Overview

Labyrinthitis is the inflammation of the inner ear (the labyrinth) leading to problems with balance and hearing. Labyrinthitis is where both the vestibular nerve and labyrinth are affected. Vestibular neuronitis is where only the vestibular nerve is affected i.e. there is no hearing loss involved, only balance problems.

Viruses are the most common cause of labyrinthitis. Other causes are bacterial infection or systemic disease.

Epidemiology

  • Viral labyrinthitis is the most common cause
  • Usually seen in 30-60 years
  • More common in women

Risk Factors

Presentation

Patients classically have an acute onset of sensorineural hearing loss and vertigo around a week following an upper respiratory tract infection. Features are:

  • Sensorineural hearing loss – can be unilateral or bilateral
  • Vertigo – this is worsened with movement but not triggered by it
  • Nausea and vomiting associated with the vertigo
  • Horizontal nystagmus towards the unaffected side
  • Gait abnormalities – patients usually fall to the affected side

Differential Diagnoses

Vestibular neuronitis

  • There is vertigo but no hearing loss as no parts of the auditory pathway are involved
  • Can also follow a recent viral infection

Meniere’s disease

  • Recurrent episodes of hearing loss, tinnitus, vertigo, and a sensation of aural fullness
  • There is usually no preceding viral infection

Benign paroxysmal positional vertigo

  • Episodes of vertigo are triggered by changes in head position
  • There is usually no preceding viral infection

Vestibular schwannoma

  • Sensorineural hearing loss, vertigo, and tinnitus present with potential cranial nerve involvement e.g. absent corneal reflex is CN V is involved

Posterior stroke

  • Ataxia
  • Romberg’s test negative
  • Facial paralysis/dysphagia
  • Contralateral lower extremity weakness

Diagnosis

If the clinical picture is clear, diagnosis is based on the history and examination.

Management

  • 1st-line: reassurance – most cases resolve spontaneously
    • Vertigo, nausea, or vomiting: consider prochlorperazine or antihistamines
  • These should be used in acute and severe cases for the shortest period as they can delay recovery
  • Symptoms persisting following treatment: vestibular rehabilitation

Monitoring

  • In uncomplicated cases of viral labyrinthitis, patients are generally only followed up if symptoms are recurrent.

Patient Advice

  • Patients should not drive or operate machinery if they are experiencing vertigo or taking prochlorperazine/antihistamines.

Complications

  • Falls
  • Hearing loss
  • Tinnitus 

Prognosis

  • Usually self-limiting and resolves over days-weeks
  • Hearing loss may recover but may also persist
  • Vertigo may remain in some patients after the acute phase of labyrinthitis ends

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