Labyrinthitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • The sudden and persistent onset of vertigo, often accompanied by hearing loss, caused by acute inflammation or infection of the labyrinth
  • Labyrinthitis is a clinical diagnosis in absence of neurologic deficits.
  • Typically presents with false sense of motion or room-spinning vertigo lasting for hours or days and often sudden unilateral hearing loss
  • Often associated with vestibular hypofunction of the involved ear. Peripheral vertigo improves over time with central compensation.
  • System(s) affected: nervous, special sensory (auditory and vestibular)
  • Synonym(s): acute peripheral vestibulopathy; vestibular neuronitis (vertigo/dizziness only); vestibular neuritis (vertigo/dizziness only)
ALERT
  • “Vertigo” and “dizziness” are commonly used terms. Clarify 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.
  • Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Unlike labyrinthitis, BPPV is episodic, with severe symptoms lasting <1 minute. BPPV is diagnosed using the Dix-Hallpike maneuver. Unlike labyrinthitis, it is not associated with hearing loss.
  • Ménière disease presents with the classic triad of episodic vertigo, tinnitus, and sensorineural hearing loss that is often fluctuant (1)[C].
Geriatric Considerations
  • Elderly are less likely to compensate fully and may report symptoms of disequilibrium lasting weeks to months after resolution of the acute vertigo.
  • Avoid excessive use of scopolamine, meclizine, and other vestibular suppressants following the initial event, as this will delay central compensation.
  • Benzodiazepines are preferred vestibular suppressant treatment but do increase the risk of falls in older persons.

Pediatric Considerations
Less common in children; incidence of vestibular vertigo in 10-year-olds estimated to be 5.7% (2)[C]

Epidemiology

  • 10% of all patients seen for dizziness
  • Most common in 30 to 50 years of age (3)
  • Predominant sex: female = male

Incidence
  • Viral labyrinthitis is the most common etiology.
  • Suppurative or serous labyrinthitis secondary to otitis media is increasingly rare.

Prevalence
In the United States, second most common cause of dizziness due to persistent peripheral vestibular hypofunction (9%); benign positional vertigo (40%) is most common. More than 1/3 of adults see a health care provider for vertigo in their lifetimes (4).

Etiology and Pathophysiology

  • Acute inflammation or damage to the inner ear, involving both branches of the vestibulocochlear nerve
  • Viruses pass via hematogenous spread into the labyrinth or directly from the middle ear to labyrinth via the round/oval window.
  • Bacterial toxins and host inflammatory mediators from a middle ear infection may reach the inner ear.
  • Ischemia: Ischemic or thromboembolic events involving the labyrinthine artery can cause symptoms that mimic acute labyrinthitis; often presents with associated neurologic symptoms
  • Autoimmune: Local or systemic inflammatory processes may affect the inner ear via autoantibodies vasculitis of the labyrinthine artery.
    • Wegener granulomatosis, Cogan syndrome, systemic lupus erythematosus, polyarteritis nodosa, Behçet disease
  • Infections
    • Common viral: cytomegalovirus, mumps, varicella zoster, rubeola, influenza, parainfluenza, herpes simplex, adenovirus, coxsackievirus, respiratory syncytial virus, HIV
    • Common bacterial: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitidis, Streptococcus spp., Staphylococcus spp., Borrelia burgdorferi
    • Treponemal: Treponema pallidum
  • Ototoxic drugs (e.g., aspirin, aminoglycosides, loop diuretics, cisplatin)

Genetics
No known genetic link

Risk Factors

  • Viral upper respiratory infection
  • Otitis media
  • Vestibulotoxic/ototoxic medications
  • Head trauma
  • History of allergies
  • Meningitis
  • Cerebrovascular disease
  • Other risk factors include autoimmune disease, herpes zoster infection, excessive alcohol consumption, and smoking.

General Prevention

  • Scheduled immunizations (to prevent common viral pathogens)
  • Prevent maternal transmission of pathogens, including syphilis and HIV.

Commonly Associated Conditions

  • Viral upper respiratory infection
  • Allergies
  • Otitis media
  • Cholesteatoma
  • Head injury

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Citation

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TY - ELEC T1 - Labyrinthitis ID - 116335 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116335/all/Labyrinthitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -