Vestibular disease
Labyrinthitis
This information is intended as a general introduction to this topic. As everyone is affected differently by balance and dizziness problems, you should speak to your doctor for individual advice.
For reasons of better readability, the generic masculine is used and the simultaneous use of the language forms male, female and diverse (m/f/d) is dispensed with. Unless otherwise indicated, the personal designations used in this patient information refer to all genders.
What is labyrinthitis?
Labyrinthitis is an inflammation of the inner ear. It causes a sudden, severe attack of vertigo, usually accompanied by nausea, vomiting and some degree of hearing loss. This attack can last for hours or days.
Labyrinthitis is usually caused by an infection. In most cases, those affected recover completely from labyrinthitis. However, depending on the cause of the infection, labyrinthitis can sometimes lead to permanent hearing loss and damage to the vestibular system.
Labyrinthitis is similar to neuritis vestibularis, but there are some differences:
- Vestibular neuritis affects the vestibular nerve, which carries signals from the inner ear to the brain; labyrinthitis affects the inner ear itself.
- Vestibular neuritis does not usually cause hearing problems, but labyrinthitis often leads to hearing loss or distorted hearing.
Labyrinthitis is sometimes also called otitis interna.
Summary
- An inflammation of the inner ear, usually caused by a viral infection.
- It triggers a sudden, acute attack of paralyzing rotary vertigo, which is usually accompanied by nausea and vomiting as well as hearing loss or hearing distortion.
- Other, more dangerous causes of sudden dizziness, such as a stroke, must be ruled out.
- The acute phase usually lasts 2 to 3 days with supportive treatment and normally passes by itself.
- Daily life, including work, can usually be resumed within 2 weeks.
- Vestibular rehabilitation can help if dizziness and balance disorders persist even after several months.
- Some patients have a permanent hearing loss - a hearing aid or, in some cases, a cochlear implant can help.
What causes labyrinthitis?
The labyrinth of the inner ear contains organs that are important for balance and hearing. These include
- the semicircular canals and macula organs, which sense when your head tilts and turns. The brain uses these signals to help you keep your balance
- the cochlea, which converts sound waves into nerve impulses so that you can hear
In labyrinthitis, the lining of these organs is inflamed (irritated). This disrupts the nerve signals they produce and causes problems with balance and hearing.
Where does the inflammation come from?
The inflammation is usually caused by an infection. Many different infections can cause labyrinthitis:
- Viral infections are the most common cause of labyrinthitis. These include colds, influenza (flu), herpes, measles, mumps, rubella, polio and chickenpox.
- More rarely, bacterial infections such as middle ear infections or bacterial meningitis can spread to the inner ear and cause labyrinthitis. The most common bacteria are Haemophilus influenzae or Streptococcus pneumoniae. However, thanks to routine childhood vaccination, these two bacteria have become rare.
In rare cases, autoimmune diseases can also cause labyrinthitis. In these diseases, the immune system sees the body's own organs and tissues as invaders and attacks them.
Bacterial labyrinthitis sometimes leads to permanent changes in the inner ear, where bone can grow in the cochlea and cause permanent hearing loss. This is a serious complication of bacterial meningitis. It is more common in children.
The first attack of labyrinthitis, known as the acute phase, usually includes the following symptoms:
- Rotational vertigo
- Balance problems
- Uncontrolled eye movements (nystagmus)
- Nausea and vomiting
- Hearing loss or distorted hearing
- Tinnitus
- A feeling of pressure in the ears
- Fever
- Blurred or shaky vision
Pain is not usually a symptom of labyrinthitis. If there is pain, it may be a sign of a treatable infection, such as herpes or a bacterial infection.
The acute phase usually lasts two or three days, but can also last a week or longer. It is often severe and restrictive in everyday life. People who are in the acute phase of labyrinthitis are often unable to stand up or walk and may vomit uncontrollably.
After the acute phase, people with labyrinthitis may still have balance problems, hearing loss, tinnitus and difficulty focusing or concentrating. Sudden head movements can cause dizziness. This phase can last for weeks or months.
Diagnosis of labyrinthitis
Labyrinthitis will usually be diagnosed by a neurologist in the emergency room. He will take a thorough medical history, perform a neurological examination and various tests to assess the function of your vestibular system.
Labyrinthitis has some of the same symptoms as a stroke, a tumor on the vestibulocochlear nerve (8th cranial nerve) or other diseases of the inner ear, so your doctor must carefully rule out serious diseases. Your doctor will also try to find out what kind of infection is causing the symptoms.
You may undergo some of the following diagnostic tests:
- Hearing tests
- Vestibular functional examination
- Otoscopic examination
- Imaging (CT or MRI scans)
- Blood tests
Treatment of labyrinthitis
The acute phase of labyrinthitis usually subsides on its own. Treatment in this phase is aimed at relieving the symptoms and making you as comfortable as possible. However, in more severe cases of infection, surgery may be necessary.
For many people, the symptoms subside within a few weeks. However, if your symptoms persist for a long time, you may need additional treatment to get back to normal. This usually includes vestibular rehabilitation.
Therapy option
Supportive treatment in the acute phase
In the first few days when you have acute symptoms, you need to rest in bed and drink plenty of water and fluids.
If you vomit and cannot control the vomiting, this could lead to dehydration. You may then need to be admitted to hospital for a short time.
Further treatments in the acute phase may include
- Medication to reduce dizziness, either by mouth, injection or intravenous line, such as dimenhydrinate or ondansetron
- Intravenous fluids to replace the fluids lost due to vomiting
- Steroids to reduce inflammation
You may also be given medication to treat the infection causing the labyrinthitis. For example, if a bacterial infection is suspected, you may be given antibiotics.
You should feel better within a few days. Most people can return to work within 2 weeks and don't notice any symptoms after a few months.
Therapy option
Vestibular rehabilitation
Sometimes the symptoms of labyrinthitis do not disappear completely and you may have dizziness and balance problems for months or, in very rare cases, years. In these cases, vestibular rehabilitation can help.
Vestibular rehabilitation is an exercise therapy. It is designed to help your brain relearn balance control and respond to signals from the vestibular and visual systems. A certified IVRT® vertigo and vestibular therapist will create a suitable exercise program with you.
Remember that vestibular rehabilitation takes time and effort. Your therapist will teach you the exercises you need to do, but you are the one who has to do them regularly!
What happens next?
What you can expect in the future.
Most people recover fully from labyrinthitis, but for some it takes longer than for others.
Some people develop permanent hearing loss after labyrinthitis. This is particularly common in children who have bacterial meningitis that has developed into labyrinthitis. The hearing loss can be partial or complete. People who have permanent hearing loss as a result of labyrinthitis may need a hearing aid. In some cases, they may also receive a cochlear implant. This is a device that bypasses the cochlea and sends electrical signals to the brain.
It is rare for someone to have more than one attack of labyrinthitis. If the symptoms recur, it is important to see a specialist. The symptoms can also be caused by another inner ear disease, e.g. Ménière's disease.
In order to keep this patient information as short as possible, we have not included a detailed list of references. However, this can be requested at any time at info@ivrt.de.
