What is labyrinthitis and vestibular neuritis?
If you’ve recently been diagnosed with an inner ear infection, the first thought going through your mind was probably the fact that you didn’t know you had an inner ear. And if you did, you may not have known that this, when infected, was an actual condition. To explain it simply, your inner ear is the section between the oval window (membrane covering the entrance to the middle ear) and the eardrum. Your middle ear is responsible for transmitting sounds from your outer ear to your inner ear. Your inner ear plays a vital part in hearing as it converts nerve impulses from the fluid inside of it and sends these to the brain.
So, now that you know that you have an inner ear, we are going to explain what it means to have an infection of the inner ear, known as labyrinthitis. The labyrinth is the part of your inner ear that helps in controlling your balance and sends signals to your brain to help you to determine spatial awareness. When this part of the ear develops an infection, it will become inflamed and swollen.
The result of this inflammation is often a sudden surge of vertigo. When you experience vertigo, you may feel dizzy, disorientated, hear a ringing noise in your ears or experience a temporary loss of or difficulty in hearing. It is also not uncommon to feel as though you are rocking on a boat, even though in reality, you are not moving.
When this happens, your doctor may refer to the condition as vestibular neuritis. The two disorders have the same treatment and symptoms as both labyrinthitis and vestibular neuritis refer to when a vestibular nerve in the labyrinth is inflamed, however, labyrinthitis also includes a loss of hearing. The vestibular system is a part of the labyrinth and is a set of complex channels that are filled with fluid – these are responsible for your movement and balance.
Vestibular neuritis and labyrinthitis (which is what we will refer to it as for the duration of this article) are often triggered by a cold, flu or upper respiratory infection of some kind – indicating that it is due to a viral infection. Other infections such as mumps, measles or glandular fever are less common causes of labyrinthitis that is viral.
It can, however, sometimes be linked to a bacterial cause, although this is not as common. These cases are more frequently found in children and are often serious. If the infection is bacterial, the bacteria will enter through the ear if the thin membranes that separate the middle and inner are broken. This often happens when you are suffering from a middle ear infection or have meningitis which infects the lining of the brain.
The labyrinth is a spiral-like cavity that is made up of two sections, the vestibular system which is responsible for balance and movement and the cochlea which facilitates hearing. Thus, when the labyrinth is compromised by infection, your hearing and balance are affected.
Vertigo is the main symptom of an inner ear infection, it can occur suddenly in random episodes and brings vomiting and nausea along with it. Vertigo is known to last for a few days or even up to a few weeks, in more severe cases it can take months to go away. Full recovery is normally seen after a few months. The inflammation that causes the condition tends to disappear on its own. The typical treatment for vertigo is rest until you can either teach your body to deal with it a little better or until it resolves completely. Sedatives and antihistamines are normally given as a treatment for vertigo.
When the labyrinth is inflamed, it can often be painful as the build-up of fluid in the inner ear creates pressure and pain. However, it is not yet known how labyrinthitis can be prevented.
The following article seeks to educate you about the condition, its causes, symptoms, treatment and more. The purpose of this article is intended to serve as information only and should not be seen as a professional medical opinion.
What are the types of labyrinthitis?
Physiological process of labyrinthitis
As stated, the labyrinth is a membrane structure that is surrounded by dense bone. When this becomes infected, it is due to an infection of the middle ear, also known as the otitis media, that spreads to the inner ear and then from there, the infection can further spread into the internal auditory canal.
There are two types of labyrinthitis, viral and bacterial, with viral being the most common. These types are explained as follows:
Also known as vestibular neuritis, this condition is often the result of a viral infection. The symptoms are typically vertigo, nausea and vomiting. The symptoms are usually acute in the first 24 hours, after which they tend to gradually subside over the next few days. If you have viral labyrinthitis, you will be cured completely in a month or so. Diazepam, which is a vestibular (inner system of the ear responsible for balance) suppressant, as well as plenty of rest and hydration, are normally the initial treatment recommended by a doctor.
- Syphilitic labyrinthitis – This type of bacterial infection can be found at birth or it may be acquired over time. The symptoms normally develop gradually and they tend to vary in each case. They tend to progress into complete imbalance and issues with hearing. Sudden deafness or dizziness may also occur. A saddle-shaped nose, chronic eye inflammation and swelling of the forehead can also occur due to this type of labyrinthitis.
- Acute suppurative labyrinthitis – This a rare type of bacterial infection and the symptoms are typically the sudden onset of vertigo. It typically occurs as the result of a middle ear infection that is chronic and that has caused a bulk of solid debris in the middle ear. This mass can often wear down the surrounding bone of the inner ear, this further exposes the middle ear to infections. Meningitis may be a cause of suppurative labyrinthitis.
- Toxic labyrinthitis – This type of infection happens when a bacterial infection of the middle ear passes into the inner ear which results in a loss of hearing and balance. This can often be treated with antibiotics.
What causes labyrinthitis?
The exact cause of labyrinthitis is not yet known. As stated, it normally appears after a viral infection or, in rare cases, a bacterial infection. The typical trigger for viral labyrinthitis is seen to be a cold or flu – upper respiratory tract infections.
The vestibular nerve is first inflamed, resulting in incorrect signals being sent to the brain, telling the brain that your body is moving, when in actual fact it is not. Your vision, however, does not detect the same message as it sees that you are still, this makes you feel like the floor is moving, or the walls are spinning and you are losing your sense of balance. This is vertigo.
Labyrinthitis is known to affect you at any age. There are a number of factors known to cause the condition.
These are briefly listed as follows:
- Respiratory infection such as the cold or flu
- Inner ear viral infections
- Herpes viruses
- Stomach viruses
- Excessive alcohol intake
- Head injury
- Severe stress
The following explains how infections of the middle ear resulting in the inflammation of the vestibular nerve occur in detail:
When you have an ear infection, it is caused by a virus or bacterium entering the middle ear. This is often the result of another illness, as mentioned above. The outcome is you being congested and your throat, nasal passages and Eustachian tubes swelling.
Eustachian tubes as a cause
Your Eustachian tubes are two narrow tubes running behind the nasal passages, from your middle ears to the higher end of the back of your throat.
Where theses tubes meet the throat, they are responsible for opening and closing in order to the perform following functions:
- Bring in fresh air to the ears
- Drain the normal secretions of the middle ear
- Regulate the air pressure of the middle ear
When these tubes become swollen, inflamed or filled with extra mucus due to an upper infection of the respiratory tract, or an allergy that is blocking them, this results in fluids accumulating in the middle ear. The symptoms of an ear infection normally appear due to a viral or bacterial infection of the fluid.
Ear infections tend to occur more commonly in children than adults, this is due to the fact that their Eustachian tubes are narrower than those of an adult and they are also more horizontal, making drainage more difficult.
Adenoids as a cause
Adenoids are the two small tissue pads found high up in the back of your nose, these have been known to also play a role in the activity of your immune system. This makes them vulnerable to potential infection, swelling and inflammation.
Due to adenoids being located near the Eustachian tube openings when the adenoids are infected, the tubes may become blocked. This results in adenoids being a contributing factor to a middle ear infection. Children have slightly large adenoids, making adenoids the result of many ear infections in children.
Other conditions of the middle ear
Middle ear conditions that are known to play a role in ear infections or can be the cause of middle ear problems that are similar to labyrinthitis are as follows (please note that these do not commonly lead to labyrinthitis):
- Otitis media with effusion (fluid buildup) – This refers to the buildup of fluid and inflammation without a viral or bacterial infection of the middle ear. This can be the result of a fluid buildup that doesn’t go away after an ear infection. It can also be the result of the Eustachian tubes being blocked.
- Chronic otitis media with effusion – This happens when there is remaining fluid in the middle ear that continuously returns without a viral or bacterial infection present. This often increases the likelihood of children developing new infections and affects their hearing.
- Chronic suppurative otitis media – This is an ear infection that is persistent and can result in the eardrum tearing or perforating.
What are the symptoms of labyrinthitis?
Labyrinthitis can be overwhelming at first and appear suddenly without warning, the first few days are usually the most difficult, however accurate diagnosis and treatment can help in easing the symptoms.
The rapid onset of symptoms and signs of labyrinthitis is as follows:
Children (these symptoms also include those of an earache)
- Earache and pain, particularly felt when lying down
- Trouble sleeping
- They will often pull or tug at their infected ear
- Unusual crying
- Acting irritated
- Expressing difficulty with balance
- Fever over 37℃ (98.6℉)
- Not wanting to eat
- Visible fluid drainage from the ear
Adults (specific to labyrinthitis)
- An ache in the middle ear (otalgia)
- Difficulty hearing
- Ringing in ears, known as tinnitus
- Nausea and vomiting
- Finding it difficult to focus eyes
When to see a doctor
If you or your child is showing symptoms and signs of labyrinthitis, or an ear infection – which may also indicate several other conditions, then you should get medical help immediately in order for your doctor to provide an accurate diagnosis.
If you experience any of the following, these may pertain to a more severe condition and should be seen as serious, therefore it is advised that you get help immediately if you experience:
- A fever
- Speech that is slurred
- Feel abnormally weak
- Double vision
How is labyrinthitis diagnosed?
A physical exam is usually conducted, this helps your doctor to determine the cause of your condition based on your symptoms. Here, he/she will use an otoscope, which is a lighted examination instrument to look into your throat, nasal passage and ears. They will also use a stethoscope to listen to your breathing, placing this on your upper back and chest areas.
This is an instrument that allows your doctor to get a good look into the ear and determine whether fluid is present behind your eardrum. The instrument sends a puff of air against your eardrum, this normally results in the eardrum moving. If it does not move, or only moves a little bit, your doctor will conclude that there is fluid present in the middle ear.
Additional tests may be performed if your doctor is unable to give an accurate diagnosis or if the condition does not improve through treatment.
These tests can include undergoing the following:
- Taking blood tests in which a sample of your blood will be sent to a lab for testing to see if another condition may be the underlying issue.
- Recording cranial structural images of your head through an MRI (magnetic resonance imaging) or CT (computerised tomography) scan.
- Having an EEG (electroencephalogram) done to examine your brain waves.
- Having an ENG (electronystagmography) done in order to test your eye movement.
- Completing a hearing test known as acoustic reflectometry. This measures how much the sound emitted from a specialised device is then reflected from the eardrum, this basically indirectly measures the fluids inside the middle ear. This test uses the pneumatic otoscope.
What is the treatment for labyrinthitis?
The following medication can be prescribed to help relieve symptoms:
- Antihistamines - desloratadine (Clarinex), or over-the-counter options such as loratadine (Claritin), diphenhydramine (Benadryl), or fexofenadine (Allegra).
- Meclizine (Antivert) which helps to reduce nausea and dizziness.
- Diazepam as a sedative.
- Prednisone as a corticosteroid (these are used to treat inflammation).
- Motion sickness medication to aid in the treatment of loss of balance and vertigo.
- Antibiotics will only be prescribed if you have a bacterial infection in the respiratory tract, or if the labyrinthitis is bacterial as antibiotics are not effective in the treatment of viral infections.
To help treat vertigo, you can do the following:
- Do not move in sudden or quick movements.
- It is better to be in low lighting as this can help if you are feeling dizzy as bright lights are often deemed overwhelming when experiencing vertigo.
- If you are lying in bed and experience vertigo, try to keep your head still and sit up slowly.
- If you are walking and experience vertigo, try to find something to lean on or slowly sit down until it subsides.
PLEASE NOTE: It is not safe to drive if you are experiencing vertigo on a regular basis.
- Try to rest in a position that is comfortable for the first few days.
- Keep hydrated and drink a lot of water.
- Try to reduce your sodium and sugar intake as this can affect your vertigo as these foods are known to spike blood sugar levels.
- Avoid chocolate, alcohol and caffeine.
- Do not smoke cigarettes as these can make you feel lightheaded.
What is the outlook for labyrinthitis?
Most cases tend to resolve themselves in a few weeks with full recovery experienced after a month or so. Try and ease back on activities such as sports, work and driving until you have fully recovered as vertigo can impact your ability to function normally and put your safety at risk.
Cases tend to vary in severity. Some people may experience severe vertigo, others may just feel lightheaded and lose their sense of balance from time to time. If you feel as though you are getting dizzy, try to sit down and wait for the feeling to pass. If you have an infection of some kind already, such as a cold or the flu, and have the symptoms mentioned in this article, then book an appointment with your doctor as these may have caused an inner ear infection. Labyrinthitis is not a chronic condition and most people will only experience it once in their life.