Labyrinthitis is an inner ear disorder that leads to disabling dizziness. This article describes all you need to know about this condition.
Labyrinthitis is a relatively common inner ear disorder; its primary symptom is debilitating dizziness and hearing loss. This disease can affect one or both ears. It is an inflammatory condition usually triggered by an inner ear infection.
The inner ear is not only in charge of the hearing; it also contains the vestibular apparatus, which sends information about your physical position directly to your brain, allowing it to maintain balance. Therefore, any inner ear disturbance will result in some form of imbalance.
Labyrinthitis is more frequent in adults between the ages of 30 and 60, and it is rarely seen in children. Viral labyrinthitis is far more frequent than bacterial labyrinthitis. This is good news because viral labyrinthitis usually resolves itself in a few days, while bacterial labyrinthitis is more likely to leave permanent sequels.
This article will explain everything you need to know about the causes, symptoms, diagnosis, treatment, prognosis, or possible outcomes of viral and bacterial labyrinthitis.
What is the inner ear?
To understand labyrinthitis, we need to understand the inner ear as well as the vestibular apparatus. The inner ear is the deepest part of the auditory canals.
The inner ear only has two main functions:
1. Interpreting sound fluctuations into electrical signs for the brain to understand
2. Maintaining balance
It has two functional structures: the vestibular system (balance and equilibrium) and the cochlea (Audition).
The vestibular system has five end organs: three semicircular channels, the utricle, and the saccule. The function of the semicircular channels is sensing rotational movements.
The utricle and saccule, on the other hand, sense straight-line accelerations. These structures have a lot of liquid inside of them. When your head moves, that liquid inside the channels amoves. This causes the tiny hair cells inside of them to move as well.
These hair cells are sensors that detect movement and send electrical signals to the brain stem through the vestibular nerve. The brain is in charge of interpreting those signals produced by the sensors and sends signals telling how the body should move to stay stable or in balance.
When you experience very strong or fast movements (i.e., a rollercoaster), in that case, the fluid in the inner ear remains stimulating after the movement has ended. That is the reason behind people being dizzy after stepping down from a rollercoaster.
Peripheral vestibular disorders like labyrinthitis affect one or multiple structures inside the inner ear. The great majority of vestibular disorders are peripheral in nature. Some inner ear diseases only affect the vestibular apparatus. Still, others affect the cochlea and the eighth cranial nerve (cochlear nerve).
Diseases like benign paroxysmic vertigo only affect the vestibular system. Labyrinthitis includes swelling of all the vestibular system and therefore causes both hearing loss and dizziness.
What causes labyrinthitis?
The complex structure containing the cochlea and the vestibular apparatus is also known as the labyrinth or the inner ear labyrinth. Labyrinthitis is the swelling of the inner ear labyrinth, which leads to impaired balance, dizziness, and hearing loss. About 99% of the time, labyrinthitis is the consequence of an infection.
Which upper respiratory infections are more likely to cause labyrinthitis?
An upper respiratory tract infection is a flu or a common cold, amongst others. Although every upper respiratory infection can turn into vestibular labyrinthitis, some are more likely than others to cause it.
For example, It is important to highlight that a middle ear infection such as otitis media (viral or bacterial) is more likely to cause labyrinthitis because the inflammatory process occurs closer to the inner ear or semicircular canals of the vestibular apparatus.
Are all cases of labyrinthitis infectious?
The great majority (99%) are due to infection; however, there are other possibilities.
Autoimmune labyrinthitis is an unusual form of labyrinthitis that does not occur due to infection, instead of as a symptom of a preexistent autoimmune disease like Wegner’s granulomatosis, polyarteritis nodosa, systemic lupus, rheumatoid arthritis, ulcerative colitis, scleroderma, and dry eye syndrome. Due to its rare nature, this disease is rarely diagnosed.
Moreover, there is labyrinthitis ossificans which is another type of this condition. It has to do with direct bone impairment or diseases that affect the bone like sickle cell disease, among other risk factors.
What does labyrinthitis feel like?
In most cases, the main complaint of labyrinthitis patients is dizziness. This makes perfect sense because it is the only word most people think of when experiencing a circular movement’s false sensation.
However, the word dizziness is not an accurate medical term because it can describe many different things. The term dizziness can describe a feeling of lightheadedness, the sensation you are about faint, nausea, imbalance, and even alcohol intoxication.
In Labyrinthitis, vertigo is a more accurate word than dizziness. Vertigo is the illusory sensation that the world is moving around you. In other words, patients with labyrinthitis do not experience lightheadedness or fainting; they experience the sensation that the world around them is constantly moving.
This symptom is a consequence of the brain receiving asymmetrical positional information from each ear. Therefore, it is a consequence of vestibular dysfunction in the inner ear.
Although vertigo is the main complaint, it is not the only symptom. Patients with labyrinthitis can also experience hearing loss, which is usually transitory; however, some patients experience permanent hearing loss. This happens because it affects the inner ear as a whole, including the cochlea (auditive system) and the vestibular system.
Other manifestations include general infection and inflammation symptoms such as ear pain, fever, malaise, and upper respiratory infection symptoms (flu-like symptoms)
Can vertigo be a sign of something more serious?
Yes, many different diseases have vertigo as their cardinal symptom. Some of these diseases are less serious, like labyrinthitis, but some are potentially life-threatening. An example of this situation is central vertigo.
In a central vestibular disorder, there is no issue with the inner ear or the vestibular apparatus. In this case, there is a problem with the brain or the brain stem.
The main cause of central vertigo is stroke. Some causes of central vertigo include central nervous system tumors, trauma, multiple sclerosis, and infection.
A stroke is a severe event that can lead to permanent disability and even death. A posterior stroke is a stroke that involves the back part of the brain. Unlike most strokes, it does not cause one-sided weakness or facial paralysis. Many posterior strokes have vertigo as the only presenting symptom. Vertigo due to a stroke is many times more subtle and discrete than labyrinthitis vertigo.
Thankfully, an experienced physician can easily distinguish peripheral vertigo due to benign cause like labyrinthitis from central vertigo due to a stroke.
Some clinical characteristics that help doctors make that distinction include these ones.
- Nystagmus presence: Nystagmus is an abnormal back and forth moving of the eyes. Peripheral vertigo always causes spontaneous nystagmus, while central vertigo does not do this. Nystagmus is probably the most important key to diagnosis in the physical exam for vertigo.
- •Intensity of the symptoms: Symptoms of peripheral vestibular dysfunction can be quite intense; patients tend to experience a strong feeling of vertigo along with nausea, vomiting, and imbalance. Central dysfunction usually has vague symptoms of imbalance and dizziness.
- Time of Onset: Peripheral vestibular dysfunction usually has a more sudden and dramatic onset, while central vertigo, on the other hand, has symptoms that appear gradually. In fact, usually, the subject will be incapable to give a specific time of onset.
Can stress bring on labyrinthitis?
Labyrinthitis is not a direct result of stress; however, stress can be a significant contributing factor. Both physical and psychological stress leads to increased cortisol levels in your body.
Cortisol has many effects on different body systems; it increases your blood pressure, your blood sugar, and produces mood changes. One significant consequence of cortisol is immune suppression.
Constant stress and increased cortisol levels make your immune system weaker and decrease its ability to fight infections. If you are under a big deal of stress, you are more likely to suffer from infections that lead to labyrinthitis.
For example, you can have a common upper respiratory infection, such as a common cold. Still, if you have high cortisol levels, that infection is more likely to progress into viral labyrinthitis.
Labyrinthitis and vestibular neuritis – what’s the difference?
Although both conditions share very similar symptoms, they are different.
Labyrinthitis exists when there is a swelling of the inner ear. Besides, the latter usually is due to a viral infection. Patients with this condition can present symptoms such as vertigo, hearing loss, ear pain, fever, and a weakening of the exact half of the muscles in the face. In most cases, flu-like symptoms, such as the runny nose, fever, and cough, can precede the vestibular symptoms (or vertigo). Importantly, vertigo, nausea, and vomiting tend to resolve within a few days, but hearing loss is more variable. Some cases of Labyrinthitis result in a profound hearing loss.
Vestibular neuronitis has many of the same symptoms as vestibular neuronitis but without hearing loss. In this case, inflammation doesn’t involve the inner ear as a whole, only the vestibular nerve’s ganglion, while the cochlear nerve (responsible for transmitting hearing information) remains intact. Just as labyrinthitis, vestibular neuritis is always preceded by either a bacterial infection or a viral infection.
What are the possible complications of labyrinthitis?
Although a quick diagnosis and treatment prevent most complications, severe labyrinthitis cases can lead to serious complications such as permanent damage to the vestibular and cochlear system.
Many cases of severe labyrinthitis and untreated labyrinthitis result in permanent sensorineural hearing loss and imbalance. A small group of patients experiences vertigo and imbalance symptoms that can last for months, even years (chronic labyrinthitis). As you may imagine, chronic labyrinthitis can cause significant impairment in your daily life and prevent you from carrying out normal work-related and social activities.
What tests are useful in the diagnosis of labyrinthitis?
In most cases, diagnosis is only based on the signs and symptoms the patient experiences. There are no specific diagnostic tests for labyrinthitis. However, some laboratory and imaging tests can be useful to rule out other pathologies.
A CT scan is useful to rule out mastoiditis (infection of the mastoid bone) as the cause of labyrinthitis. Mastoiditis is an infection in a part of one of the bones in your head; it constitutes a medical emergency that requires immediate IV antibiotic treatment (antibiotics directly through the vein) because, due to its location, it can quickly evolve into bacterial meningitis.
An MRI helps rule out causes of central vertigo-like stroke, brain tumor, acoustic neuroma, brain access, and multiple sclerosis. Some radiologic patterns are also observable through MRI images that indicate labyrinthitis and can aid the diagnosis in unclear cases.
An audiography is a test that graphically records the hearing ability to various sound frequencies. This test is very useful in detecting the degree of hearing loss in labyrinthitis.
What is the treatment for labyrinthitis?
The treatment for labyrinthitis varies depending on the cause.
Viral labyrinthitis treatment consists mainly of hydration and bed rest. Most viral infections do not have any specific treatment. Doctors and patients have to wait until the virus finishes its cycle to notice any significant improvement.
This group of patients also benefits from symptomatic treatment to decrease symptoms of dizziness, nausea, and vomiting. Some common anti-dizziness drugs that can improve symptoms before the virus dies.
Commonly used anti-dizziness medication include the following.
- Anticholinergic agents
- First-generation antihistamines
A short course of corticosteroid drugs has been shown to decrease the duration of symptoms; however, the evidence supporting this is not strong. Antiviral drugs such as acyclovir, valacyclovir, and famciclovir have reduced the time of symptoms.
In labyrinthitis due to herpes virus infection. Antiviral agents decrease the risk of suffering from long term complications like chronic labyrinthitis and permanent hearing loss in one ear. However, antiviral drugs only prevent complications when administered in the first 72 hours after the appearance of symptoms.
Cases of suppurative labyrinthitis do require antibiotic treatment to end the infection. The objective of treatment is to eliminate the underlying infection. Patients with bacterial labyrinthitis should receive broad-spectrum antibiotics. Ideally, your doctor should take a sample of your ear secretion to identify the offending bacteria and choose the ideal antibiotic to treat it.
The use of corticosteroid therapy in bacterial labyrinthitis is controversial. Some cases of labyrinthitis due to otitis media may require surgical drainage of the effusion.
Who can benefit from vestibular rehabilitation?
A patient who evolves into chronic labyrinthitis with permanent dizziness and imbalance that doesn’t respond to regular treatment forms is a candidate for vestibular rehabilitation therapy.
Vestibular rehabilitation therapy can change the life of many chronic labyrinthitis patients unable to lead normal lives. A vestibular rehabilitation exercise program must be designed by a certified vestibular therapist to work adequately—the whole idea of vestibular rehabilitation, teaching the body how to use other senses to compensate for vestibular impairment.
This program is custom made for each individual patient to solve that person’s specific problems. Before starting a therapy program, the in question therapist will do an extensive examination to identify the main problems related to your vestibular disorder. The therapist will recommend one or a combination of three principal methods of exercise, depending on the specific findings:
- Gaze stabilization: Trains eye control to have a clear vision during movement
- Balance training: Improves stability and balance.
- Habituation exercises: Controls the dizziness produced by motion or visual stimuli
What happens if labyrinthitis goes untreated?
Once again, this depends on the type of labyrinthitis we are dealing with. Most cases of viral labyrinthitis go away in two weeks or less without treatment. However, cases due to herpes zoster virus are more likely to cause complications without early and adequate treatment, so it is always better to give early preventive treatment whenever possible.
Although most cases heal spontaneously, symptoms such as dizziness, vertigo, and nausea are extremely unpleasant. So, even if symptomatic treatment with drugs such as antihistamines and benzodiazepines does not alter the disease’s course, they can make your time with labyrinthitis a lot less unpleasant.
Bacterial labyrinthitis, on the other hand, does not heal by itself. It requires antibiotic treatment to stop the infection and prevent complications like permanent hearing loss and chronic labyrinthitis. An untreated middle ear infection can even lead to life-threatening complications like brain access or bacterial meningitis. So, treatment is not optional here.
Do you have symptoms of labyrinthitis? Let us look for them.
This tool is a Labyrinthitis Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this condition. Therefore, it would tell anybody who uses it the likelihood that its symptoms are because of labyrinthitis. Besides, it is free and only takes a few minutes to complete.