Labyrinthitis

Some sources consider vestibular neuritis and labyrinthitis to be the same thing (some differentiate based on auditory symptoms)

Background

• Infection of cochlear and vestibular apparatus (from middle ear via round/oval windows)
• Acute suppurative labyrinthitis is only cause of peripheral vertigo requiring urgent treatment
• Some sources consider vestibular Neuritis and labyrinthitis to be the same thing
  • Some differentiate based on auditory symptoms

Clinical Features

• Peripheral vertigo + hearing loss + middle ear findings
  • Severity depends on type of labyrinthitis:
    • Acute suppurative labyrinthitis
      • Caused by extension of infection from otitis media, meningitis, mastoiditis
      • Signs of toxicity
    • Serous labyrinthitis
      • Caused by inflammatory response to nearby infections (including viral)
        • May find serous serous fluid behind tympanic membrane
      • Clinical course similar to Vestibular Neuritis (Neuronitis)

Differential Diagnosis

Vertigo

• Vestibular/otologic
  • Benign paroxysmal positional vertigo (BPPV)
  • Traumatic (following head injury)
  • Infection
    • Labyrinthitis
    • Vestibular neuritis
    • Ramsay Hunt syndrome
  • Ménière's disease
  • Ear foreign body
  • Otic barotrauma
  • Otosclerosis
• Neurologic
  • Cerebellar stroke
  • Vertebrobasilar insufficiency
  • Lateral Wallenberg syndrome
  • Anterior inferior cerebellar artery syndrome
  • Neoplastic: cerebellopontine angle tumors
  • Basal ganglion diseases
  • Vertebral Artery Dissection
  • Multiple sclerosis
  • Infections: neurosyphilis, tuberculosis
  • Epilepsy
  • Migraine (basilar)
• Other
  • Hematologic: anemia, polycythemia, hyperviscosity syndrome
  • Toxic
    • Alcohol
    • Aminoglycosides
  • Chronic renal failure
  • Metabolic
    • Thyroid Disease
    • Hypoglycemia

Evaluation

See Vertigo

Management

• Suppurative form requires antibiotics
• Prochlorperazine 10mg PO q6 PRN for nausea/vomiting
• Lorazepam OR diazepam as vestibular depressant
• Bed rest and hydration
• Corticosteroids controversial especially in concomitant suppurative form

Disposition

• Suppurative form require admission for definitive ENT treatment

See Also

• Vertigo
• Dizziness
• Vestibular Neuritis (Neuronitis)