What Is Labyrinthitis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Labyrinthitis is an irritation and swelling of the inner ear that can cause vertigo (dizziness or a sense that you or your surroundings are spinning) and, in some cases, hearing loss. (1)

The terms labyrinthitis and vestibular neuritis are often used interchangeably; both describe any inflammation along the pathway from the labyrinth (the inner ear) to the vestibular nerve (which connects the inner ear to the brain) to the vestibular nuclei, explains Sujana S. Chandrasekhar, MD, a partner at ENT and Allergy Associates in New York City.

There are two kinds of labyrinthitis: viral labyrinthitis and bacterial labyrinthitis. Viral labyrinthitis — which is also called serous labyrinthitis or serous or viral neuritis — is much more common, says Dr. Chandrasekhar.

“Viral labyrinthitis can occur in clusters, like other viral diseases can,” she explains. “Viral labyrinthitis is usually not associated with hearing loss (unless there’s a middle ear infection along with the inner ear infection, which will resolve).”

Bacterial labyrinthitis, which is also called suppurative labyrinthitis, is quite rare and much more dangerous, says Chandrasekhar.

“This is a catastrophic occurrence because there is bacteria and therefore pus in the inner ear and the inner ear becomes destroyed,” she says. “It causes hearing loss that persists even after the vertigo and dizziness are gone. Because the damage to the inner ear is so bad, the inner ear can fill up with scar tissue and calcium.”

Both forms of labyrinthitis usually only affect one ear, adds Chandrasekhar.

Labyrinthitis symptoms range from mild to severe, says Chandrasekhar. “Some people will be dizzy for a few hours or a couple of days; others can have severe vertigo that lasts several days,” she explains.

The onset of symptoms (known as the acute phase) is usually very sudden, with severe dizziness developing abruptly in the middle of the day. (2) In other cases, you experience symptoms when you first wake up in the morning. After the initial phase of spinning vertigo, there will be some disequilibrium or imbalance, says Chandrasekhar.

Other symptoms of labyrinthitis include: (1)

• Your eyes moving on their own, making it difficult to focus them.
• Loss of balance — you may fall toward one side.
• Dizziness that leads to nausea and vomiting.
• Ear symptoms including ringing in the ear (tinnitus) or hearing loss in the affected ear.

The diagnosis of labyrinthitis can be presumed on the basis of your symptoms and a physical exam, including a neurological exam with specific clinical tests and maneuvers. There is no single test to confirm labyrinthitis. (2) Because the symptoms often mimic those of other medical conditions, your doctor must examine you and may request additional tests to rule out other causes of dizziness.

You may have one or more of the following tests to rule out other conditions: (1)

• Electroencephalogram (EEG), which measures the electrical activity of the brain
• Electronystagmography (ENG), which is used to determine whether vertigo symptoms are caused by an inner ear problem
• Caloric stimulation, in which the inner ear is warmed and cooled with air or water to test eye reflexes
• Cranial computed tomography (CT scan of your head)
• Hearing tests
• Magnetic resonance imaging (MRI) of your head

What Tests Will My Doctor Use to Diagnose Vertigo?

Prognosis of Labyrinthitis

Viral labyrinthitis usually resolves completely with supportive measures, says Chandrasekhar. The longer and more severe the initial symptoms, the longer it will take for recovery. Older people may have a bit of underlying weakness in their balance system, so their recovery may take longer than it does for young people.

Bacterial labyrinthitis is very rare, and the prognosis is less clear. The vertigo goes away with time, but most people will be left with some degree of permanent hearing loss. However, a cochlear implant or hearing aid can help.

In very rare cases, some hearing loss is permanent in viral labyrinthitis. (1) Some people have chronic dizziness, but this is more common in older patients, says Chandrasekhar.

Supportive measures for viral labyrinthitis include rest, hydration, and, while the vertigo is really severe, vestibular suppressants such as meclizine or Valium (diazepam) for a brief time, says Chandrasekhar. The spinning vertigo is commonly accompanied by nausea and sometimes vomiting, and medications can reduce this as well, she adds.

After the initial phase of spinning vertigo is over, and there is still some disequilibrium or imbalance, people with labyrinthitis should not take vestibular suppressants, as this will delay their recovery, Chandrasekhar says. Instead, they should start doing vestibular (balance) exercises and resuming as many normal activities as possible.

Bacterial labyrinthitis cases require strong antibiotic treatment along with supportive treatments including intravenous hydration and anti-vertiginous and anti-nausea medications, says Chandrasekhar. As quickly as possible after recovery, people with bacterial labyrinthitis should have a CT scan and MRI of the ear and, if they wish, undergo cochlear implantation quickly, before the inner ear calcifies and becomes hard and difficult or impossible to implant. This is likely to restore hearing, she notes.

Medication Options

Your doctor may prescribe the following medications, depending on your symptoms: (1)

• Antihistamines
• Medicines to control nausea and vomiting, such as prochlorperazine
• Medicines to relieve dizziness, such as meclizine or scopolamine
• Sedatives, such as Valium
• Corticosteroids
• Antiviral drugs

Alternative and Complementary Therapies

Self-Care for Labyrinthitis

The following can help you manage vertigo: (1)

• Stay still and rest
• Avoid sudden movements or position changes
• Rest during severe episodes, and slowly resume activity. If you lose your balance, you may need help walking
• Avoid bright lights, TV, and reading during attacks
• After the nausea and vomiting have passed, ask your healthcare provider about balance therapy. Chandrasekhar typically recommends labyrinthitis exercises or vestibular (balance) exercises like looking up and down and side to side while keeping the head still; head movements like bending the head forward and backward and side to side; arm and body movements like shrugging and circling the shoulders; standing exercises like moving from sitting to standing; and moving exercises like walking across the room and around a chair.
• Avoid driving, climbing, or operating heavy machinery until your symptoms have not occurred for at least one week.

Prevention of Labyrinthitis

Avoiding the common cold and flu and other viruses by practicing good hand hygiene and protective social behaviors can help prevent labyrinthitis, according to Chandrasekhar.

Labyrinthitis is not a common condition. (3) Chandrasekhar estimates that it may occur in 1 out of every 25,000 people.

The disorder is diagnosed in an estimated 6 percent of patients who visit emergency departments in the United States complaining of dizziness. (4) Labyrinthitis has no gender preference and usually affects people in middle age, although anyone can get it. Children almost never get labyrinthitis — unless it’s bacterial, from meningitis, says Chandrasekhar.

MedlinePlus

MedlinePlus is a service of the National Library of Medicine (NLM), which is part of the National Institutes of Health (NIH). MedlinePlus offers useful information about labyrinthitis, including causes, symptoms, and treatment.

VeDA

The Vestibular Disorders Association (VeDA) provides information about balance, dizziness, and vestibular disorders; diagnosis and treatment; vision and hearing challenges with vestibular disorders; and psychological aspects of vestibular disorders and coping strategies.