Alternate Names: Bacterial labyrinthitis; Serous labyrinthitis

Causes and Risks: The cause of labyrinthitis is unknown but since it commonly occurs following otitis media or an upper respiratory infection (URI), it is thought to be a consequence of viral or bacterial infection. It may also follow allergy, cholesteatoma, or ingestion of toxic drugs.

The semicircular canals of the inner ear (labyrinth) become inflamed. This disrupts their function, including the regulation of balance. Risk factors include recent viral illness, respiratory infection, or ear infection; use of prescription or nonprescription drugs (especially aspirin); stress; fatigue; and a history of allergy, smoking, or alcohol consumption.

Prevention: Prompt treatment of respiratory infections and ear infections may help prevent labyrinthitis.

Symptoms:

• dizziness
• abnormal sensation of movement (vertigo)
  • may be accompanied by nausea and vomiting
  • may be severe
  • may be continuous for up to a week at a time
  • severe episodes may be followed by transient episodes for several weeks
• loss of balance, especially falling toward the affected side
• hearing loss in the affected ear (especially with bacterial labyrinthitis)
• ringing or other noises in the ears (tinnitus)
• involuntary eye movements

Signs and Tests: An ear examination may not reveal any changes.

Differentiation from other causes of dizziness or vertigo may include:

• head CT scan or MRI scan
• hearing testing (audiology/audiometry)
• caloric stimulation (tests reflexes of the eye)
• electronystagmography
• EEG, evoked auditory potential studies

Treatment: Labyrinthitis usually runs its course over a few weeks. However, symptoms may need treatment. Medications that may reduce symptoms include antihistamines, anticholinergics, sedative-hypnotics, anti-emetics (antinausea medications), and diazepam.

To prevent worsening of symptoms during episodes of labyrinthitis, keep still, rest during attacks, and gradually resume activity. Avoid sudden position changes. Do not try to read during attacks, and avoid bright lights.

Assistance with walking may be needed during attacks. Avoid hazardous activities (such as driving, operating heavy machinery and climbing, etc.) until 1 week after symptoms disappear.

Prognosis: Recovery is usually spontaneous and hearing usually returns to normal.

Complications:

• injury to self or others during attacks of vertigo
• permanent hearing loss in the affected ear (rare)
• spread of inflammation to other ear areas or to the brain (rare)

Call your health care provider if dizziness, vertigo, loss of balance, or other symptoms of labyrinthitis are present. Also call if hearing loss occurs.

Urgent or emergency symptoms include convulsions, fainting, persistent vomiting, or vertigo accompanied by fever over 101 degrees Fahrenheit.