An Overview of Labyrinthitis

Labyrinthitis is a condition characterized by dizziness and hearing loss. It is associated with inflammation in the inner ear and it can be temporary if caused by an infection, or it can be recurrent if caused by allergies or medication.

It may take weeks or even months to reach a diagnosis of labyrinthitis because there are so many causes of dizziness. Treatment can help alleviate your symptoms, and the underlying cause of labyrinthitis may require medical attention as well.

Symptoms

Labyrinthitis can cause a variety of symptoms. In general, it comes on rapidly, worsening over a few hours or days. The severity of your symptoms can vary from mild to quite intense, and in rare cases, it may be disabling.

The most common complaints you may have with labyrinthitis include:

  • Mild to severe vertigo (a sense of spinning)
  • Dizziness
  • Lightheadedness
  • Nausea
  • Vomiting
  • Instability or imbalance when walking
  • Worsened symptoms when your eyes are open
  • Difficulty concentrating
  • Tinnitus (ringing in the ears—labyrinthitis typically affects one side)
  • One-sided diminished hearing or hearing loss

While you may experience any of the effects listed above, the most common features of labyrinthitis are a sudden onset of vertigo accompanied by nausea and vomiting. Symptoms that affect your ear generally affect one ear, rather than both.

The effects of this condition are usually at their worst around 24 hours after they begin, and then they gradually improve.

When to See a Doctor

It is important that you seek medical attention for sudden vertigo or difficulty walking because these symptoms can be caused by a more serious illness, such as a stroke, brain tumor, heart disease, kidney failure, or dehydration.

Causes 

Labyrinthitis is caused by inflammation of the inner ear, in the area described as the labyrinth. The cause of labyrinthitis is not well understood, but symptoms often begin after an infection or after an inflammatory condition.

Illnesses that commonly precede labyrinthitis include:

Risk Factors 

There are several conditions that can predispose you to labyrinthitis. These conditions may interfere with your ability to fight infections in your middle ear.

  • Smoking
  • Excessive alcohol consumption
  • A history of allergies
  • Stress

Diagnosis

Diagnosis of labyrinthitis relies on your clinical history and physical examination, several diagnostic tests, and sometimes ruling out other conditions that could be the cause of your symptoms.

Physical Examination

Your doctor will check your hearing, which can be decreased in one ear when you have labyrinthitis. You may have a sign called saccades, which is a jumpiness of your eye movements that can occur with labyrinthitis. And your doctor will also check your balance and coordination by asking you to walk and to do simple tasks, such as touching your nose with your finger.

Diagnostic Tests

Several diagnostic tests can be helpful in assessing symptoms of labyrinthitis. You are not likely to need all of these tests, but you may have some, depending on whether your doctor is concerned about other causes of your symptoms.

  • You will likely have your ears examined with an otoscope, which is a non-invasive instrument that doctors use to look in your ears.
  • You may also have Head Impulse Testing (HIT), a non-invasive test that involves evaluating how your eyes move after moving your head. This examination can help assess the function of the semicircular canals in the inner ear, which would suggest more extensive inflammation.
  • Tympanometry, a test that uses a device similar to an otoscope, measures fluid in the ear and assesses the function of the middle ear and eardrum.
  • If you have developed decreased hearing, you may need a hearing test, such as an audiogram or electronystagmography (ENG) test to help further identify the cause of your symptoms.
  • If there is a concern that you could have a more serious medical condition, such as a stroke or a brain tumor, you may need such as a brain magnetic resonance imaging test (MRI) or computerized tomography (CT) scan.

Vestibular Neuritis

The inflammation in labyrinthitis often affects the vestibulocochlear nerve, which is also called the eighth cranial nerve. This nerve sends information from the labyrinth of the inner ear to other regions of your brain to help to regulate your balance and coordination. Vestibular neuritis is inflammation of the vestibulocochlear nerve, and it produces the same symptoms as labyrinthitis.

The two conditions often occur together and are medically managed in the same way.

Treatment

The symptoms related to labyrinthitis can be bothersome or even debilitating. Fortunately, the condition is usually self-limited, meaning that it improves on its own.

Symptoms of labyrinthitis may begin to subside 1-4 weeks after they begin. Labyrinthitis usually goes away completely in 2-3 months. Sometimes, intermittent dizziness persists and hearing loss may be permanent. This is more likely if you already had some hearing loss or experienced dizziness prior to your bout of labyrinthitis.

It is a good idea to try to relax as you are recovering. Stress can increase your symptoms. Your doctor may recommend bed rest to avoid falls or exacerbation of your symptoms. Gradually, you can increase your activity level as your symptoms decrease.

Medication

Most people do not need medication for the treatment of labyrinthitis, but when symptoms are persistent or difficult to tolerate, prescription medications are an option. Treatments for labyrinthitis are targeted at managing symptoms and reducing the inflammation. Antiviral or antibacterial medications aren't used to manage labyrinthitis, but they may be used to treat an infection.

Medications used for management of labyrinthitis include:

Corticosteroids: Prednisone, a commonly used steroid, decreases inflammation, and may hasten the recovery time of labyrinthitis. Steroids can cause adverse reactions when stopped abruptly, so your doctor may give you a schedule to taper the medication.

Antihistamines: These medications can be used to help suppress symptoms of dizziness. The most common antihistamines used for managing symptoms of labyrinthitis are usually Antivert (meclizine), Dramamine (dimenhydrinate), and Benadryl (diphenhydramine).

Antiemetics: If you experience severe nausea or vomiting, your doctor may prescribe an antiemetic (anti-nausea medications) to help reduce these symptoms.

  • Reglan(metoclopramide)
  • Phenergan (promethazine)
  • Zofran (ondansetron)
  • Compro (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.

In severe cases, nausea and vomiting may result in dehydration. In fact, you might need hospitalization, intravenously (IV) fluid replacement, and monitoring of your vital signs (pulse and respiration). Once your labyrinthitis resolves, nausea and vomiting should resolve as well.

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.

This type of rehabilitation includes balance exercises (like yoga), and strategies for helping you get around safely if your balance is limited.

A Word From Verywell

Labyrinthitis can be aggravating and worrisome. If you experience vertigo, dizziness, unsteadiness, or other symptoms of this condition, be sure to get prompt medical attention because this is a diagnosis of exclusion—meaning that other illnesses need to be ruled out first. And some of the other illnesses can be serious, requiring urgent medical care.

As you recover, be sure to talk to your doctor if you have any lingering symptoms so that you can get rehabilitation and treatment for any persistent issues.

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