Labyrinthitis

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What is labyrinthitis?

Labyrinthitis (say “lab-uh-rin-THY-tus”) is a problem deep inside the inner ear. It happens when the labyrinth, a part of the inner ear that helps control your balance, gets swollen and inflamed.

The inflammation may cause sudden vertigo. This makes you feel like you're spinning or whirling. Labyrinthitis may also cause temporary hearing loss or a ringing sound in your ears.

See a picture of the labyrinth.

What causes labyrinthitis?

The cause of labyrinthitis is not clear. Labyrinthitis can happen after a viral infection or, more rarely, after an infection caused by bacteria. It is often triggered by an upper respiratory infection, such as the flu or a cold. Less often, it may start after a middle ear infection.

What are the symptoms?

The main symptom of labyrinthitis is vertigo. Vertigo is not the same as feeling dizzy. Dizziness means you feel unsteady or lightheaded. But vertigo makes you feel like you're spinning or whirling. Symptoms of vertigo and dizziness may be caused by many problems other than labyrinthitis.

With labyrinthitis, the vertigo begins without warning. It often starts 1 to 2 weeks after you've had the flu or a cold. It may be severe enough to make you vomit or make you feel sick to your stomach. Vertigo slowly goes away over a few days to weeks. But for a month or longer you may still get vertigo symptoms if you suddenly move your head a certain way.

Labyrinthitis may also cause hearing loss and a ringing sound in your ears (tinnitus). Most often, these symptoms don't last for more than a few weeks.

How is labyrinthitis diagnosed?

Your doctor can tell if you have labyrinthitis by doing a physical exam and asking about your symptoms and past health. If you have vertigo, your doctor will find out if it is caused by an inflamed labyrinth. Your doctor will look for signs of viral infections that can trigger labyrinthitis.

If the cause of your vertigo is not clear, your doctor may do other tests to rule out other problems.

How is it treated?

Most of the time, labyrinthitis goes away on its own. This normally takes several weeks. If the cause is a bacterial infection, your doctor will give you antibiotics. But most cases are caused by viral infections, which can't be cured with antibiotics. Your doctor may give you other medicines to help control the nausea and vomiting caused by vertigo.

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The main symptom of labyrinthitis is vertigo, a spinning or whirling sensation you feel although neither you nor your surroundings are moving. Vertigo results when there is a problem with your balance sensory systems—including your vision, sensory nerves, inner ear, and skin pressure sensation—that are all interpreted by your brain.

People often think the terms vertigo and dizziness mean the same thing, but these symptoms are different and they may indicate different problems. Vertigo is a feeling that you or your surroundings are moving when there is no actual movement. The motion is commonly described as a feeling of spinning or whirling but can also include sensations of falling or tilting. Nausea and vomiting often accompany more severe episodes of vertigo. It may be difficult to walk or stand, and you may lose your balance and fall.

Vertigo caused by labyrinthitis begins suddenly without warning and gradually goes away over a few days to weeks, although sudden head movement can trigger vertigo for a month or longer.

You may also develop a condition called nystagmus, which is involuntary or "jerking" eye movements.

Labyrinthitis may also cause hearing loss, which is usually temporary, along with a ringing sound in the ears (tinnitus).

Labyrinthitis is diagnosed with a medical history and a physical examination. If you have symptoms of vertigo (spinning or whirling sensation), your doctor will determine whether it is from inflammation of the labyrinth and, if so, whether you have recently had a viral or bacterial infection.

Your doctor may perform a Dix-Hallpike test, which can offer clues about the cause of vertigo. Your doctor may also look for signs of an ear infection, which can cause labyrinthitis.

If the cause of your vertigo is unclear, your doctor may want to do more tests. Such tests can help determine whether your vertigo is caused by problems in the inner ear or brain. Brain-related causes of vertigo (such as stroke, head injury, brain tumors, or multiple sclerosis) are less common.

Additional tests that may be done to rule out other causes of your vertigo include:

• Electronystagmogram, which uses electrodes to detect eye movements. It looks for characteristic eye movements that occur when the inner ear is stimulated. The pattern of eye movements can indicate the location of the cause of the vertigo, such as the inner ear or the central nervous system.
• Imaging tests, such as computed tomography of the head and face (CT scan) or magnetic resonance imaging of the head (MRI), which may be done if the vertigo could be caused by a brain problem.
• Hearing tests, although these tests are of limited use in finding the cause of vertigo. Hearing tests measure the ability of sound to reach the brain. A specific type of hearing test, called an auditory brain stem response (ABR) test, may be done to determine whether the nerve from the inner ear to the brain is working correctly.

Labyrinthitis usually goes away on its own within a few days to weeks. If labyrinthitis was triggered by a bacterial infection, antibiotics may be prescribed. Viral infections cannot be cured with antibiotics.

Additional treatment is intended to keep you comfortable until the labyrinthitis goes away. Medicines called vestibular suppressants may be prescribed to reduce symptoms.

• Antiemetics, such as prochlorperazine or promethazine, control severe nausea and vomiting.
• Antihistamines reduce nausea, dizziness, and vomiting. Examples include diphenhydramine hydrochloride (Benadryl) and dimenhydrinate (Dramamine).
• Scopolamine reduces vomiting. An example is Transderm-Scop, a patch that is placed on the skin behind the ear.
• Sedatives reduce vomiting, nausea, and anxiety. These include clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan).

If a bacterial infection has injured your inner ear, you may continue to have symptoms of vertigo even after the infection has healed. Over time, your body should adjust to the confusing signals from the balance sensory systems that falsely tell your brain to detect motion that isn't occurring. The vertigo will eventually improve or disappear completely. This process is called compensation. Remaining as active as possible speeds compensation. Medicines may slow compensation and should only be taken for 1 to 2 weeks.

What To Think About

If your doctor prescribes antibiotics, be sure to take them exactly as prescribed. And do not stop taking them even if you feel better; otherwise, the infection may not go away.

Persistent vertigo may be caused by other conditions and should be evaluated by your doctor.

Vertigo (a whirling or spinning sensation) is most intense during the first 2 to 3 days of labyrinthitis. Bed rest and keeping your head still may initially relieve symptoms of nausea, vomiting, and vertigo.

But if vertigo lasts for more than a few days, returning to normal daily activities may help. Staying active, while difficult if it triggers vertigo, usually helps the brain adapt (compensate) to the vertigo more quickly. It is especially important to move your head as you normally would and avoid holding it completely still. As compensation occurs, vertigo will gradually go away.

Although labyrinthitis is generally a short-term condition, there are steps you can take at home to manage your symptoms.

• Take safety precautions for vertigo, such as keeping your home uncluttered and using nonskid mats around your house and in your bath.
• Try balance exercises for vertigo, such as simple head movements and maintaining your balance while standing or sitting.
• Do Brandt-Daroff exercises for vertigo, which include sitting on the edge of your bed or sofa, quickly leaning to one side, and then lying on that side until the spinning or whirling sensation goes away or for at least 30 seconds.

Check with your doctor first before trying exercises at home to reduce symptoms of vertigo associated with labyrinthitis.

Organization

Related Information

• Benign Paroxysmal Positional Vertigo (BPPV)
• Dizziness: Lightheadedness and Vertigo
• Ear Infections
• Ménière's Disease
• Meningitis
• Vestibular Neuritis

Other Works Consulted

• Baloh RW (2008). Hearing and equilibrium. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 23rd ed., pp. 2881–2888. Philadelphia: Saunders Elsevier.

• Daroff RB (2008). Dizziness and vertigo. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 1, pp. 144–147. New York: McGraw-Hill Medical.

• Valvassori GE (2003). Imaging of the temporal bone. In JB Snow Jr, JJ Ballenger, eds., Ballenger's Otorhinolaryngology Head and Neck Surgery, 16th ed., chap. 7, pp. 195–229. Hamilton, ON: BC Decker.