Labyrinthitis

What is labyrinthitis?

Labyrinthitis is the inflammation of part of the inner ear called the labyrinth. The eighth cranial nerve (vestibulocochlear nerve) may also be inflamed. The inflammation of these causes symptoms such as a feeling of spinning (vertigo), hearing loss, nausea, vomiting, impaired hearing, and tinnitus (ringing in the ear). In most people, these symptoms go away over time. It is not a common condition. It often only affects one ear.

The inner ear has a system of fluid-filled tubes and sacs called the labyrinth. Inside the inner ear, the cochlea gathers information about sound. The vestibular organs gather information about motion and changes in space. These all help to create a sense of balance. The eighth cranial nerve sends all of this information from the inner ear to the brain.

When one of the nerves or the labyrinth is infected, it can become inflamed and irritated. This can cause it to not work normally. It may cause hearing loss in one ear. The brain now has to make sense of the information that doesn’t match between the normal nerve and the affected one. This causes vertigo.

What causes labyrinthitis?

A viral infection of the eighth cranial nerve or labyrinth may cause the condition. The virus may have spread all over your body. Or it may affect only the eighth cranial nerve and labyrinth. In most cases, only one nerve is affected. Viruses known to cause labyrinthitis include:

• Herpes viruses

• Influenza

• Measles

• Mumps

• Rubella

• Polio

• Hepatitis

• Epstein-Barr

• Varicella

Bacterial infections of the middle ear are fairly common in children. In rare cases, an infection in the middle part of the ear can spread to the inner ear and cause labyrinthitis. This is more of a risk with middle-ear infections that are long-lasting (chronic) and not treated. In rare cases, bacterial meningitis, a head injury, or having a certain autoimmune condition may cause labyrinthitis. In other cases, the cause is not known.

Who is at risk for labyrinthitis?

Having a viral infection that can cause labyrinthitis increases your risk. Your child’s risk may increase if they haven’t had the advised vaccines or if they have long-lasting, untreated, middle-ear infections.

What are the symptoms of labyrinthitis?

Symptoms of labyrinthitis may include:

• A feeling of spinning (vertigo)

• Dizziness

• Lack of balance when walking

• Nausea and vomiting

• Not able to focus (concentrate)

• Periods of uncontrolled, back-and-forth eye movements (nystagmus)

• Hearing loss

• Ringing in the ears (tinnitus)

Your symptoms might range from mild to severe. They may come on very quickly. In many people, these symptoms go away over several weeks. Others have symptoms that last longer.

A related syndrome is called vestibular neuritis. It causes similar symptoms. But it doesn't cause hearing problems. Inflammation affects only the vestibular part of the labyrinth and eighth cranial nerve.

Labyrinthitis doesn't cause neurological symptoms such as severe headache, speech problems, or loss of arm or leg movement.

How is labyrinthitis diagnosed?

Your healthcare provider will ask about your health history. You may also have a physical exam. This may include hearing and balance tests. It will also include an exam of your nervous system. Many neurological and other health conditions can cause dizziness and vertigo. Your provider may need to rule these out.

There are no tests for labyrinthitis. But your provider may have you take an imaging test. This can help to rule out other causes of your symptoms, such as stroke.

You may have tests such as:

• MRI. This imaging test is done to rule out stroke.

• Electrocardiogram (ECG) or other cardiovascular tests. These can rule out cardiovascular causes.

• Electronystagmography (ENG) or videonystagmography (VNG). These record your eye movement. This helps to find the exact area of the problem in your vestibular system and evaluate the cause of your balance disorder.

How is labyrinthitis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on the underlying cause and how severe the condition is.

Immediate treatment for labyrinthitis might include:

• Corticosteroid medicines (to help reduce nerve inflammation)

• Antiviral medicines

• Antibiotics (if there are signs of a bacterial infection)

• Medicines to take for a short time that control nausea and dizziness (such as diphenhydramine and lorazepam)

If your symptoms go away in a few weeks, you likely won’t need other treatment. If you have symptoms that don’t go away, you may need to do certain exercises. These are known as vestibular rehabilitation exercises. They are a form of physical therapy. These exercises may help your brain learn to adjust to the vestibular imbalance. Rarely, surgical intervention may be needed to treat labyrinthitis.

What are possible complications of labyrinthitis?

In most cases, labyrinthitis doesn't cause any problems. In rare cases, it causes lasting (permanent) damage to the eighth cranial nerve. This can cause lasting problems with balance, and part or total hearing loss. You might need to use a hearing aid. Get treatment right away to help reduce your risk for these complications.

When should I call my healthcare provider?

Call your healthcare provider if your symptoms get worse or don’t begin to go away after a few days of treatment. Also call your provider right away if you have new symptoms, such as trouble moving an arm or a leg.

Key points about labyrinthitis

• Labyrinthitis often results from a viral infection of the eighth cranial nerve or the labyrinth.

• Symptoms include vertigo, hearing loss, dizziness, issues with balance, tinnitus, and nausea and vomiting. Symptoms may start suddenly and go away in a few weeks.

• Your healthcare provider will need to rule out other more dangerous causes of vertigo, such as stroke.

• You might need medicines to treat your symptoms.

• If your symptoms don’t go away, you may need rehabilitation exercises to help your brain adjust to the vestibular imbalance.

• In rare cases, this condition can cause permanent hearing loss and ongoing vertigo.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also, know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.