Chronic labyrinthitis is a debilitating condition that affects the inner ear, or more specifically, the membranous labyrinth, causing persistent inflammation and resulting in a range of distressing symptoms.1 The symptoms associated with inflammation in this area could include long-lasting hearing loss, nausea, tinnitus, vertigo or vomiting, or a combination of these. This article aims to shed light on the causes of chronic labyrinthitis and explore the various factors that contribute to this challenging condition.
Definition of chronic labyrinthitis
The inner ear structure is also known as the labyrinth. The labyrinth, which consists of the cochlea and vestibular system, is responsible for our sense of balance and hearing. Labyrinthitis is an infection of the inner ear, in which inflammation of the delicate structure affects your hearing and balance, along with other symptoms. Labyrinthitis is usually self-limiting. That is, it will resolve itself after a few weeks. For a small number of people, however, some of these symptoms can last for several months or even years. When it lasts for several months, this is defined as chronic labyrinthitis.
Importance of understanding the causes
Understanding the causes of chronic labyrinthitis is important for several reasons:
Identifying the underlying causes helps healthcare professionals make an accurate diagnosis and differentiate chronic labyrinthitis from other conditions with similar symptoms. This is crucial for developing an appropriate treatment plan.
Different causes of chronic labyrinthitis may require different treatment approaches. If a bacterial or viral infection causes the condition, appropriate antibiotics or antiviral medications may be prescribed. On the other hand, if chronic labyrinthitis is due to an autoimmune disorder, immunosuppressive drugs might be necessary. Understanding the specific cause helps guide the selection of the most effective treatment options.
Prevention and risk management
Knowledge of the causes of chronic labyrinthitis can assist in identifying risk factors and implementing preventive measures. For instance, certain viral infections like herpes or bacterial infections like meningitis can lead to labyrinthitis. By understanding these associations, appropriate vaccinations or precautions can be taken to reduce the risk of developing chronic labyrinthitis.
Patient education and support
Understanding the causes of chronic labyrinthitis enables healthcare providers to educate patients about their condition. By explaining the underlying factors contributing to their symptoms, patients can gain a better understanding of the condition and its prognosis. This knowledge can alleviate anxiety and help individuals cope with their symptoms more effectively. Additionally, it allows healthcare professionals to provide appropriate support and resources to patients.
Causes of chronic labyrinthitis
Labyrinthitis can be due to an infection or can be due to non-infectious factors.1
Labyrinthitis is usually caused due to viral infections and sometimes due to bacterial infections.1
The most common cause of chronic labyrinthitis is viral infections. Viruses such as herpes simplex virus, measles virus, varicella-zoster virus and Epstein-Barr virus can target the inner ear, triggering inflammation and damage to the labyrinth. Viral labyrinthitis can often result from a previous viral infection, such as an upper respiratory tract infection or a viral illness like the flu. In some cases, the virus may directly invade the inner ear, leading to chronic labyrinthitis symptoms that persist long after the initial infection has resolved.1
The herpes virus group, which is the cause of chickenpox, shingles, and cold sores, is a common cause of inner ear infections that may lead to labyrinthitis.
Epstein-Barr virus is a common viral infection that spreads through saliva and bodily fluids. The virus attaches to white blood cells in your body. White blood cells help fight infection. When the virus attaches to your white blood cells, the cells cannot fight the infection as well, and you experience symptoms of a virus. This can result in prolonged infections, which can lead to labyrinthitis.
Another cause of labyrinthitis may be the reactivation of the varicella-zoster virus, called Ramsay Hunt syndrome. This is like shingles of the ear and can occur with labyrinthitis in addition to blisters in and around the ear, pain in the ear and facial weakness.2
Bacterial infections can also play a role in the development of chronic labyrinthitis. Common bacteria associated with this condition include Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Bacterial labyrinthitis typically occurs as a complication of middle ear infections or meningitis. The infection can spread to the inner ear, causing persistent inflammation and resulting in chronic symptoms. Timely treatment of bacterial infections and appropriate management of associated conditions are crucial in preventing the progression of chronic labyrinthitis.1
In some cases, labyrinthitis can also be caused by allergic reactions, trauma or autoimmune disorders.
Allergic reactions can also trigger chronic labyrinthitis symptoms in some individuals. Allergens such as pollen, dust mites, and certain foods can induce an inflammatory response within the inner ear, leading to chronic inflammation. This condition, known as allergic labyrinthitis, can cause persistent dizziness, vertigo, and hearing problems. Proper identification and management of allergens, along with appropriate allergy treatment, are essential for alleviating symptoms and preventing their recurrence.
Allergic rhinitis is where an allergen such as pollen irritates your nose causing sneezing, itchy nose and eyes, cough and a blocked or runny nose. Whilst rare, this can result in dizziness and/or vertigo. Allergies can block the eustachian tubes, which remove fluid and equalise the air pressure in your inner ear. When these are blocked, it impacts the pressure in your ear, resulting in dizziness and/or vertigo.
There is little evidence to suggest that food allergies result in chronic labyrinthitis. Similar to allergic rhinitis, they might, in rare cases, result in dizziness or vertigo associated with inner ear pressure.
Certain autoimmune disorders can contribute to the development of chronic labyrinthitis. Conditions such as systemic lupus erythematosus, rheumatoid arthritis, and Ménière's disease have been linked to inner ear inflammation and chronic labyrinthitis. In these cases, the immune system mistakenly attacks the healthy tissues of the inner ear, leading to prolonged inflammation and damage. Autoimmune-related labyrinthitis may require a comprehensive approach involving immunosuppressive medications and other treatment modalities to manage the symptoms effectively.1
Dysfunction in the vestibular system, part of the inner ear making up the labyrinth, is observed in 49–59% of people with Multiple Sclerosis. These people may experience symptoms such as dizziness and/or imbalance and vertigo.3
Cogan’s syndrome is an autoimmune disease characterised by inflammation of the inner ears and the eyes. The inflammation can lead to chronic labyrinthitis. The disease progresses over 3 to 90 days, and the most effective treatment for Cogan’s syndrome appears to be steroids.4
Trauma, particularly to the head, can result in chronic labyrinthitis. Blows to the head, falls, and accidents can cause damage to the delicate inner ear. This can lead to persistent inflammation. Inner ear fractures, concussion of the head and inner ear, or bleeding in the inner ear can all lead to labyrinthitis. Trauma to the head should be followed by medical assessment and appropriate treatment to minimise the risk of chronic labyrinthitis.
In some cases, trauma or injury to the head or inner ear can result in chronic labyrinthitis. Accidents, falls, and sports-related injuries that involve a blow to the head can cause damage to the delicate structures of the inner ear, leading to persistent inflammation. The resulting chronic labyrinthitis may manifest as ongoing dizziness, balance issues, and hearing problems. Prompt medical evaluation and appropriate treatment following head injuries are crucial in minimising the risk of chronic labyrinthitis.
Barotrauma refers to physical damage caused by a pressure difference in an unvented space in our body. This can cause tissue to tear or overstretch.5 The trauma to this injured area in the inner ear can result in chronic labyrinthitis.
Other underlying medical conditions
Vestibular dysfunction is reported to be present in a high percentage of people with diabetes and should be immediately considered if a person with diabetes experiences dizziness.6 However, this vestibular dysfunction does not necessarily mean that the person has labyrinthitis. However, a careful assessment must be made by a doctor so that the exact cause of the dizziness can be identified.
Vertigo and dizziness in hypertensive patients are not caused by elevated blood pressure but are related to neurological or peripheral vestibular diseases as well as hypotension. Hypertensive patients with vertigo need correction of the condition causing it.7
Chronic labyrinthitis is a debilitating condition that affects the delicate inner ear system, also known as the labyrinth. In chronic labyrinthitis, the inflammation is persistent, resulting in a range of distressing symptoms. The symptoms associated with inflammation in this area could be long-lasting hearing loss, nausea, tinnitus, vertigo, vomiting, or a combination of these.
Labyrinthitis can be caused by infection or by non-infectious factors. Most commonly caused by viral infections and sometimes by bacterial infections. Auto-immune conditions, allergies, trauma and certain underlying medical conditions can also lead to labyrinthitis. Understanding the causes of chronic labyrinthitis is important for accurate diagnosis, targeted treatment, prevention and risk management, patient education and support, and advancing scientific knowledge in this field.
If you’re experiencing any persistent difficulties relating to balance, dizziness, hearing, nausea, tinnitus or vertigo and are unsure why, then visit your doctor for an assessment.
- Barkwill D, Arora R. Labyrinthitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jul 6]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560506/
- Ohtani F, Furuta Y, Aizawa H, Fukuda S. Varicella-zoster virus load and cochleovestibular symptoms in ramsay hunt syndrome. Ann Otol Rhinol Laryngol [Internet]. 2006 Mar [cited 2024 Jan 9];115(3):233–8. Available from: http://journals.sagepub.com/doi/10.1177/000348940611500312
- Marsden J, Pavlou M, Dennett R, Gibbon A, Knight-Lozano R, Jeu L, et al. Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with a booklet-based vestibular rehabilitation for vestibulopathy and a 12-month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo. BMC Neurology [Internet]. 2020 Nov 27 [cited 2023 Jul 6];20(1):430. Available from: https://doi.org/10.1186/s12883-020-01983-y
- Salman EJ, Tripathy K. Cogans syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jul 6]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK580546/
- Battisti AS, Haftel A, Murphy-Lavoie HM. Barotrauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jul 6]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK482348/
- Walley M, Anderson E, Pippen MW, Maitland G. Dizziness and loss of balance in individuals with diabetes: relative contribution of vestibular versus somatosensory dysfunction. Clin Diabetes [Internet]. 2014 Apr [cited 2023 Jul 6];32(2):76–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485245/
- Parfenov VA. [Differential diagnosis and treatment of vertigo in hypertensive patients]. Ter Arkh. 2005;77(1):56–9. Available from: https://pubmed.ncbi.nlm.nih.gov/15759456/