Labyrinthitis and Vestibular Neuritis

Woman experiencing vertigo.
Woman experiencing vertigo. Eric O'Connell/Getty Images

What is Labyrinthitis and Vestibular Neuritis?

Labyrinthitis is a broad term for a rare condition that causes inflammation of the inner ear, particularly the vestibular system. The vestibular system is the portion of the inner ear that receives information about the position of the body and its balance, and then relays that information to the brain.

Vestibular neuritis is inflammation of the vestibulocochlear nerve.

The vestibulocochlear nerve is responsible for transmitting information about sound and your body's position to the brain. Because labyrinthitis and vestibular neuritis have similar symptoms and are treated in the same way, we will use the two terms interchangeably here.

Causes of Labyrinthitis?

The causes of labyrinthitis and vestibular neuritis are not well understood but symptoms often begin after an infection or other conditions which cause inflammation. The following conditions may lead to the development of this disorder:

Risk Factors for Labyrinthitis

  • smoking
  • excessive alcohol consumption
  • a history of allergies
  • stress
  • upper respiratory infection

Symptoms of Labyrinthitis

Symptoms play an important role in the diagnosis of labyrinthitis.

The most common complaints that people have are:

  • mild to severe vertigo
  • nausea
  • vomiting
  • instability
  • visual impairment
  • difficulty concentrating
  • tinnitus (ringing of the ears)
  • one-sided hearing loss

While you may experience any of the side-effects listed above, the most common features noticed will be a sudden onset of vertigo accompanied by nausea and vomiting.

The symptoms are usually the worst at around 24 hours and then gradually improve.

When to See a Doctor

It is important to receive medical attention immediately when having new symptoms of labyrinthitis because other, more serious illnesses have similar symptoms including a stroke.

Diagnosing Labrynthitis

There is no single test used to diagnose labyrinthitis. Your physician will likely perform several tests after doing a thorough ear exam at the visit with an otoscope. Aside from testing your ears, your doctor will also check your cranial nerve function to check for any problems with your neurologic system that could be causing your symptoms. The third basic check your doctor will perform is known as HIT (Head Impulse Testing) to check the function of your semicircular canals in the inner ear.

If hearing problems are noticed, you will likely receive an order for an audiogram or electronystagmography (ENG) test to help further identify the cause of your symptoms. While not frequently needed to diagnose labyrinthitis, your physician may request imaging tests such as an MRI or CT scan to help rule out a stroke or identify structural problems if you have significant risk factors.

Resolution of Labyrinthitis

The symptoms related to labyrinthitis can be worrisome. First off, make sure to try and relax. Stress can actually increase your symptoms. You will probably initially be put on bed rest and then have your activity level increased over time as able.

Symptoms of labyrinthitis may begin to subside 1-4 weeks after they begin. Labyrinthitis usually goes away completely in 2-3 months, however, hearing loss may be permanent. Some patients may continue to have dizziness but this is rare and more likely to occur in elderly patients. Short term disability resulting from the symptoms of labyrinthitis can be significant. A qualified physician may help you to manage symptoms.

Medications to Treat Labyrinthitis

Corticosteroids, such as Prednisone, which decrease inflammation are believed to hasten the recovery time of labyrinthitis. Some studies have found that treating with antiviral medications such as valacylovir are not useful in the treatment of labyrinthitis; however there aren’t enough studies to confirm this. Other treatments are targeted at managing symptoms. Three main classifications of medications are used to help alleviate these symptoms:

Antihistimines can be used to help suppress symptoms of dizziness related to the vestibular system that isn't working right. The most common medication to be tried is usually meclizine, however dimenhydrinate and Benadryl can also be used.

Antiemetics are medications that help to ease nausea and vomiting. Some individuals may experience severe enough vomiting to become dehydrated. In this case hospitalization may be required so that fluid loss can be replaced intravenously. The following antiemetics may be used to manage these symptoms:

  • domperidone
  • metoclopramide (Phenergan)
  • ondansetron (Zofran)
  • prochlorperazine

Scopolamine is an anticholinergic drug that may also be used to treat nausea. It is administered through a patch that is usually placed behind the ear.

Vestibular Rehabilitation

Vestibular rehabilitation may be useful if your symptoms persist for a long time or become chronic. Vestibular rehabilitation is a form of physical therapy that works to retrain your mind and body to compensate for your vestibular imbalance.

As previously mentioned most cases of labyrinthitis completely resolve without permanent disability. In rare cases hearing loss or dizziness may persist.

Sources:

American Hearing Research Foundation. Vestibular Neuritis and Labyrinthitis. Accessed: May 7, 2009 from http://american-hearing.org/disorders/vestibular-neuritis-and-labyrinthitis/

Ferri, FF. (2017). Labyrinthitis: Ferri's Clinical Advisor 2017. Accessed from http://www.clinicalkey.com (Subscription Required).

Pubmed Health. Labyrinthitis. Accessed on June 14, 2016 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0027300/

Vestibular Disorders Association. Labyrinthitis and Vestibular Neuritis. Accessed: September 1, 2013 from http://www.vestibular.org/vestibular-disorders/specific-disorders/labyrinthitisvest-neuritis.php

UptoDate for Patients. Vestibular Neuritis. Accessed: May 7, 2009 from http://www.uptodate.com/patients/content/topic.do?topicKey=~spN6u8nazQQzLN&selectedTitle=1~11&source=search_result Subscription required.

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