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Viral Labyrinthitis

Labyrinthitis is a term denoting inflammation and infection of the labyrinth, the constitutive anatomical part of the inner ear. Viral pathogens are rarely the underlying cause, as labyrinthitis is primarily associated as a complication of bacterial acute otitis media or meningitis. Principal symptoms include vertigo, dizziness and hearing loss, as both parts of the vestibulocochlear nerve are affected. The diagnosis rests on clinical criteria and several diagnostic procedures.


Presentation

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].

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.[raam.org]
  • […] 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[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]
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]
  • 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]
  • 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]
Malaise
  • […] with exposure of the membranous labyrinth. labyrinthitis [lab′ərinthī′tis] Etymology: Gk, labyrinthos, maze, itis inflammation or dysfunction of the labyrinthine canals of the inner ear, resulting in vertigo, often accompanied by nausea, vomiting, or malaise[medical-dictionary.thefreedictionary.com]
  • The following morning, Wednesday, I visit my GP, who examines me and finds nothing obvious to explain my growing malaise. Could I have labyrinthitis, a viral inner-ear infection? She agrees it seems the most likely diagnosis.[theguardian.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]
  • If the virus reaches the vestibular system, dizziness, severe vertigo with nausea and vomiting, and imbalance can occur.[zfin.org]
  • These include anti-vertigo agents, antihistamines, sedatives and or anti-nausea agents. There are some other things that you can do to help alleviate the symptoms.[hearingcentral.com]
  • Dizziness Hearing loss Tinnitus AND ataxia Surgical intervention Introduction A form of peripheral vertigo Preceded by viral respiratory illness History of a recent viral infection is common Presentation Symptoms acute onset of severe, contiguous vertigo nausea[medbullets.com]
  • Vertigo Hearing loss Tinnitus AND ataxia Surgical intervention Introduction A form of peripheral vertigo Preceded by viral respiratory illness History of a recent viral infection is common Presentation Symptoms acute onset of severe, contiguous vertigo nausea[step2.medbullets.com]
Vomiting
  • If the virus reaches the vestibular system, dizziness, severe vertigo with nausea and vomiting, and imbalance can occur.[zfin.org]
  • I found Stemetil helped me a lot, and if I was nauseous/vomiting I would use Buccastem instead.[arthritisinsight.com]
  • Hearing loss Tinnitus AND ataxia Surgical intervention Introduction A form of peripheral vertigo Preceded by viral respiratory illness History of a recent viral infection is common Presentation Symptoms acute onset of severe, contiguous vertigo nausea vomiting[medbullets.com]
  • Ear, Nose & Throat Community 13.3k Members Whilst in Holland early this July, I developed, over the course of about half an hour to an hour, dizziness so severe I was unable to walk, nausea [and vomited several times], a bad fever and terrible earache[medhelp.org]
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.[raam.org]
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[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]
  • But it does not cause hearing problems. It affects only the vestibular portion of the labyrinth and nerve. Labyrinthitis does not cause neurological symptoms (such as severe headache, speech problems, or loss of arm or leg movement).[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]
Labyrinth Disorder
  • Vertigo is never a permanent symptom - it comes and goes, with the bouts lasting from a few seconds to a few days (as with one particular form of labyrinth disorder).[dailymail.co.uk]
  • (disorder) English MEDCIN 37575 L7574531 no S8721246 Y viral labyrinthitis (diagnosis) French MedDRA French 10047466 L5021956 preferred S5709461 N Labyrinthite virale French MedDRA French 10047466 L5021956 preferred S5709461 Y Labyrinthite virale German[doctor.am]
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]
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]
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.[raam.org]
  • The past couple of mornings I have felt a bit worst when I wake up - I open my eyes and feel a bit dizzy. I find that I am constantly monitoring it which doesn't help.[mumsnet.com]
  • Principal symptoms include vertigo, dizziness and hearing loss, as both parts of the vestibulocochlear nerve are affected. The diagnosis rests on clinical criteria and several diagnostic procedures.[symptoma.com]
Headache
  • 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.[raam.org]
  • 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]
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.[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]
  • She did the Epley, looked for nystagmus, when i was on one side, counted the seconds carefully. Next other side.[gransnet.com]
Ataxia
  • Overview Disease Characteristics Symptoms Diagnostic Test Treatment Benign positional vertigo Changes with position Diagnosis: Dix-Hallpike maneuver Vertigo without hearing loss, tinnitus, or ataxia MRI of internal auditory canal Epley maneuver Meclizine[medbullets.com]
  • Profound hearing loss, severe vertigo, ataxia, and nausea and vomiting are common symptoms of bacterial labyrinthitis.[emedicine.medscape.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

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.

Treatment

  • There are several medications that your physician may recommend if they feel that the vertigo associated with the vestibular neuronitis or viral labyrinthitis requires treatment.[hearingcentral.com]
  • Most commonly, treatment for viral infections includes drinking lots of fluids, getting rest, eating well and letting the illness run its course.[sharecare.com]
  • Overview Disease Characteristics Symptoms Diagnostic Test Treatment Benign positional vertigo Changes with position Diagnosis: Dix-Hallpike maneuver Vertigo without hearing loss, tinnitus, or ataxia MRI of internal auditory canal Epley maneuver Meclizine[medbullets.com]
  • […] 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]

Prognosis

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

Etiology

  • 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]

Epidemiology

  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]

Prevention

  • 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]
  • 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]
  • […] 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]

References

Article

  1. Agrup C, Gleeson M, Rudge P. The inner ear and the neurologist. J Neurol Neurosurg Psychiatry. 2007;78(2):114-122.
  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.

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Last updated: 2019-07-11 21:18