Labyrinthitis

Picture of the Outer, Middle, and Inner Ear Structures

Labyrinthitis means an inflammation of the inner ear structure called the labyrinth. Sometimes the term labyrinthitis refers to other causes of inner ear problems that have no inflammation because those problems produce similar symptoms.

• You have a labyrinth in each of your inner ears, encased in the thick bone near the base of your skull. As the name implies, the labyrinth is a maze of interconnected fluid-filled channels and canals.
• Half of the labyrinth, the cochlea, is shaped like a snail's shell. It sends information about sounds to the brain. The other half looks something like a gyroscope with 3 semicircular canals connected to an open cavern or vestibule.
• The vestibule portion of the labyrinth sends information to the brain regarding the position and movement of your head. Any disturbance of the vestibule can lead to faulty information going to your brain.
• Your eyes also send positioning information to your brain. When information from the labyrinth and the eyes don't match, the brain has trouble interpreting what is happening. This misinterpreting often leads to a sensation that you are spinning (vertigo) or a feeling that you are moving when in fact you are remaining still. Feelings of motion sickness (nausea and vomiting) often follow. Sometimes you will experience hearing loss or abnormal sounds such as high- or low-pitched ringing (tinnitus).

• The most common symptoms
  • Vertigo
  • Nausea
  • Vomiting
  • Loss of balance
• Other possible symptoms
  • A mild headache
  • Tinnitus (a ringing or rushing noise)
  • Hearing loss
• These symptoms often are provoked or made worse by moving your head, sitting up, rolling over, or looking upward.
• Symptoms may last for days or even weeks depending on the cause and severity.
  • Symptoms may come back, so be careful about driving, working at heights, or operating heavy machinery for at least 1 week from the time the symptoms end.
  • Rarely, the condition may last all your life, as with Meniere's disease. This condition usually involves tinnitus and hearing loss with vertigo. In rare cases, it can be debilitating.

Many times, you cannot determine the cause of labyrinthitis. Often, the condition follows a viral illness such as a cold or the flu. Viruses, or your body's immune response to them, may cause inflammation that results in labyrinthitis.

Other potential causes are these:

• Trauma or injury to your head or ear (similar to concussion)
• Bacterial infections: If found in nearby structures such as your middle ear, such infections may cause the following:
  • Fluid collects in the labyrinth (serous labyrinthitis)
  • Fluid directly invades the labyrinth, causing pus-producing (suppurative) labyrinthitis
• Allergies
• Alcohol abuse
• A benign tumor of the middle ear
• Certain medications taken in high doses
  • Furosemide (Lasix)
  • Aspirin
  • Some IV antibiotics
  • Phenytoin (Dilantin) at toxic levels
• Benign paroxysmal positional vertigo: With this condition, small stones, or calcified particles, break off within the vestibule and bounce around. The particles trigger nerve impulses that the brain interprets as a movement.
• More serious causes of vertigo can mimic labyrinthitis, but these occur rarely.
  • Tumors at the base of the brain
  • Strokes or insufficient blood supply to the brainstem or the nerves surrounding the labyrinth

When to call the doctor

• You feel dizzy just from moving your head or body.
• You occasionally feel nauseous and have vomiting.
• You have ringing or rushing noises in your ear.
• You have a sudden hearing loss.

When to go to the hospital

• You cannot eat, drink, or take medications because of vomiting.
• Your hearing progressively worsens.
• You have a severe headache or lethargy.
• You have a fever.
• You have ear pain.
• You recently injured your head or ear.
• Your dizziness doesn't stop after a few minutes.
• You develop double vision.
• You develop speech problems.
• Your arm or leg suddenly gets numb or weak.
• Muscles on your face become weak or paralyzed.
• Your gait (ability to walk normally) is affected.

A doctor will ask you questions that help determine whether or not the cause is serious. In many cases, the doctor will first need to make sure your symptoms are not associated with a stroke

These questions may include the following

• How quickly the symptoms began
• Whether they are worse with head movement
• What other medical problems do you have
• What medications you are taking
• What other symptoms do you have

The doctor then will perform an exam that focuses on your ears and nervous system. The physician may try to reproduce the symptoms by quickly turning your head or changing your body position. The doctor may then prescribe a trial therapy with medications or special maneuvers while you are still in the office or emergency department to see if they work.

• If the physician strongly suspects a more serious cause, the doctor may order a CT scan or MRI of your head.
• A doctor usually can tell by a physical examination whether more serious conditions exist. If suspected, or if symptoms worsen or continue over time, a doctor may seek an opinion from an ear, nose, and throat (ENT) specialist or neurologist.
• The doctor will likely send you for a hearing test with an audiologist to further assess the inner ear function.

Depending on the cause of the labyrinthitis symptoms, the doctor likely will try one or more of the following therapies:

• Medical treatment
  • Meclizine (Antivert)
  • Diazepam (Valium)
  • Promethazine (Phenergan)
  • Dimenhydrinate (Dramamine)
  • An antibiotic (rarely)
  • An antihistamine such as diphenhydramine (Benadryl)
• Therapeutic maneuvers such as the Epley maneuver, if the doctor thinks benign positional vertigo-tiny stones bouncing around in the labyrinth-may be the cause. The Epley maneuver, developed by Dr. John Epley, is a movement of your head to move the stones a certain way to end the dizziness.

• Lie still in a comfortable position, often flat on your side.
• Reduce your salt and sugar intake.
• Avoid chocolate, coffee, and alcohol.
• Stop smoking.
• Try to create a low-noise, low-stress environment.
• Talk to your doctor about certain maneuvers or exercises (Brandt and Daroff exercises and Epley maneuver) that may speed your recovery. These positions attempt to rearrange tiny particles inside your ear and/or desensitize you to their effects.
  • Sit on the edge of your bed near the middle, with your legs hanging down.
  • Turn your head 45° to your right side.
  • Quickly lie down on your left side, with your head still turned, and touch the bed with the portion of your head behind your ear.
  • Hold this position and every following position for about 30 seconds.
  • Sit up again.
  • Quickly turn your head 45° toward your left side and lie down on your right side.
  • Sit up again.
  • Do 6-10 repetitions, 3 times per day.

• Visit your doctor regularly if symptoms continue despite therapy and rest.
• Do not drive, work at heights, or operate heavy machinery until the dizziness leaves you.
• Rest in bed for the first few days to avoid falls and injuries around the house.
• Consult a neurologist or ENT physician if you do not understand your diagnosis.

The only causes of labyrinthitis that you can try to avoid are accidents or trauma to your ear.

• For most causes of simple labyrinthitis, you likely will recover within a matter of days or weeks.
• Some people may experience symptoms for weeks or months.
• Others may have periodic recurrences.