Labyrinthitis

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What is labyrinthitis?

Labyrinthitis is an inflammation of the inner ear. Located deep inside the inner ear, the labyrinth is made up of 3 semicircular canals that help control your balance. Inflammation of these canals, or labyrinthitis, can occur as a result of a viral or, more rarely, a bacterial infection.

Labyrinthitis may cause vertigo—a sensation of spinning or whirling—that may be severe enough to cause nausea or vomiting. The vertigo gradually goes away over a period of several days to weeks. However, for a month or longer, a sudden head movement can trigger another attack of vertigo. Labyrinthitis may be accompanied by hearing loss, which is usually temporary.

Bacterial labyrinthitis may develop after a middle ear infection (otitis media) or an infection of the lining of the brain (meningitis) and is a more serious condition. See an illustration of an inflamed labyrinth .

What causes labyrinthitis?

The cause of labyrinthitis is not clear. It is often triggered by an upper respiratory infection (such as the flu or a cold).¹ Less often, labyrinthitis may develop after a middle ear infection (otitis media).² Rarely, labyrinthitis is triggered by a bacterial infection.

What are the symptoms?

The main symptom of labyrinthitis is vertigo, a spinning or whirling sensation you feel although neither you nor your surroundings are moving. Vertigo is not the same as feeling dizzy. Dizziness is feeling unsteady or lightheaded, while vertigo is a sensation of whirling or spinning. Symptoms of dizziness and vertigo may be caused by many conditions other than labyrinthitis. With labyrinthitis, the vertigo begins suddenly, without warning, and often occurs 1 to 2 weeks after you've had the flu or a cold or other viral or bacterial infection. The sudden onset of vertigo may be severe enough to cause vomiting and nausea. Vertigo gradually goes away over a few days to weeks, although sudden head movement can cause vertigo symptoms for a month or longer.

You may have hearing loss and a roaring sound in your ears (tinnitus). Rarely—and generally only if the labyrinthitis is caused by a bacterial infection—the hearing loss may be permanent.

How is labyrinthitis diagnosed?

Labyrinthitis is diagnosed with a medical history and a physical examination. If you have symptoms of vertigo, your health professional will determine whether it is due to inflammation of the labyrinth. In particular, your health professional will look for signs of viral or bacterial infection, such as an ear infection, which can trigger labyrinthitis.

If the cause of your vertigo is not clear, your health professional may perform additional tests to rule out other conditions.

How is it treated?

Labyrinthitis usually goes away on its own. This normally requires several weeks. If the cause is bacterial, antibiotics will be prescribed. Viral infections cannot be cured with antibiotics.

Medications may also be used to control nausea and vomiting caused by the vertigo.

Frequently Asked Questions

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The main symptom of labyrinthitis is vertigo, a spinning or whirling sensation you feel although neither you nor your surroundings are moving. Vertigo results when there is a problem with your balance sensory systems—including your vision, sensory nerves, inner ear, and skin pressure sensation—that are all interpreted by your brain.

People often use the terms vertigo and dizziness interchangeably, but they are different symptoms and may indicate different problems. Vertigo is a feeling that you or your surroundings are moving when there is no actual movement. The motion is commonly described as a feeling of spinning or whirling but can also include sensations of falling or tilting. Nausea and vomiting often accompany more severe episodes of vertigo. It may be difficult to walk or stand, and you may lose your balance and fall.

Vertigo caused by labyrinthitis begins suddenly without warning and gradually goes away over a few days to weeks, although sudden head movement can trigger vertigo for a month or longer.

You may also develop a condition called nystagmus, which is involuntary or "jerking" eye movements.

Labyrinthitis may also cause hearing loss, which is usually temporary, along with a roaring sound in the ears (tinnitus).

Labyrinthitis is diagnosed with a medical history and a physical examination. If you have symptoms of vertigo (spinning or whirling sensation), your health professional will determine whether it is from inflammation of the labyrinth and, if so, whether you have recently had a viral or bacterial infection.

Your health professional may perform a Dix-Hallpike test, which can offer clues about the cause of vertigo. In particular, your health professional will look for signs of an ear infection, which can cause labyrinthitis.

If the cause of your vertigo is unclear, your health professional may want to do more tests. Such tests can help determine whether your vertigo is caused by problems in the inner ear or brain.³ Brain-related causes of vertigo (such as stroke, head injury, brain tumors, or multiple sclerosis) are less common.

Additional tests that may be done to rule out other causes of your vertigo include:⁴

• Electronystagmogram, which uses electrodes to detect eye movements. It looks for characteristic eye movements that occur when the inner ear is stimulated. The pattern of eye movements can indicate the location of the cause of the vertigo, such as the inner ear or the central nervous system.
• Imaging tests, such as computed tomography of the head and face (CT scan) or magnetic resonance imaging of the head (MRI), which may be done if the vertigo could be caused by a brain problem. Access to MRI scanners is not available in all areas; if you need an MRI scan, you may need to travel to a regional center.
• Hearing tests, although these tests are of limited use in finding the cause of vertigo. Hearing tests measure the ability of sound to reach the brain. A specific type of hearing test, called an auditory brain stem evoked potential (ABEP) study, may be done to determine whether the nerve from the inner ear to the brain is working correctly.

Labyrinthitis usually goes away on its own within a few days to weeks. If labyrinthitis was triggered by a bacterial infection, antibiotics may be prescribed. Viral infections cannot be cured with antibiotics.

Additional treatment is intended to keep you comfortable until the labyrinthitis goes away. Medications called vestibular suppressants may be prescribed to reduce symptoms.

• Antiemetics, such as Compazine or Phenergan, control severe nausea and vomiting.
• Antihistamines reduce nausea, dizziness, and vomiting. Examples include diphenhydramine hydrochloride (Benadryl) and dimenhydrinate (Dramamine).
• Corticosteroids reduce inflammation. One example is methylprednisolone (Depo-Medrol).
• Scopolamine reduces vomiting. An example is Transderm-Scop, a patch that is placed on the skin behind the ear.
• Sedatives reduce vomiting, nausea, and anxiety. These include clonazepam (Klonopin), diazepam (Valium, Valrelease), and lorazepam (Ativan).

If a bacterial infection has injured your inner ear, you may continue to have symptoms of vertigo even after the infection has healed. Over time, your body should adjust to the confusing signals from the balance sensory systems that falsely tell your brain to detect motion that isn't occurring. The vertigo will eventually improve or disappear completely. This process is called compensation. Remaining as active as possible speeds compensation. Unfortunately, medications may slow compensation and should only be taken for 1 to 2 weeks.

What To Think About

Be sure to take your medications exactly as prescribed. And do not stop taking them even if you feel better; otherwise, the infection may not go away.

Persistent vertigo may be caused by other conditions and should be evaluated by your health professional.

Vertigo (a whirling or spinning sensation) is most intense during the first 2 to 3 days of labyrinthitis. Bed rest and keeping your head still may initially relieve symptoms of nausea, vomiting, and vertigo.

But if vertigo lasts for more than a few days, returning to normal daily activities may help. Staying active, while difficult if it triggers vertigo, usually helps the brain adapt (compensate) to the vertigo more quickly. It is especially important to move your head as you normally would and avoid holding it completely still. As compensation occurs, vertigo will gradually go away.

Although labyrinthitis is generally a short-term condition, there are steps you can take at home to manage your symptoms.

• Take safety precautions for vertigo, such as keeping your home uncluttered and using nonskid mats around your house and in your bath.
• Try balance exercises for vertigo, such as simple head movements and maintaining your balance while standing or sitting.
• Do Brandt-Daroff exercises for vertigo, which include sitting on the edge of your bed or sofa, quickly leaning to one side, and then lying on that side until the spinning or whirling sensation goes away or for at least 30 seconds.

Check with your health professional first before trying exercises at home to reduce symptoms of vertigo associated with labyrinthitis.

Organization

• Dizziness: Lightheadedness and Vertigo
• Ear Infections
• Ménière's Disease
• Meningitis
• Vestibular Neuronitis

Citations

1. Baloh RW (2004). Hearing and equilibrium. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 22nd ed., vol. 2, pp. 2436–2442. Philadelphia: Saunders.

2. Harker LA (2003). Cranial and intracranial complications of acute and chronic otitis media. In JB Snow Jr, JJ Ballenger, eds., Ballenger's Otorhinolaryngology Head and Neck Surgery, 16th ed., chap. 11, pp. 294–316. Hamilton, ON: BC Decker.

3. Solomon D, Frohman EM (2005). The dizzy patient. In DC Dale, DD Federman, eds., ACP Medicine, section 11, chap. 1. New York: WebMD.

4. Valvassori GE (2003). Imaging of the temporal bone. In JB Snow Jr, JJ Ballenger, eds., Ballenger's Otorhinolaryngology Head and Neck Surgery, 16th ed., chap. 7, pp. 195–229. Hamilton, ON: BC Decker.

Other Works Consulted

• Daroff RB, Carlson MD (2005). Dizziness and vertigo section of Syncope, faintness, dizziness, and vertigo. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 16th ed., vol. 1, pp. 130–133. New York: McGraw-Hill.

Author:	Sabra L. Katz-Wise	Last Updated July 13, 2006
Medical Review:	Adam Husney, MD - Family Medicine Colin Chalk, MD, CM, FRCPC - Neurology
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