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Otitis Interna - Labyrinthitis


Overview, Causes, & Risk Factors

Labyrinthitis is inflammation of the inner ear, usually due to an infection.

What is going on in the body?

The inner ear has two main functions. The first is to turn sounds into electrical signals that are sent to the brain. The second function is to aid in balance. When the inner ear gets inflamed, usually from an infection, hearing and balance may be impaired.

What are the causes and risks of the infection?

Labyrinthitis usually follows an infection in another part of the body, such as acute otitis media or meningitis. A person may also develop labyrinthitis suddenly without another apparent infection. In these cases, the cause is thought to be a viral infection of the inner ear itself.


Symptoms & Signs

What are the signs and symptoms of the infection?

Symptoms of labyrinthitis often occur quickly and may include:

  • feeling unsteady when standing
  • hearing impairment, including deafness
  • nausea and vomiting
  • ringing in the ears
  • vertigo, a form of dizziness in which a person feels that the room is spinning around him or her
  • A person also may have the symptoms of the infection that led to the labyrinthitis. For instance, an infection of the middle ear, called acute otitis media, may lead to labyrinthitis. An infection of the lining around the brain, called meningitis, can also lead to labyrinthitis.


    Diagnosis & Tests

    How is the infection diagnosed?

    Diagnosis of labyrinthitis begins with the medical history and physical exam. A hearing test can detect hearing impairments. Special tests may be done to further study the problem with the inner ear.


    Prevention & Expectations

    What can be done to prevent the infection?

    Prompt treatment of acute otitis media and meningitis with antibiotics can prevent some cases of labyrinthitis. There is no known way to prevent cases caused by viral infection of the inner ear.

    What are the long-term effects of the infection?

    With labyrinthitis caused by a bacterial infection, hearing impairment or deafness is often permanent. The balance part of the inner ear is also usually permanently destroyed. However, the brain can often learn to adjust to the balance problem. Because of this, the vertigo usually improves over time. It may soon only occur with fast or complex head movements.

    A person with the viral form of labyrinthitis can have varying degrees of balance and hearing problems. Some people recover completely, while others have permanent problems.

    What are the risks to others?

    Labyrinthitis itself is not contagious and poses no risk to others. However, acute otitis media and meningitis are often contagious.


    Treatment & Monitoring

    What are the treatments for the infection?

    Antibiotics are given for labyrinthitis caused by bacteria, often through an intravenous line, or IV. An IV is a thin tube that is inserted though the skin and into a vein, usually in the hand or forearm. Surgery may also be needed inside the ear.

    Viral infections may be treated with corticosteroids, such as prednisone, and antiviral medications. If there is permanent hearing impairment, a hearing aid may be useful.

    Vertigo can be treated with medications such as meclizine. Medications are only used short-term for balance trouble. They allow the brain to learn to adjust to the inner ear injury. Special exercises can often help speed and improve the brain's ability to adjust.

    What are the side effects of the treatments?

    Antibiotics can cause allergic reactions and stomach upset. Antivertigo medications may cause drowsiness, a dry mouth, and allergic reactions. Surgery may cause balance problems, bleeding, infection, or allergic reaction to anesthesia.

    What happens after treatment for the infection?

    Most people need no further treatment after the infection causing labyrinthitis is cleared up. Those with balance problems are often advised to continue balance exercises to adjust to the inner ear damage. If the hearing impairment doesn't improve within two weeks, the loss is likely to be permanent.

    How is the infection monitored?

    Those with labyrinthitis caused by a bacteria are often monitored in the hospital for a short time . Others can often monitor their symptoms at home. Regular hearing tests may be advised in some cases to follow symptoms. Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:Mark Loury, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:03/30/01
    Reviewer:Adam Brochert, MD
    Date Reviewed:08/06/01

    Sources

    Harrison's Principles of Internal Medicine, 1998, Fauci et al.

    Cecil Textbook of Medicine, 1997, Bennett et al.


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