Explanation of labyrinthitis
The inner ear is made up of the cochlea, vestibule and the semicircular canal (labyrinth). The cochlea is the innermost part of your ear that is responsible for gathering sound, while the vestibule processes our forward, backward, up and down motions as well as spatial awareness.
The labyrinth is the middle part of your inner ear. It is lined with tiny hairs and filled with fluid, which are responsible for how you react to movement and stay balanced. An inner ear infection can cause inflammation known as labyrinthitis and can affect your balance.
Brief overview of symptoms in adults
The most common symptoms of labyrinthitis are vertigo, dizziness, loss of balance, tinnitus or hearing loss, but you may also have pus, nausea, pain, headaches and other flu-like symptoms.
The symptoms could come on gradually or suddenly and may come and go over weeks or years if you have chronic labyrinthitis.
Vestibular neuritis is another inner ear infection that can often be misdiagnosed as labyrinthitis, however tinnitus and hearing loss does not occur in patients with vestibular neuritis.
Causes of labyrinthitis
Approximately 50% of viral labyrinthitis are caused from ear, nose, throat and chest infections. Other viral pathogens that can cause viral labyrinthitis are influenza (flu) and various herpes viruses, which can cause cold sores, chickenpox and shingles.
Other systemic viral infections have been known to cause labyrinthitis, such as glandular fever (mono), measles, mumps, rubella and polio, although they occur a lot less frequently.1
The most common respiratory bacteria are Streptococcus pneumoniae, Morexella catarrhalis, Neisseria meningitidis and Haemophilus influenzae. They are usually a complication of other infections such as otitis media (middle ear infection) or meningitis.2 They may directly invade the labyrinth and even perforate the eardrum or release toxins that can affect the inner ear.
Other bacteria such as Escherichia coli (E. coli), Proteus species and Pseudomonads are also common pathogens found in bacterial labyrinthitis.
Labyrinthitis can also occur in patients with comorbidities, underlying conditions and immuno-suppressed patients. Having a history of allergies can increase your risk of labyrinthitis due to your heightened response to allergens. Other causative agents include drinking, smoking, over-the-counter medications and prescription medication.
Symptoms of labyrinthitis in adults
Benign paroxysmal positional vertigo (BPPV) is the feeling of everything moving around you, even if you are standing still or laying down. It is usually described as a ‘spinning sensation’ or ‘being on a rollercoaster’. In severe cases of chronic labyrinthitis, a patient may get recurrent vertigo that may go on for years.
Loss of balance
You may faint or struggle to stay upright, especially when walking, and could appear to be under the influence of alcohol.
From mild to severe, tinnitus is usually related to some form of hearing loss. Tinnitus is defined as ringing or humming in the ear, often due to the tiny hairs being damaged. The noise is your brain overcompensating for the lack of sound.
Mild or total loss of hearing can vary in each patient, from slightly muffled to sudden and complete loss of audio. This could be from pus building up or from general inflammation. Permanent hearing loss, whether partial or complete, can be life altering and may result in having to use hearing aids.
Nausea and vomiting
Feeling sick and motion sickness are the most common symptoms caused by dizziness and vertigo. Changes in temperature, motion and being tired can make nausea and vomiting worse. In severe cases, patients may suffer from dizziness for months or years, affecting their quality of life.
Mild to severe headaches can be eased by staying hydrated. Headaches usually pass with rest and over-the-counter medication such as paracetamol.
A fever (a temperature above 38C or 100.4F) is the body's way of trying to heal, avoid dehydration and stay rested. Paracetamols or ibuprofen can be used to ease this symptom.
Fatigue is exhaustion or the feeling of tiredness even after rest. You may have trouble concentrating, loss of interest, low energy, muscle aches, anxiety or depression. This is normal with infections and should pass as your symptoms ease.
Changes in vision, such as blurred or double vision, can be a side effect of labyrinthitis and usually improves with your symptoms. You should contact your doctor if it does not improve or gets worse.
Diagnosis of labyrinthitis
Investigating your medical history is a key process of diagnosing labyrinthitis - have you had a recent infection? Do you have allergies? What symptoms have you experienced? These questions will help your practitioner to set a timeline of your illness and rule out other possible causes of your symptoms.
A physical examination may involve rotating your head or body to monitor your balance; these tests are called the Dix-Hallpike test and Romberg test.3
- The Dix-Hallpike test allows your doctor to monitor involuntary eye movements and whether you are experiencing vertigo symptoms
- The Romberg test is designed for your doctor to monitor your balance. You may be asked to walk in a straight line or stand with your eyes closed
Your doctor may use an otoscope to check your ears for signs of inflammation. An otoscope has a light and a magnifying glass to allow your doctor to see inside your ear.
If pus or fluid is present, your doctor will take a swab or sample to investigate for bacterial pathogens. They will send these to a laboratory to see if any colonies can be grown, and you may have these results in as little as 2 days.
Other clinical tests may include taking blood or fluid from your spine (lumbar puncture).
Acoustic reflectometry (AR) allows an audiologist to measure the sound you receive and reflect from your eardrum, measuring whether fluid is present.4 A pneumatic otoscope works in a similar way to the otoscope but can detect this fluid behind your eardrum using a puff of air to check for movement and pressure.
Magnetic resonance imaging (MRI) and computerised tomography (CT) are used to see detailed structural images in your head and 3D images of your brain. These tests are usually follow up tests when an injury has occurred or with chronic/persistent labyrinthitis.5
Treatment for labyrinthitis
Home remedies for labyrinthitis symptoms include:
- Drinking plenty of fluids
- Avoiding sudden movements
- Using over-the-counter pain relievers
You may be prescribed medication to cure or ease the symptoms of labyrinthitis, which may include:
- These are to treat bacterial infections and may come as oral tablets, capsules or injections
- Anti-inflammatory drugs
- Anti-nausea medication
- Antiemetics are a prescription drug used to treat nausea, vomiting, vertigo and dizziness6
With severe or chronic labyrinthitis, you may be advised to undergo physiotherapy or even surgery in severe cases.7 Physiotherapy can help with restoring balance in long-term sufferers.
Prevention of labyrinthitis
Vaccinations can be used to prevent illness. If you are immunosuppressed, make sure your vaccination status is up to date.
If you are immunosuppressed or have an underlying condition, it is very important to keep up with your personal hygiene, especially during flu season. Make sure you are regularly washing your hands.
If you suffer from allergies such as hay fever, changing your clothes and rinsing your face after being outside may help to reduce your exposure. Limiting your exposure to pathogens and triggers will reduce your risk of developing labyrinthitis or lessen repeated episodes, if you suffer with chronic labyrinthitis.
If you are susceptible to labyrinthitis then there are steps you can take to avoid certain triggers:
- Reduce your alcohol consumption
- Quit smoking
- Reduce your caffeine intake (coffee, energy drinks and fizzy drinks that contain caffeine such as cola)
Labyrinthitis is inflammation of the inner ear. The most common cause is viral infections; however, bacterial infections and underlying conditions can also be the cause.
There is no set criteria for diagnosing labyrinthitis but your doctor will rule out other conditions based on your symptoms.
You may have to have further testing if your symptoms do not go away on their own. The infection may resolve on its own with home remedies or you may be required to undergo treatments prescribed by your doctor.
Chronic labyrinthitis can reoccur for weeks or months, so it is best to avoid any triggers such as smoking, alcohol and caffeine.
- Alzaidi SS, Alali AA, Alebrahim ZR, Mayouf HA, Alomairy RF, Alhedaithy FY, et al. Viral and bacterial causes of labyrinthitis. JPRI [Internet]. 2021 Oct 8 [cited 2023 Jun 8];412–7. Available from: https://www.researchgate.net/publication/355203959_Viral_and_Bacterial_Causes_of_Labyrinthitis
- Barkwill D, Arora R. Labyrinthitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jun 8]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560506/
- Thompson TL, Amedee R. Vertigo: a review of common peripheral and central vestibular disorders. Ochsner J [Internet]. 2009 [cited 2023 Jun 8];9(1):20–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096243/
- Teppo H, Revonta M. Consumer acoustic reflectometry by parents in detecting middle-ear fluid among children undergoing tympanostomy. Scand J Prim Health Care [Internet]. 2009 [cited 2023 Jun 8];27(3):167–71. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413189/
- Taxak P, Ram C. Labyrinthitis and Labyrinthitis Ossificans - A case report and review of the literature. J Radiol Case Rep [Internet]. 2020 May 31 [cited 2023 Jun 8];14(5):1–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536013/
- Hauser JM, Azzam JS, Kasi A. Antiemetic medications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jun 8]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532303/
- Al-juboori A, Al Hail AN. Gradenigo’s syndrome and labyrinthitis: conservative versus surgical treatment. Case Reports in Otolaryngology [Internet]. 2018 Jul 30 [cited 2023 Jun 8];2018:e6015385. Available from: https://www.hindawi.com/journals/criot/2018/6015385/