Labyrinthitis is an inflammation of the inner ear. It derives its name from the labyrinths that house the vestibular system (which sense changes in head position). Labyrinthitis can cause balance disorders.
In addition to balance control problems, a labyrinthitis patient may encounter hearing loss and tinnitus. Labyrinthitis is usually caused by a virus, but it can also arise from bacterial infection, head injury, extreme stress, an allergy or as a reaction to a particular medication. Both bacterial and viral labyrinthitis can cause permanent hearing loss, although this is rare.
A prominent and debilitating symptom of labyrinthitis is acute vertigo. The vestibular system is a set of sensory inputs consisting of three semicircular canals, sensing changes in rotational motion, and the otoliths, sensing changes in linear motion. The brain combines visual cues with sensory input from the vestibular system to determine adjustments required to retain balance. When working properly, the vestibular system also relays information on head movement to the eye muscle, forming the vestibulo-ocular reflex, in order to retain continuous visual focus during motion. When the vestibular system is affected by labyrinthitis, rapid, undesired eye motion (nystagmus), often results from the improper indication of rotational motion. Nausea, anxiety, and a general ill feeling are common due to the distorted balance signals that the brain receives from the inner ear.
This can also be brought on by pressure changes such as those experienced while flyingor scuba diving.
Recovery from acute labyrinthine inflammation generally takes from one to six weeks; however, it is not uncommon for residual symptoms (dysequilibrium and/or dizziness) to last for many months or even years if permanent damage occurs.
Recovery from a permanently damaged inner ear typically follows three phases:
- An acute period, which may include severe vertigo and vomiting
- approximately two weeks of sub-acute symptoms and rapid recovery
- finally a period of chronic compensation which may last for months or years.
Labyrinthitis and anxiety
Chronic anxiety is a common side effect of labyrinthitis which can produce tremors, heart palpitations, panic attacks, derealizationand depression. Often a panic attack is one of the first symptoms to occur as labyrinthitis begins. While dizziness can occur from extreme anxiety, labyrinthitis itself can precipitate a panic disorder. Three models have been proposed to explain the relationship between vestibular dysfunction and panic disorder:
- Psychosomatic model: vestibular dysfunction which occurs as a result of anxiety.
- Somatopsychic model: panic disorder triggered by misinterpreted internal stimuli (e.g., stimuli from vestibular dysfunction), that are interpreted as signifying imminent physical danger. Heightened sensitivity to vestibular sensations leads to increased anxiety and, through conditioning, drives the development of panic disorder.
- Network alarm theory: panic which involves noradrenergic, serotonergic, and other connected neuronal systems. According to this theory, panic can be triggered by stimuli that set off a false alarm via afferents to the locus ceruleus, which then triggers the neuronal network. This network is thought to mediate anxiety and includes limbic, midbrain and prefrontal areas. Vestibular dysfunction in the setting of increased locus ceruleus sensitivity may be a potential trigger.
Vestibular rehabilitation therapy (VRT) is a highly effective way to substantially reduce or eliminate residual dizziness from labyrinthitis. VRT works by causing the brain to use already existing neural mechanisms for adaptation, plasticity, and compensation. The direction, duration, frequency, and magnitude of the directed exercises are closely correlated with adaptation and recovery. Symmetry is more rapidly restored when VRT exercises are specifically tailored for the patient.
Prochlorperazine is commonly prescribed to help alleviate the symptoms of vertigo and nausea.
Because anxiety interferes with the balance compensation process, it is important to treat an anxiety disorder and/or depression as soon as possible to allow the brain to compensate for any vestibular damage. Acute anxiety can be treated in the short term with benzodiazepinessuch as diazepam(Valium); however, long-term use is not recommended because of the addictive nature of benzodiazepines and the interference they may cause with vestibular compensation and adaptive plasticity. Benzodiazepines and any other form of mind or mood altering addictive drug should not be used on patients with addictive history.
In this Article
- What Causes It?
- What Are the Symptoms?
- Viral Labyrinthitis
- Bacterial Labyrinthitis
- How Is It Diagnosed?
- WhatвЂ™s the Treatment?
- Will It Come Back?
- What Can I Do About My Symptoms?
When your inner ear gets infected or inflamed, it can cause a type of balance disorder known as labyrinthitis. Sometimes you can get it when you have an upper respiratory infection, like the flu.
Inner ear infections that lead to labyrinthitis are usually caused by a virus. Sometimes bacteria can cause it, too. The symptoms of viral and bacterial infections can be so similar that a doctor needs to confirm which type you have before they can treat it
What Causes It?
Your inner ear contains a system of loopy tubes and sacs called the labyrinth. It contains some fluid and hair cells. It also controls your balance and hearing. An infection can disrupt information that flows from this area to your brain.
What Are the Symptoms?
Labyrinthitis can not only affect your hearing, it can also make you feel dizzy. You might experience something more severe, like vertigo. This is the sudden feeling that you or the inside of your head is spinning.
Other symptoms might include:
- Blurry vision
- Feeling unbalanced, like youвЂ™re about to fall
- Feeling lightheaded, or like youвЂ™re floating
- Nausea and vomiting
- Ringing in your ears or hearing loss
Symptoms often appear without warning. For instance, you might notice them when you wake up one morning. This can be scary. If you feel lightheaded, or have trouble with your balance or vision, call your doctor or go to the ER right away.
This form of the infection is more common than bacterial. But doctors know less about it. Some viruses seem to be linked. These include measles, mumps, hepatitis, and the types of herpes that cause cold sores, chicken pox, or shingles.
If you have viral labyrinthitis, it usually will affect only one ear. It might quickly run its course and seem to go away. But it can return without warning.
This can happen in one of two ways: First, bacteria from a middle ear infection make toxins that get into the inner ear and cause inflammation and swelling. Or second, an infection in the bones surrounding the inner ear makes toxins that cause the same symptoms.
A chronic, or ongoing, middle ear infection can cause it.
A more severe and uncommon type of bacterial labyrinthitis occurs when germs invade the labyrinth from outside the ear. A condition like bacterial meningitis can be the cause of this type.
How Is It Diagnosed?
There arenвЂ™t any specific tests that let your doctor know you have labyrinthitis. TheyвЂ™ll first rule out other conditions that mimic it. They may want to test for health issues like:
- Brain or heart disease
- Head injury
- Side effects of prescription drugs or substances like alcohol, tobacco, or caffeine
WhatвЂ™s the Treatment?
If your doctor rules out bacteria as the cause, they might prescribe antiviral meds or those that control swelling. Steroids like cortisone can help, too.
You might also need medication to treat your symptoms, such as nausea or vertigo.
Special exercises can help you regain your balance. A physical therapy program that focuses on this can speed up your recovery.
It might take a while — from a few weeks to months — but most people recover completely from labyrinthitis. ItвЂ™s possible to have another bout of vertigo later on. This can happen if you turn over in bed or even tilt your head a certain way. Physical therapy can help you get better.
Will It Come Back?
It may, but it might be a milder case. Your doctor likely will look for another cause for your symptoms at this point.
What Can I Do About My Symptoms?
- DonвЂ™t move too quickly — you might lose your balance.
- Remove tripping hazards like area rugs and electrical cords. Put non-slip mats in your bath and shower.
- If you start to feel dizzy, lie down right away. People with vertigo often feel better if they lie down in a quiet, darkened room with their eyes closed.
- Drink lots of fluids and eat well. Avoid caffeine, alcohol, salt, and tobacco.
- If you think your meds are making you feel dizzy, talk to your doctor. They may change your dose, have you stop using them, or try something else.
- DonвЂ™t drive if you have dizzy spells.
U.S. National Library of Medicine (PubMed Health): вЂњLabyrinthitis.вЂќ
National Institutes of Health: вЂњBalance Disorders.вЂќ
Vestibular Disorders Association: вЂњLabyrinthitis and Vestibular Neuritis.вЂќ
Mayo Clinic: вЂњBenign Paroxysmal Positional Vertigo.вЂќ
Johns Hopkins Medicine: вЂњLabyrinthitis.вЂќ
Mayo Clinic: вЂњDizziness: Lifestyle and Home Remedies.вЂќ
Join the Community
Nausea and lightheadedness can be caused by a number of different things, not all of which are serious. They are both common symptoms of an illness such as the flu; they may also be caused by medical issues such as thyroid disorders, low blood sugar, high blood pressure, or diabetes, just to name a few. In many cases, though, these symptoms may have a simpler explanation, such as overindulgence in alcohol, eating food that was perhaps not prepared properly, or even from motion sickness such as what can occur after riding in a car, boat, or plane.
The flu is one of the most common causes of nausea and lightheadedness, and it will usually progress to a fever as well as body aches and pains. If these symptoms persist and are unexplained by any illnesses or recent lifestyle changes, it may be best to visit a doctor to rule out anything more serious. He or she will typically be able to do some tests and determine if the symptoms are cause for concern. In most non-serious cases, however, nausea and dizziness can be treated by getting some rest, taking some deep breaths in through the nose, and eating something bland such as plain crackers or sipping on ginger ale. If the symptoms are caused by low blood sugar, eating a snack or having some juice can help.
Drinking too much alcohol is one of the most common causes of stomach upset and lightheadedness. It may occur immediately after drinking, or it might not occur until the next morning. It is a good idea to drink a lot of water to rehydrate after drinking too much. Too much caffeine can also cause similar sensations.
Food poisoning is a common source of nausea and lightheaded, but it typically progresses to vomiting or diarrhea if the food was actually bad. Extreme pain, from an injury such as a broken bone, or blood loss, can also cause immediate nausea and lightheadedness. In addition, some people find that prolonged or acute stress can cause them to feel slightly nauseous or dizzy, and anxiety or panic attacks can cause these symptoms as well.
Motion sickness is another one of the most common causes of nausea and lightheadedness. Some people experience this on any form of transportation, while others will only feel ill on a boat or airplane, for example. It may be helpful to take ginger pills or motion sickness medication beforehand, to prevent the motion sickness from occurring. It is also helpful to take deep breaths and to look at a fixed point on the horizon to prevent the nausea from worsening.
- Inner Ear Infection (Labyrinthitis)
- What are the types of labyrinthitis?
- What are the symptoms of labyrinthitis?
- What causes labyrinthitis?
- How is labyrinthitis diagnosed?
- What is the treatment for labyrinthitis?
- Outlook for labyrinthitis
- Answers to inner ear infection (Labyrinthitis) FAQs
Treating the symptoms associated with labyrinthitis
The following medication can be prescribed to help relieve the symptoms of an inner ear infection:
- Antihistamines – desloratadine (Clarinex), or over-the-counter options such as loratadine (Claritin), diphenhydramine (Benadryl), or fexofenadine (Allegra).
- Meclizine (Antivert) which helps to reduce nausea and dizziness.
- Diazepam as a sedative.
- Prednisone as a corticosteroid (these are used to treat inflammation).
- Motion sickness medication to aid in the treatment of loss of balance and vertigo.
- Antibiotics will only be prescribed if you have a bacterial infection in the respiratory tract, or if the labyrinthitis is bacterial as antibiotics are not effective in the treatment of viral infections. Blood cultures and swabs of the fluid, if there is fluid available, will detect which bacteria is present and then an antibiotic will be prescribed.
Treating vertigo associated with an inner ear infection
- Do not move in sudden or quick movements.
- It is better to be in low lighting as this can help if you are feeling dizzy as bright lights are often deemed overwhelming when experiencing vertigo.
- If you are lying in bed and experience vertigo, try to keep your head still and sit up slowly.
- If you are walking and experience vertigo, try to find something to lean on or slowly sit down until it subsides.
PLEASE NOTE: It is not safe to drive if you are experiencing vertigo on a regular basis.
Home remedies for treating an inner ear infection
- Try to rest in a position that is comfortable for the first few days.
- Keep hydrated and drink a lot of water.
- Try to reduce your sodium and sugar intake as this can affect your vertigo as these foods are known to spike blood sugar levels.
- Avoid chocolate, alcohol and caffeine.
- Do not smoke cigarettes as these can make you feel lightheaded.
Treatment for chronic labyrinthitis
Some people may suffer from vertigo and dizziness associated with an inner ear infection for a number of months or years, experts and doctors will typically refer to this as chronic labyrinthitis (i.e. long-term labyrinthitis).
The symptoms of chronic labyrinthitis are not usually experienced as severely as when one is first diagnosed with an inner ear infection and vertigo and dizziness tend to lessen over time. However, these mild symptoms associated with an inner ear infection may persist and adversely impact one’s daily activities and quality of life.
In order for those suffering from chronic labyrinthitis to seek some form of relief from long-term symptoms, a form of treatment known as VRT (vestibular rehabilitation therapy) is often recommended by doctors.
VRT (vestibular rehabilitation therapy)
This exercise-based form of treatment is designed to help ease the symptoms of a chronic inner ear infection, particularly those of vertigo and dizziness, the exercise program does this by promoting vestibular (i.e. relating to the inner ear) adaptation, as well as substitution. Simply put, VRT aids in retraining the nervous system and brain in order to compensate for any abnormal symptoms and signs stemming from the vestibular system.
VRT is typically supervised by a specialist such as a physiotherapist. A physiotherapist is a qualified expert in treating injury, disease or deformity through utilising physical methods such as exercise, massage and even heat treatment. He or she will make use of a range of different exercises designed to aid in the below ways:
- Improvement of hand-eye co-ordination – enhancing the stability of one’s gaze
- Simulation of dizziness in order to allow the brain to adjust to the specific disruptive signals that are sent to it from the vestibular system and train it to ignore these signals.
- Improvement of walking ability and balance
- Improvement of fitness and strength
Written by Mohan Garikiparithi
| –> Hearing Health | –> Published on May 21, 2017
Labyrinthitis is a condition that causes inflammation of the inner ear. It affects the labyrinth, which is a delicate structure within the ear. Symptoms of labyrinthitis include dizziness, hearing loss, and vertigo. Symptoms can range in severity and may be accompanied by pain in the ear, tinnitus, fluid or pus leakage, nausea, fever, changes in vision, and mild headaches.
Although labyrinthitis may clear up on its own, there are natural treatments you can try to speed up the recovery.
Natural treatments for labyrinthitis
- Avoid activities that can worsen your condition, such as overconsumption of alcohol, fatigue, allergies, smoking, stress, and certain medications.
- Take an over-the-counter antihistamine.
- Get plenty of bed rest, especially during vertigo attacks.
- Do exercises to reduce vertigo. Sit at the edge of your bed and turn your head in the direction causing the vertigo. Lay back on the bed with your head still in that position. Turn your head 90 degrees to the opposite direction and hold for 30 seconds. Rotate your body to the side your head is pointing and hold for 30 seconds. Sit back up and repeat this a few times until vertigo is relieved.
- Consult with your doctor about any possible medications that can help.
- Try vestibular rehabilitation therapy, which is a physical therapy that can help you adapt to and correct your symptoms.
Other treatments for labyrinthitis include medications such as benzodiazepines, antiemetics, antibiotics, and corticosteroids.
Other home remedies to treat ear infection
While ear infections should be taken care of by a trained professional, there are home remedies you can try. It would be a good idea to speak to your doctor before trying any sort of treatment for serious infection. The following are some natural at-home remedies for adult ear infections:
Salt. Found in nearly every home, salt can be a great way to provide ear irritation relief. This can be done by heating up salt in a pan or microwave, putting the heated salt in a cloth, and sealing it in a bag. When the bag is at a comfortable temperature, put it on the affected ear for about five to 10 minutes. This is a good way to relieve pain and swelling.
Garlic. Contains anti-viral, anti-oxidizing, and antimicrobial properties that can make it effective as a home remedy for ear infections. You can crush a few garlic cloves, wrap them in a small cloth, and place it on your ear for about 30 minutes. This will provide relief from ear pain and swelling.
Warm garlic oil. Having many of the same properties as whole garlic, garlic oil can be used similarly. Put a few drops in a bowl of warm water. Place the affected ear in the bowl for about five minutes. You can also put a few drops of warm garlic oil directly into the ear, allowing it to sit inside.
Tea tree oil. Known for its effective antiseptic properties, this oil can be used to kill bacteria or viruses that infect the ear. It can be used by steam inhalation with the use of a humidifier. This can provide instant relief for the sinuses and respiratory system.
Lavender oil. Has some anti-inflammatory properties and smells great. This can be used by mixing it in a bowl of warm water. Then, using a cotton ball, soak ball with the solution and place it in your ear.
Neem oil. Contains antimicrobial properties that help fight against bacteria and soothe inflammation. It will also prevent itching and irritation.
Basil. Considered an antibacterial herb and is effective for treating ear infections. Use five to six basil leaves and crush them thoroughly to extract their juice. Apply the juice to the affected ear and pour some into the ear canal.
Mullein. This flowering plant originated from Europe and Asia. It is great for treating various medical diseases, like coughs, congestion, eczema, and bronchitis.
Onion. A common food item and one that holds many medicinal properties to help ear infections. You can pour onion juice into the infected ear or make an onion compress.
White vinegar. An acidic solution that is toxic to microorganisms that lead to ear infections. It can also help eliminate growth and reproduction of the bacteria. Place a few drops in the ear and put some on a warm compress. Place it against the ear.
When to see a doctor for labyrinthitis
You should seek immediate medical attention for your labyrinthitis if you experience mental confusion, slurred speech, double vision, weakness or numbness in one part of your body, or changes in the way you walk.
Furthermore, if your condition does not improve within three weeks, make an appointment to see your doctor. They may refer you to an otorhinolaryngologic (ear, nose, and throat doctor).
What is labyrinthitis?
Labyrinthitis is the inflammation of part of the inner ear called the labyrinth. The eighth cranial nerve (vestibulocochlear nerve) may also be inflamed. The inflammation of these causes a feeling of spinning (vertigo), hearing loss, and other symptoms. In most people, these symptoms go away over time. It is not a common condition. It often only affects one ear.
The inner ear has a system of fluid-filled tubes and sacs called the labyrinth. Inside the inner ear, the cochlea gathers information about sound. The vestibular organs gather information about motion and changes in space. These all help to create a sense of balance. The eighth cranial nerve sends all of this information from the inner ear to the brain.
When one of the nerves or the labyrinth is infected, it can become inflamed and irritated. This can cause it to not work normally. It may cause hearing loss in one ear. The brain now has to make sense of the information that doesn’t match between the normal nerve and the infected one. This causes vertigo.
What causes labyrinthitis?
A viral infection of the eighth cranial nerve or labyrinth may cause the condition. The virus may have spread all over your body. Or it may only affect the eighth cranial nerve and labyrinth. In most cases only one nerve is affected. Viruses known to cause labyrinthitis include:
- Herpes viruses
Bacterial infections of the middle ear are fairly common in children. In rare cases, an infection in the middle part of the ear can spread to the inner ear and cause labyrinthitis. This is more of a risk with middle-ear infections that are long-lasting (chronic) and not treated. In rare cases, bacterial meningitis or a head injury may cause labyrinthitis. In other cases, the cause is not known.
Who is at risk for labyrinthitis?
Having a viral infection that can cause labyrinthitis increases your risk. Your child’s risk may increase if he or she hasn’t had the recommended vaccines.
What are the symptoms of labyrinthitis?
Symptoms of labyrinthitis may include:
- A feeling of spinning (vertigo)
- Lack of balance when walking
- Nausea and vomiting
- Not able to focus (concentrate)
- Periods of uncontrolled, back-and-forth eye movements (nystagmus)
- Hearing loss
- Ringing in the ears
Your symptoms might range from mild to severe. They may come on very quickly. In many people, these symptoms go away over several weeks. Others have symptoms that last longer.
A related syndrome is called vestibular neuritis. It causes similar symptoms. But it does not cause hearing problems. It affects only the vestibular part of the labyrinth and nerve.
Labyrinthitis does not cause neurological symptoms such as severe headache, speech problems, or loss of arm or leg movement.
How is labyrinthitis diagnosed?
Your healthcare provider will ask about your health history. You may also have a physical exam. This may include hearing and balance tests. It will also include an exam of your nervous system. Many neurological and other health conditions can cause dizziness and vertigo. Your healthcare provider may need to rule these out.
There are no tests for labyrinthitis. But your provider may have you take an imaging test. 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.
- Electronystagmography (ENG) or videonystagmography (VNG). These record your eye movement. This helps to find the exact area of the problem in your vestibular system and evaluate the cause of your balance disorder.
How is labyrinthitis treated?
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.
Immediate treatment for labyrinthitis might include:
- Corticosteroid medicines (to help reduce nerve inflammation)
- Antiviral medicines
- Antibiotics (if there are signs of a bacterial infection)
- Medicines to take for a short time that control nausea and dizziness (such as diphenhydramine and lorazepam)
If your symptoms go away in a few weeks, you likely won’t need other treatment. If you have symptoms that don’t go away, you may need to do certain exercises. These are known as vestibular rehabilitation exercises. They are a form of physical therapy. These exercises may help your brain learn to adjust to the vestibular imbalance.
What are possible complications of labyrinthitis?
In most cases, labyrinthitis does not cause any problems. In rare cases, labyrinthitis causes lasting (permanent) damage to the eighth cranial nerve. This can cause lasting problems with balance, and part or total hearing loss. You might need to use a hearing aid. Get treatment right away to help reduce your risk for these complications.
When should I call my healthcare provider?
Call your healthcare provider if your symptoms get worse or don’t begin to go away after a few days of treatment. Also call your healthcare provider right away if you have new symptoms, such as trouble moving an arm or a leg.
Key points about labyrinthitis
- Labyrinthitis often results from a viral infection of the eighth cranial nerve or the labyrinth.
- Symptoms include vertigo, hearing loss, and dizziness. Symptoms may start suddenly and go away in a few weeks.
- Your healthcare provider will need to rule out other more dangerous causes of vertigo, such as stroke.
- You might need medicines to treat your symptoms.
- If your symptoms don’t go away, you may need rehab exercises to help your brain adjust to the vestibular imbalance.
- In rare cases, this condition can cause permanent hearing loss and ongoing vertigo.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
Labyrinthitis is a disorder associated with inflammation of the inner ear. The labyrinth is a fluid-filled compartment that consists of the cochlea and the vestibular organs.
The cochlea is the hearing organ and the vestibular organs are responsible for balance and spatial orientation.
Labyrinthitis has several potential causes, and patients of any age and gender may be affected. Patients with labyrinthitis can experience hearing loss in the affected ear, imbalance, dizziness, and nausea. When the balance organ’s input to the brain is suddenly changed, patients experience vertigo, feeling like you are spinning or moving when you are still. Severe symptoms may limit activities of daily living, the ability to work, and restrict recreational activities.
Labyrinthitis is a self-limiting illness that usually gets better in several weeks. Symptom can begin suddenly and gradually worsen over the course of hours to days before improvement is noticed. Failure to seek treatment may put patients at higher risk for permanent hearing loss and imbalance. Although uncommon, it is possible to have some permanent hearing loss despite treatment. While most patients with imbalance and mild dizziness with head movement recover, sometimes it may take months to years to fully recover. Patients with substantial balance issues may benefit from physical therapy, specifically vestibular physical therapy.
What are the Symptoms of Labyrinthitis?
The symptoms of labyrinthitis can include:
- Hearing loss, often in high frequency pitch range
- Decreased ability to understand speech
- Tinnitus, or ringing or buzzing sensation in the ear
- Imbalance and unsteadiness, falling or swaying to one side while walking
- Vertigo, or feeling like you are spinning when you are still
- Involuntary twitching or jerking of the eyeball, called nystagmus
- Nausea and vomiting
Viral infection—Viral infections of the inner ear or activation of a virus that is normally inactive and stays within nerve endings are thought to be the most common cause of labyrinthitis. The specific virus that causes this is usually unknown in most cases. A unique type of labyrinthitis may be caused by reactivation of the varicella-zoster virus, called Ramsay Hunt syndrome, or herpes zoster oticus. This is like shingles of the ear and can occur with labyrinthitis in addition to ear pain, facial weakness, and blisters around the ear, ear canal, and eardrum.
Bacterial infection—A bacterial infection of the middle ear (the space behind the ear drum) can spread to the inner ear and cause bacterial labyrinthitis. Children with inner ear deformities are at a higher risk for bacterial labyrinthitis either from a middle ear infection or from the spread of bacterial meningitis to the inner ear. Severe bacterial labyrinthitis can occur with ear pain, ear infection, drainage of pus from the ear, fevers, or chills. Patients may require hospitalization. This type of infection has a higher risk for permanent hearing loss and may also lead to labyrinthitis ossificans, where there is bone formation in the inner ear after the infection.
Autoimmune—Autoimmune labyrinthitis is a rare cause of labyrinthitis and may come and go. It is often associated with other autoimmune disorders such as systemic lupus erythematosus, inflammatory bowel disease, rheumatoid arthritis, or other autoimmune disorders.
Trauma and surgery—Inner ear trauma puts patients at risk for developing labyrinthitis. Fractures involving the inner ear, concussion of the head and inner ear, or bleeding in the inner ear can cause labyrinthitis.
A tumor of the nerves supplying the inner ear, such as a schwannoma (acoustic neuroma), may also involve hearing loss, vertigo, or labyrinthitis. Your ENT (ear, nose, and throat) specialist, or otolaryngologist, may order an MRI to rule out this condition.
Other potential risk factors include allergies, stress, alcohol and tobacco consumption, and certain medications.
Treating most cases of labyrinthitis includes observation, bed rest, and hydration. Steroids, such as prednisone, are typically prescribed to minimize inner ear inflammation. In some cases, steroids may be injected through the eardrum into the middle ear space. Antivirals may also be prescribed. Severe nausea and vomiting may be treated with anti-nausea medications. Vertigo may be treated with antihistamines or sedatives, such as benzodiazepines, although long-term use will impair the recovery of balance function.
The treatment of bacterial labyrinthitis is to control the primary infection, which is usually a middle ear infection. This may require antibiotics, placement of an ear tube, or more advanced ear surgery. Treatment for autoimmune labyrinthitis addresses the underlying autoimmune condition with steroids or other immune modulating medications usually directed by the rheumatologist.
A multidisciplinary team involving your ENT specialist, audiologist, and vestibular therapist is important to evaluate your hearing, minimize the potential long-term effects of labyrinthitis, and discuss options for possibly restoring your hearing. For severe hearing loss, the patient may be a candidate for a bone-conduction hearing aid or a cochlear implant. When the balance organs are damaged, the brain needs time to adjust to improve balance function again. Vestibular therapy and balance exercises help many patients regain their balance.
Although labyrinthitis is not life-threatening, vertigo may rarely be a sign of a more serious disorder such as a stroke or brain tumor. Patients with sudden, persistent vertigo or additional worsening symptoms such as double vision, slurred speech, facial droop, limb weakness, or numbness should seek immediate medical attention.
Alleviating Symptoms of Labyrinthitis at Home
- Vertigo (a spinning feeling when standing still)
- Difficulty focusing due to your eyes moving on their own
- Hearing loss
- Nausea and vomiting
- Tinnitus (ringing or other noises in your ears)
- Overconsumption of alcohol
- Severe allergies
- Certain medications (such as aspirin)
- Rest as best as you can and try to stay still without moving your head
- Avoid changing positions or making sudden movements
- Resume activities slowly
- Get help walking so you don’t injure yourself in a fall
- Avoid bright lights, television (and other electronic screens), and reading during attacks
- Sit in the middle of your bed at the edge with your head turned 45° toward the direction that induces the vertigo.
- Quickly lay down backward with your head still toward the direction that produces the vertigo. This will likely lead to a strong vertiginous response. Stay in this position for thirty seconds.
- Turn your head 90° to the opposite direction and hold for another thirty seconds.
- Rotate both your head and your body in the same direction (you will now be on your side with your head over the edge of the bed pointed 45° toward the ground). Hold for another thirty seconds before sitting back up.
- Repeat this five or six times until you no longer experience a response of vertigo to the maneuver.