of an outer osseous framework surrounding the delicate membranous labyrinth which contains the peripheral end organs of hearing and balance. [sites.google.com]

Etiology and Pathophysiology Acute inflammation and damage to the labyrinth, involving both the vestibular apparatus and cochlea. [unboundmedicine.com]

The anatomic relationships of the labyrinth, middle ear, mastoid, and subarachnoid space are essential to understanding the pathophysiology of labyrinthitis. [emedicine.medscape.com]

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. [epainassist.com]

Early treatment of acute otitis media to prevent complications Scheduled immunizations (to prevent common viral pathogens) Prevent maternal transmission of pathogens, including syphilis and HIV. [unboundmedicine.com]

Prevention The most effective preventive strategy includes prompt treatment of middle ear infections, as well as monitoring of patients with mumps, measles, influenza, or colds for signs of dizziness or hearing problems. [healthofchildren.com]

My policy is prevention rather than cure and my life is governed by avoiding the movements or positions which can bring on an attack. [gransnet.com]

There is no known way to prevent labyrinthitis. visHeader References Polensek SH. [nicklauschildrens.org]

If bacterial labyrinthitis is suspected then consider antibiotics Prognosis, Prevention, and Complications Lasts days to weeks Please rate topic. Average 5.0 of 1 Ratings Thank you for rating! [medbullets.com]

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2. Thompson TL, Amedee R. Vertigo: A Review of Common Peripheral and Central Vestibular Disorders. Ochsner J. 2009;9(1):20-26.
3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
4. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.
5. Arbusow V, Theil D, Strupp M, Mascolo A, Brandt T. HSV-1 not only in human vestibular ganglia but also in the vestibular labyrinth. Audiol Neurootol. 2001;6(5):259-262.
6. Merchant SN, Durand ML, Adams JC. Sudden Deafness: Is It Viral? ORL J Otorhinolaryngol Relat Spec. 2008;70(1):52-62.