Labyrinthitis: Difference between revisions

Latest revision as of 09:35, 22 March 2026

Some sources consider vestibular neuritis and labyrinthitis to be the same condition; differentiation is based on the presence of auditory symptoms.

Background

Inflammation of the inner ear (cochlear and vestibular apparatus)
Key distinction from vestibular neuritis: Labyrinthitis includes hearing loss in addition to vertigo
Types:
- Viral/serous: Most common; follows viral URI; self-limited (similar course to vestibular neuritis)
- Suppurative (bacterial): Extension from otitis media, meningitis, or mastoiditis — requires urgent treatment

Clinical Features

Acute, continuous peripheral vertigo (not positional)
Unilateral sensorineural hearing loss and/or tinnitus (distinguishes from vestibular neuritis)
Nausea/vomiting
Unidirectional horizontal nystagmus (fast phase away from affected ear)
Normal neurologic exam otherwise
Suppurative form: Fever, otorrhea, signs of systemic toxicity, concurrent otitis media or mastoiditis

Differential Diagnosis

Vertigo

Vestibular/otologic
- Benign paroxysmal positional vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- 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

HINTS Exam: Differentiates peripheral from central cause of acute vestibular syndrome
- HI: Head impulse test (positive/corrective saccade = peripheral)
- N: Nystagmus (unidirectional = peripheral; direction-changing = central)
- TS: Test of skew (vertical skew deviation = central)
Hearing assessment (bedside finger rub; formal audiometry outpatient)
Assess for otitis media/mastoiditis on otoscopy
CT/MRI brain: If HINTS concerning for central cause, or if suppurative form suspected

Management

Viral/serous:
- Vestibular suppressants (short-term, 24-72 hours only): meclizine 25 mg PO q6h, diazepam 2-5 mg PO q8h, or promethazine
- Antiemetics: ondansetron, prochlorperazine
- Early vestibular rehabilitation (encourage mobilization after acute phase)
- Corticosteroids controversial but may hasten recovery
Suppurative: IV antibiotics targeting middle ear pathogens; urgent ENT consult

Disposition

Viral: discharge with vestibular suppressants (limit to 3 days), antiemetics, PCP/ENT follow-up
Suppurative: admit for IV antibiotics and ENT evaluation
Return if: New neurologic symptoms, severe headache, inability to tolerate PO

References

Authors:

@@ Line 1: / Line 1: @@
+''Some sources consider [[Vestibular Neuritis (Neuronitis)|vestibular neuritis]] and labyrinthitis to be the same condition; differentiation is based on the presence of auditory symptoms.''
 ==Background==
-*Infection of cochlear and vestibular apparatus (from middle ear via round/oval windows)
+*Inflammation of the inner ear (cochlear and vestibular apparatus)
-*Acute suppurative labyrinthitis is only cause of peripheral vertigo requiring urgent tx
+*Key distinction from [[Vestibular Neuritis (Neuronitis)|vestibular neuritis]]: Labyrinthitis includes hearing loss in addition to vertigo
-*Some sources consider [[Vestibular Neuritis]] and Labyrinthitis to be the same thing
+*Types:
-**Some differentiate based on auditory symptoms
+**Viral/serous: Most common; follows viral URI; self-limited (similar course to vestibular neuritis)
+**Suppurative (bacterial): Extension from [[otitis media]], [[meningitis]], or [[mastoiditis]] — requires urgent treatment
+==Clinical Features==
+*Acute, continuous peripheral [[vertigo]] (not positional)
+*Unilateral sensorineural [[hearing loss]] and/or [[tinnitus]] (distinguishes from vestibular neuritis)
+*[[Nausea/vomiting]]
+*Unidirectional horizontal nystagmus (fast phase away from affected ear)
+*Normal neurologic exam otherwise
+*Suppurative form: Fever, otorrhea, signs of systemic toxicity, concurrent [[otitis media]] or [[mastoiditis]]
-==Diagnosis==
+==Differential Diagnosis==
-===Clinical Features===
+{{Vertigo DDX}}
-*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 respones to nearby infections (including viral)
-****Clinical course similar to [[Vestibular Neuritis (Neuronitis)]]
-==Workup==
+==Evaluation==
-See [[Vertigo]]
+*[[HINTS Exam]]: Differentiates peripheral from central cause of acute vestibular syndrome
+**HI: Head impulse test (positive/corrective saccade = peripheral)
+**N: Nystagmus (unidirectional = peripheral; direction-changing = central)
+**TS: Test of skew (vertical skew deviation = central)
+*Hearing assessment (bedside finger rub; formal audiometry outpatient)
+*Assess for otitis media/mastoiditis on otoscopy
+*CT/MRI brain: If HINTS concerning for central cause, or if suppurative form suspected
-==Treatment==
+==Management==
-*Suppurative form requires abx
+*Viral/serous:
+**Vestibular suppressants (short-term, 24-72 hours only): [[meclizine]] 25 mg PO q6h, [[diazepam]] 2-5 mg PO q8h, or [[promethazine]]
+**Antiemetics: [[ondansetron]], [[prochlorperazine]]
+**Early vestibular rehabilitation (encourage mobilization after acute phase)
+**Corticosteroids controversial but may hasten recovery
+*Suppurative: IV antibiotics targeting middle ear pathogens; urgent ENT consult
 ==Disposition==
-*Suppurative form require admission for definitive ENT treatment
+*Viral: discharge with vestibular suppressants (limit to 3 days), antiemetics, PCP/ENT follow-up
+*Suppurative: admit for IV antibiotics and ENT evaluation
+*Return if: New neurologic symptoms, severe headache, inability to tolerate PO
 ==See Also==
 *[[Vertigo]]
+*[[Vestibular Neuritis (Neuronitis)]]
+*[[HINTS Exam]]
+*[[Benign paroxysmal positional vertigo]]
 *[[Dizziness]]
-*[[Vestibular Neuritis (Neuronitis)]]
-==Source==
+==References==
-Tintinalli
+<references/>
 [[Category:ENT]]