Labyrinthitis

BASICS

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

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

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

Incidence

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

Prevalence

Unclear due to limited data; increases with age.

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

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

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

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

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