Labyrinthitis

BASICS

BASICS

BASICS

Inflammation of the membranous labyrinth of the inner ear that often leads to impaired hearing and balance.

DESCRIPTION

DESCRIPTION

DESCRIPTION

  • The sudden onset of vertigo, accompanied by sensorineural hearing loss and tinnitus, lasting hours to days, and caused by acute inflammation or infection of the labyrinth of the inner ear.
  • Can be categorized as suppurative or serous/toxic labyrinthitis (1)
  • Labyrinthitis is a clinical diagnosis in absence of neurologic deficits.
  • Typically presents with a subjective sense of motion or room-spinning vertigo lasting for hours or days and often sudden unilateral sensorineural hearing loss
  • Often associated with vestibular hypofunction of the involved ear; peripheral vertigo improves over time with central compensation. Hearing loss generally improves in the case of serous labyrinthitis but is permanent in the case of suppurative labyrinthitis.
  • System(s) affected: nervous, special sensory (auditory and vestibular)
ALERT
  • “Vertigo” and “dizziness” are commonly used terms. Clarify the symptoms by giving options of alternative descriptions such as light-headedness, disequilibrium, room-spinning vertigo, or imbalance.
  • Hearing loss and duration of symptoms can help narrow the differential diagnosis in patients with vertigo.
  • Vestibular neuritis/neuronitis occurs due to inflammation of the vestibular nerve causing vertigo lasting hours to days without the auditory symptoms of labyrinthitis (2).

EPIDEMIOLOGY

EPIDEMIOLOGY

EPIDEMIOLOGY

  • Most common in 30 to 50 years of age
  • 10% of all patients seen for dizziness, if vestibular neuritis is included

Incidence

Incidence

Incidence

Estimated incidence of 3.5 per 100,000 if including vestibular neuritis

Prevalence

Prevalence

Prevalence

Unclear due to limited data; increases with age.

ETIOLOGY AND PATHOPHYSIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

  • Viral labyrinthitis is the most common etiology with acute inflammation and damage to the labyrinth, involving both the vestibular apparatus and cochlea.
    • Common viral causes: cytomegalovirus, mumps, varicella zoster, rubeola, influenza, parainfluenza, herpes simplex, adenovirus, coxsackievirus, respiratory syncytial virus, HIV
  • Bacterial invasion of the inner ear, either from a middle ear infection or meningitis, occurs in suppurative labyrinthitis (1).
    • Common bacterial causes: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitidis, Streptococcus spp., Staphylococcus spp., Borrelia burgdorferi

RISK FACTORS

RISK FACTORS

RISK FACTORS

  • Viral upper respiratory infection
  • Otitis media
  • Cholesteatoma
  • Head trauma
  • Meningitis

GENERAL PREVENTION

GENERAL PREVENTION

GENERAL PREVENTION

  • Early treatment of acute otitis media to prevent complications
  • Scheduled immunizations (to prevent common viral pathogens)
  • Prevent maternal transmission of pathogens, including syphilis and HIV.

COMMONLY ASSOCIATED CONDITIONS

COMMONLY ASSOCIATED CONDITIONS

COMMONLY ASSOCIATED CONDITIONS

  • Viral upper respiratory infection
  • Otitis media, cholesteatoma
  • Head injury

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