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Labyrinthitis

Cross section of ear showing outer, middle, and inner ear with closeup of labyrinth.Labyrinthitis is the inflammation of part of the inner ear called the labyrinth. It usually affects only one ear. A nerve in the head called the eighth cranial nerve may also be inflamed. Labyrinthitis causes a sense of spinning and hearing loss. In most people these go away over time.

Understanding the inner ear

The inner ear has a system of fluid-filled tubes and sacs. This system is called the labyrinth. Inside the inner ear, the cochlea senses sound. The vestibular organs take in sense motion and changes in space. These create your sense of balance. The eighth cranial nerve (vestibulocochlear nerve) sends all of this information from the inner ear to the brain.

When one of the nerves or the labyrinth is infected, it can become inflamed. This can cause it to not work normally. It may cause hearing loss in 1 ear. The brain now has to make sense of the information that doesn't match between the normal nerve and the infected one. This causes a feeling that the world is spinning around you (vertigo).

What causes labyrinthitis?

A viral infection may cause the condition. The virus may have spread throughout your body. Or it may only affect the labyrinth and eighth cranial nerve. Usually only 1 nerve is affected. Viruses that can cause labyrinthitis include:

  • Herpes viruses

  • Influenza

  • Measles

  • Mumps

  • Rubella

  • Polio

  • Hepatitis

  • Epstein-Barr

  • Varicella

Chronic bacterial infections of the middle ear can spread to the inner ear and cause labyrinthitis. In rare cases bacterial meningitis or head trauma may cause labyrinthitis. In other cases the cause of labyrinthitis is not known.

Symptoms of labyrinthitis

Symptoms of labyrinthitis of may include:

  • A feeling of spinning (vertigo)

  • Dizziness

  • Lack of balance when walking

  • Nausea and vomiting

  • Trouble concentrating

  • Back-and-forth eye movements that you can't control (nystagmus)

  • Hearing loss

  • Ringing in the ears

Symptoms might range from mild to severe. They may come on very quickly. In many people, these symptoms go away over several weeks. Or symptoms can last longer.

Diagnosing labyrinthitis

Your health care provider will ask about your past health. You may also have a physical exam. This may include hearing and balance tests. It will also include an exam of your nervous system. There are no tests for labyrinthitis. But your health care provider may have you take an imaging test. Many health conditions can cause dizziness and vertigo. Your health care provider will need to make sure you don't have another condition that causes these symptoms, such as stroke.

You may have tests such as:

  • MRI, to check for a stroke

  • Electrocardiogram (ECG), to check for cardiovascular causes

  • Electronystagmography (ENG) or videonystagmography (VNG). Either of these records your eye movement to find where the problem is in your vestibular system. These tests can find the cause of a balance disorder.

Treatment for labyrinthitis

Treatment depends on your overall health and symptoms. Treatment for labyrinthitis may include:

  • Corticosteroids to help reduce inflammation of the nerve

  • Antiviral medicines

  • Antibiotics if you have signs of a bacterial infection

  • Medicines to take for a short time that control nausea and dizziness, such as diphenhydramine or lorazepam

If your symptoms go away in a few weeks, you likely won't need other treatment. If you have symptoms that don't go away, you may need to do certain exercises. These are known as vestibular rehabilitation exercises. They are a form of physical therapy. These exercises may help your brain learn to adjust to the vestibular imbalance.

Possible complications of labyrinthitis

In most cases labyrinthitis does not cause any complications. In rare cases it may permanently damage the eighth cranial nerve. This can cause lasting problems with balance, and partial or total loss of hearing. This may require you to use a hearing aid. Getting treated right away can help reduce your risk for these complications.

 

When to call the health care provider

Call your health care provider right away if you have any of these:

  • Symptoms that get worse, or don't get better with treatment

  • New symptoms 

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