Labyrinthitis

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Basics

Description

  • The sudden onset of vertigo, accompanied by sensorineural hearing loss and tinnitus, lasting hours to days, and caused by acute inflammation or infection of the labyrinth
  • Can be categorized as suppurative or serous/toxic labyrinthitis (1)
  • Labyrinthitis is a clinical diagnosis in absence of neurologic deficits.
  • Typically presents with a subjective sense of motion or room-spinning vertigo lasting for hours or days and often sudden unilateral sensorineural hearing loss
  • Often associated with vestibular hypofunction of the involved ear. Peripheral vertigo improves over time with central compensation. Hearing loss generally improves in the case of serous labyrinthitis but is permanent in the case of suppurative labyrinthitis.
  • System(s) affected: nervous, special sensory (auditory and vestibular)
ALERT
  • “Vertigo” and “dizziness” are commonly used terms. Clarify symptoms by giving options of alternative descriptions such as light-headedness, disequilibrium, room-spinning vertigo, or imbalance.
  • Hearing loss and duration of symptoms can help narrow the differential diagnosis in patients with vertigo.
  • Vestibular neuritis/neuronitis occurs due to inflammation of the vestibular nerve causing vertigo lasting hours to days without the auditory symptoms of labyrinthitis (2).
  • Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Unlike labyrinthitis, BPPV is episodic, with severe symptoms lasting <1 minute. BPPV is diagnosed using the Dix-Hallpike maneuver. Unlike labyrinthitis, it is not associated with hearing loss.
  • Vestibular migraine is the second most common cause of recurrent vertigo, lasting hours and usually with a history of migraine. Up to 10% of cases can occur without headaches (2).

Epidemiology

  • Data is lacking for labyrinthitis alone.
  • Most common in 30 to 50 years of age (3)
  • 10% of all patients seen for dizziness, if vestibular neuritis is included (4)
  • Predominant sex: female = male

Incidence
  • Estimated incidence of 3.5 per 100,000 if including vestibular neuritis (3)
  • Viral labyrinthitis is the most common etiology.
  • Suppurative labyrinthitis secondary to otitis media or meningitis is increasingly rare.

Prevalence
20–30% of adults see a health care provider for vertigo in their lifetimes (3). True labyrinthitis is rare.

Etiology and Pathophysiology

  • Acute inflammation and damage to the labyrinth, involving both the vestibular apparatus and cochlea.
  • Viral or bacterial toxins may pass into the labyrinth directly from the middle ear to labyrinth via the round or oval window, in the case of serous labyrinthitis.
  • Bacterial invasion of the inner ear, either from a middle ear infection or meningitis, occurs in suppurative labyrinthitis (1).
  • Infections
    • Common viral: cytomegalovirus, mumps, varicella zoster, rubeola, influenza, parainfluenza, herpes simplex, adenovirus, coxsackievirus, respiratory syncytial virus, HIV
    • Common bacterial: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitidis, Streptococcus spp., Staphylococcus spp., Borrelia burgdorferi
    • Treponemal: Treponema pallidum

Genetics
No known genetic link

Risk Factors

  • Viral upper respiratory infection
  • Otitis media
  • Cholesteatoma
  • Head trauma
  • Meningitis

General Prevention

  • Early treatment of acute otitis media to prevent complications
  • Scheduled immunizations (to prevent common viral pathogens)
  • Prevent maternal transmission of pathogens, including syphilis and HIV.

Commonly Associated Conditions

  • Viral upper respiratory infection
  • Otitis media
  • Cholesteatoma
  • Head injury

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