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Labyrinthitis - Causes, Symptoms and Treatment

Definition:

An inflammation of the labyrinth of the inner ear, labyrinthitis frequently incapacitates the patient by producing severe vertigo that lasts for 3 to 5 days; symptoms gradually subside in 3 to 6 weeks. Associated symptoms include tinnitus and hearing loss. This disorder is rare, although viral labyrinthitis is often associated with upper respiratory tract infections.

Causes of Labyrinthitis

Labyrinthitis is usually caused by viral infection. It may be a primary infection; the result of trauma; or a complication of influenza, otitis media, or meningitis. In chronic otitis media, cholesteatoma formation crodes the bone of the labyrinth, allowing bacteria to enter from the middle ear. Ototoxic drugs (particularly aminoglycosides) or toxic drug ingestion are other possible causes of labyrinthitis.

Signs and Symptoms of Labyrinthitis

Because the inner ear controls both hearing and balance, this infection typically produces severe vertigo (with any movement of the head) and sensorineural hearing loss. Vertigo begins gradually but peaks within 48 hours, causing loss of balance and falling in the direction of the affected ear. Other associated signs and symptoms include spontaneous nystagmus, with jerking movements of the eyes toward the unaffected ear; nausea, vomiting, and giddiness; with cholesteatoma, signs of middle ear disease; and with severe bacterial infection, purulent drainage. To minimize symptoms such as giddiness and nystagmus, the patient may assume a characteristic posture-lying on the side of the unaffected ear and looking in the direction of the affected ear.

Diagnosis for Labyrinthitis

A typical clinical picture and history of upper respiratory tract infection suggest labyrinthitis. Common diagnostic measures include culture and sensitivity testing to identify the infecting microbe if purulent drainage is present, and audiometric testing. When an infectious etiology can't be found, additional testing must be done to rule out a brain lesion or Meniere's disease. Differential diagnoses include benign positional vertigo, vestibular neuronitis, Meniere's disease, acoustic neuroma and other tumors of the cerebellopontine angle, and basilar insufficiency.

Treatment for Labyrinthitis

Symptomatic treatment includes bed rest, with the head immobilized between pillows; oral medicine to control vertigo; and massive doses of antibiotics to combat diffuse purulent labyrinthitis. Oral fluids can prevent dehydration from vomiting; for severe nausea and vomiting, I.V. fluids may be necessary. When conservative management fails, surgical excision of the cholesterol and drainage of the infected areas of the middle and inner ear may be done.

Special Considerations and Prevention Tips for Labyrinthitis

  • Keep the side rails up to prevent falls.
  • If vomiting is severe, administer antipyretics. Record intake and output, and give I.V. fluids as necessary.
  • Tell the patient that recovery may take as long as 6 weeks. During this time, the patient should limit activities that vertigo may make hazardous.
  • If recovery doesn't occur within 4 to 6 weeks, a computed tomography scan should be performed to rule out an intracranial lesion.

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