Labyrinthitis
| Labyrinthitis | ||
| ICD-10 | H83.0 | |
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| ICD-9 | 386.3 | |
| DiseasesDB | 29290 | |
| MeSH | C09.218.568.315 | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Aditya Ganti M.B.B.S. [2]
Synonyms and keywords: Otitis interna, vestibular neuronitis, vestibular neuritis
Overview
Labyrinthitis is a disorder that affects the balance in the body. It is basically an inflammatory process of the Labyrinth, which is the inner ear, and contains the vestibular system. Thus, it is responsible for sensing the position of the head and body on the whole. It contains fluid-filled channels, which in turn control the balance of the body and hearing. With any movement, the fluid moves in the channels and transmits electrical signals to the brain, thus helping the body to balance. Due to the difference in the transmitted signals from the inflamed and noninflamed ear, derangements can occur, which ultimately makes the person feel dizzy [1].
Along with balance problems, patients often experience hearing loss and tinnitus. Usually caused by a virus, or from bacterial infection,upper respiratory tract infection, labyrinthitis can also occur due to head injury, an allergy or as adverse drug reaction to any medicine. Although rare, all these can cause permanent hearing loss.
Labyrinthitis is also known as Vestibular neuritis or acute peripheral vestibulopathy [2]. Mostly, it is a self-limited disorder, with acute short term symptoms like vertigo, nausea, vomiting, and gait impairment, with complete recovery in most patients.
Another common condition associated with labyrinthitis is anxiety, which produces tremors, palpitations, panic attacks, and depression. in many cases, panic attacks and anxiety are the first symptoms to be associated with labyrinthitis.
Classification
- Viral labyrinthitis: This is caused by an viral upper respiratory tract infection, which includes cold or flu. Apart from this, many other viruses like the varicella-zoster virus, and the mumps, measles, and rubella viruses can also cause labyrinthitis [3]. This type of disease is the most prevalent.
- Bacterial labyrinthitis: This is second most common after viral infections, often, occurring as a complication of infection in the middle ear,(otitis media)[4]. Often, there is sudden unilateral hearing loss, dizziness, and vertigo. These are more prevalent in children than in adults. The best treatment approach is with antibiotics, which successfully manages the bacterial labyrinthitis and causes full recovery.
- Autoimmune labyrinthitis: This type of labyrinthitis is less common than others.
- Conditions causing damage to the cochlea inside your inner ear like meningitis, circulatory problems, or Ménière’s disease.
Differential diagnosis
Conditions which mimic Labyrinthitis are[5]:
- Meniere's disease
- Migraine headache
- Stroke
- Intracranial hemorrage
- Damage to the vascular structures in the neck
- Benign paroxysmal positional vertigo
- Brain tumor
Epidemiology and Demographics
- Adults in the age group of 30 to 60 years are most commonly affected. The incidence of labyrinthitis is around 3.5 cases per 100,000.
- Viral labyrinthitis, the most common type, is more prevalent in adults, whereas the other types of infections affect the children on a larger scale. This can be assessed by the fact that children under the age of two are more predisposed to develop bacterial labyrinthitis.
- Bacterial labyrinthitis is overall, less prevalent than other causes.
Risk Factors
Certain conditions can increase the risk of labyrinthitis:
- Upper respiratory tract infections
- Infections of the middle ear
- Meningitis
- Head injuries
- Respiratory illnesses like bronchitis
- Viral infections, like herpes and measles
- Autoimmune diseases
Natural History, Complications, and Prognosis
- The symptoms of labyrinthitis usually start suddenly. Occasionally the patient wakes up with these symptoms and they are progressive.
- There is usually a relief in the symptoms after a few days. Often, the loss of balance is restored in a couple of weeks, but in some cases, it can take longer.
- In some severe and rare cases, there can be a permanent loss of hearing.
- Certain factors like cold, previous illnesses, fatigue, menstruation, and respiratory infections can worsen the symptoms.
Recovery
The recovery from an attack of labyrinthitis follows the following phases:
- An acute period, which includes symptoms like vertigo, nausea, and vomiting.
- ssubacute symptoms, which last for a couple of weeks, followed by a rapid recovery
- chronic compensation, which extends over a period of a couple of months or even years.
Diagnosis
Diagnostic Study of Choice
Viral labyrinthitis is a clinical diagnosis. But a number of a diagnostic tests are performed to rule out other diseases. Tests that can rule out other causes of your symptoms include:
- EEG (measures the electrical activity of the brain)
- Electronystagmography, and warming and cooling the inner ear with air or water to test eye reflexes (caloric stimulation)
- Head CT scan
- Hearing test
- MRI of the head
History and Symptoms
Labyrinthitis is characterized by following symptoms and signs including :
- Dizziness
- Vertigo
- Loss of balance/gait instability
- Nausea and vomiting
- Tinnitus
- Loss of hearing in the high-frequency range
- Difficulty focusing your eyes
Physical Examination
- Hearing tests
- Eye test
- Blood pressure
- Assessment of balance
Laboratory Findings
Labyrinthitis is a clinical diagnosis. As a result, routine blood tests are not helpful in making any diagnosis. However, if systemic infection is suspected, FBC and blood cultures are indicated
Diagnostic Studies and Imaging Findings
- A CT scan can help rule out mastoiditis.
- A temporal bone CT scan may help in patients with cholesteatoma and labyrinthitis, although gadolinium MRI is more useful in the early stages of suppurative labyrinthitis
- Perform culture and sensitivity testing of middle ear effusions if present
- Vestibular function testing like Caloric testing and an electronystagmogram may be used
- Vestibular-evoked myogenic potentials to assess vestibular activity
Treatment
Viral labyrinthitis causes a sudden onset of vertigo, nausea, vomiting, and sudden hearing loss. Due to the inefficacy of antibiotics against viruses, symptomatic treatment is preferred which includes antivertigo medications, antihistamines, and rest. Usually, the patient feels better within a week and after two weeks will begin to compensate for the dizziness/vertigo. Acute episodes can sometimes last up to one to two months. Most people recover fully from viral labyrinthitis and the vestibular rehabilitation exercises are highly recommended.
Certain emergency conditions which warrant immediate medical attention are
- Fainting
- Convulsions
- Slurred speech
- Fever
- Weakness
- Paralysis
- Double vision
Medical Therapy
Symptomatic patients need treatment with the following:
- Antihistamines, like desloratadine and loratadine
- Drugs that can reduce dizziness and nausea, such as meclizine
- Sedatives, such as diazepam
- Corticosteroids, such as prednisone
- Over-the-counter antihistamines, such as fexofenadine, diphenhydramine, or loratadine
Prochlorperazine is commonly prescribed to help alleviate the symptoms of vertigo and nausea.
Because anxiety interferes with the balance compensation process, it is important to treat an anxiety disorder and/or depression as soon as possible to allow the brain to compensate for any vestibular damage. Acute anxiety can be treated in the short term with benzodiazepines such as diazepam (Valium); however, long-term use is not recommended because of the addictive nature of benzodiazepines and the interference they may cause with vestibular compensation and adaptive plasticity (Solomon and Shepard, 2002).
Evidence suggests that selective serotonin-reuptake inhibitors may be more effective in treating labyrinthitis. They act by relieving anxiety symptoms and may stimulate new neural growth within the inner ear, allowing more rapid vestibular compensation to occur. Trials have shown that SSRIs do in fact affect the vestibular system in a direct manner and can decrease dizziness (Staab and Ruckenstein, 2005).
Some evidence suggests that viral labyrinthitis should be treated in its early stages with corticosteroids such as prednisone, and possibly antiviral medication such as Valtrex and that this treatment should be undertaken as soon as possible to prevent permanent damage to the inner ear.
Interventions
Apart from medical therapy, we can use several techniques to relieve vertigo associated with labyrinthitis:
- Avoid quick or sudden movements or brisk changes in position
- Try and sit still during a vertigo attack
- Slow and smooth movements while getting up from lying down position
- Avoid prolonged watching of screens, and bright or flashing lights during an attack
- Sitting up in a chair and keeping the head still, if experience vertigo in sitting position also
- Stress management techniques to control emotional and psychological stress
- Using warm compresses over the ear helps in relieving the pain
- Avoid smoking and limit alcohol intake
Primary Prevention
- Rest in a dark room if feeling dizzy
- Plenty of fluids, drink little quantities and often
- Avoid loud noise and bright lights
- Get adequate sleep
Secondary Prevention
- Physical and occupational therapy to help improve balance.
- Vestibular rehabilitation: exercises under the supervision of a physiotherapist, that can help to restore balance. Vestibular rehabilitation therapy (VRT) is a highly effective way to substantially reduce or eliminate residual dizziness from labyrinthitis. VRT works by causing the brain to use already existing neural mechanisms for adaptation, plasticity, and compensation. Vestibular rehabilitation therapy can help with your balance and walking and make everyday activities easier. The direction, duration, frequency, and magnitude of the directed exercises are closely correlated with adaptation and recovery. Symmetry is more rapidly restored when VRT exercises are specifically tailored for the patient.
See also
References
- Bronstein A (2002), Visual and psychological aspects of vestibular disease, Current Opinion in Neurology 2002, 15:1–3.
- Simon NM, Pollack MH, Tuby KS et al (1998), Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety, Ann Clin Psychiatry, 10(2):75–80.
- Solomon D and Shepard NT (2002), Chronic Dizziness, Current Treatment Options in Neurology, 4:281–288.
- Staab J and Ruckenstein M (2005), Chronic Dizziness and Anxiety, Arch Otolaryngol Head Neck Surg, 131:675-679.
External links
- My personal battle with Labyrinthitis How Ryan Roper overcame the condition.
- DizzyTimes.com
- Dr. Rauch's Online Otology Clinic — video clips
- Labyrinthitis.co.uk
- Labyrinthitis.org.uk
- Vestibular neuritis and labyrinthitis
- neuro/686 at eMedicine - "Labyrinthitis and related conditions"
- ent/666 at eMedicine - "Vestibular rehabilitation therapy"
- Inner ear healthboard
- The Dizzy Lounge
- Labyrinthitis Support Forums
- Labyrinthitis and vestibular neuritis
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Template:WH Template:WikiDoc Sources
- ↑ Karmody CS (December 1983). "Viral labyrinthitis: early pathology in the human". Laryngoscope. 93 (12): 1527–33. doi:10.1288/00005537-198312000-00001. PMID 6606097.
- ↑ Baloh RW (March 2003). "Clinical practice. Vestibular neuritis". N. Engl. J. Med. 348 (11): 1027–32. doi:10.1056/NEJMcp021154. PMID 12637613.
- ↑ Brill GC (January 1982). "Acute labyrinthitis: a possible association with influenza". J R Coll Gen Pract. 32 (234): 47–50. PMC 1970972. PMID 7086745.
- ↑ Jang CH, Park SY, Wang PC (February 2005). "A case of tympanogenic labyrinthitis complicated by acute otitis media". Yonsei Med. J. 46 (1): 161–5. doi:10.3349/ymj.2005.46.1.161. PMC 2823044. PMID 15744821.
- ↑ Thompson TL, Amedee R (2009). "Vertigo: a review of common peripheral and central vestibular disorders". Ochsner J. 9 (1): 20–6. PMC 3096243. PMID 21603405.