Labyrinthitis

Definition

Labyrinthitis is an inflammation of the inner ear that is often a complication of otitis media. It is caused by the spread of bacterial or viral infections from the head or respiratory tract into the inner ear.

Description

Labyrinthitis is characterized by dizziness or feelings of motion sickness caused by disturbance of the sense of balance.

— Rebecca J. Frey

(medicine) Inflammation of the labyrinth of the inner ear.

Definition

Labyrinthitis is an inflammation of the inner ear that is often a complication of infection of the middle ear (otitis media). It is usually caused by the spread of bacterial or viral infections from the head or respiratory tract into the inner ear.

Description

The labyrinth is a group of interconnected canals chambers located in the inner ear. It is made up of the cochlea and the semicircular canals. The cochlea is involved in transmitting sounds to the brain. The semicircular canals send information to the brain about the head's position and how it is moving. The brain uses this information to maintain balance. Labyrinthitis is caused by the inflammation of the labyrinth. Its most frequent symptom is vertigo (dizziness), because the information that the semicircular canals send to the brain about the position of the head is affected.

Demographics

Labyrinthitis is rare and is more likely to occur after middle ear infections, meningitis, or upper respiratory infection. It may also occur after trauma, because of a tumor, or after the ingesting of toxic substances. It is thought to be more common in females than in males.

Causes and Symptoms

When a disease agent causes labyrinthitis, the disease agent usually reaches the inner ear by one of three routes:

• Bacteria may be carried from the middle ear or the membranes that cover the brain.
• Viruses, such as those that cause mumps, measles, influenza, and colds may reach the inner ear following an upper respiratory infection.
• The rubella virus can cause labyrinthitis in infants prior to birth.

Labyrinthitis can also be caused by toxins, by a tumor in the ear, by trauma to the ear, and sometimes high doses of medications or allergies.

The primary symptoms of labyrinthitis are vertigo and hearing loss, along with a sensation of ringing in the ears called tinnitus. Vertigo occurs because the inner ear controls the sense of balance, as well as hearing. Some individuals also experience nausea and vomiting and spontaneous eye movements in the direction of the unaffected ear. Bacterial labyrinthitis may produce a discharge from the infected ear.

When to Call the Doctor

If a child has vertigo, especially along with nausea, vomiting, or hearing loss, the doctor should be called.

Diagnosis

Diagnosis of labyrinthitis is based on a combination of the individual's symptoms and history, especially a history of a recent upper respiratory infection. The doctor will test the child's hearing and order a laboratory culture to identify the organism if the patient has a discharge.

If there is no history of a recent infection, the doctor will order tests such as a commuted topography (CT) scan or a magnetic resonance imaging (MRI) scan to help rule out other possible causes of vertigo, such as tumors. If it is believed a bacterium is causing the labyrinthitis, blood tests may be done, or any fluid draining from the ear may be analyzed to help determine what type of bacteria is present.

Treatment

If a bacterial agent is found to be the cause, the individual is given antibiotics to clear up the infection. Antibiotics cannot cure viral infections. Some patients may require surgery to drain the inner and middle ear. If an underlying condition such as a tumor is found to be the cause of the labyrinthitis, treatment will depend on the underlying condition.

Because most labyrinthitis resolves on its own, most treatment is focused on controlling the symptoms. Medications may be prescribed to help reduce vertigo and nausea. If vomiting cannot be controlled, so that fluids cannot be kept down, fluids may be administered intravenously to prevent dehydration.

Individuals with labyrinthitis should rest in bed until the acute dizziness subsides. Some experts believe that recovery is aided by moving around once the most acute symptoms are no longer present. This can be difficult, however, because moving often makes symptoms worse.

Prognosis

Most people who have labyrinthitis recover completely, although it often takes five to six weeks for the vertigo to disappear entirely and the individual's hearing to return to normal. In a few cases, the hearing loss may be permanent. Permanent hearing loss is more common in cases of labyrinthitis that are caused by bacteria. For some individuals, episodes of dizziness may still occur months after the main episode is over.

Prevention

The most effective preventive strategy includes prompt treatment of middle ear infections, as well as monitoring of patients with mumps, measles, influenza, or colds for signs of dizziness or hearing problems.

Parental Concerns

Labyrinthitis generally resolves by itself; however, in some cases permanent hearing loss can result. Labyrinthitis may cause repeated episodes of vertigo even after the main symptoms have gone away. If the episodes occur when the head is moved suddenly, this can make it difficult for a child to engage in some physical activities or sports.

Resources

Books

Goebel, Joel A., ed. Practical Management of the Dizzy Patient. Philadelphia: Lippincott Williams & Wilkins, 2001.

Labyrinthitis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: Icon Group International, 2004.

Poe, Dennis. The Consumer Handbook on Dizziness and Vertigo. Sedona, AZ: Auricle Ink Publishers, 2005.

Periodicals

Aferzon, Mark, and Carl L. Reams. "Labyrinthitis ossificans." Ear, Nose, and Throat Journal 80 (October 2001): 700.

Hartnick, Christopher J., et al. "Preventing Labyrinthitis Ossificans: The Role of Steroids." Archives of Otolaryngology—Head & Neck Surgery 127 (February 2001): 180.

Sandhaus, Sonia. "Stop the Spinning: Diagnosing and Managing Vertigo." The Nurse Practitioner 27 (August 2002): 11–20.

Organizations

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: www.aap.org.

[Article by: Helen Davidson]

Inflammation of the inner ear (labyrinthitis) causing vomiting, vertigo, and loss of balance.

Inflammation of the labyrinth; otitis interna.

This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (May 2008)

Labyrinthitis
Classification and external resources
Vestibular system
ICD-10	H83.0
ICD-9	386.3
DiseasesDB	29290
MeSH	D007762

Labyrinthitis is an inflammation of the inner ear.^[1] It derives its name from the labyrinths that house the vestibular system (which sense changes in head position). Labyrinthitis can cause balance disorders.

In addition to balance control problems, a labyrinthitis patient may encounter hearing loss and tinnitus. Labyrinthitis is usually caused by a virus, but it can also arise from bacterial infection, head injury, extreme stress, an allergy or as a reaction to a particular medication. Both bacterial and viral labyrinthitis can cause permanent hearing loss, although this is rare.

Labyrinthitis often follows an upper respiratory tract infection (URI).

Contents 1 Labyrinthitis 2 Recovery 3 Labyrinthitis and anxiety 4 Treatment 5 See also 6 References 7 External links

Labyrinthitis

A prominent and debilitating symptom of labyrinthitis is acute vertigo. The vestibular system is a set of sensory inputs consisting of three semicircular canals, sensing changes in rotational motion, and the otoliths, sensing changes in linear motion. The brain combines visual cues with sensory input from the vestibular system to determine adjustments required to retain balance. When working properly, the vestibular system also relays information on head movement to the eye muscle, forming the vestibulo-ocular reflex, in order to retain continuous visual focus during motion. When the vestibular system is affected by labyrinthitis, rapid, undesired eye motion (nystagmus), often results from the improper indication of rotational motion. Nausea, anxiety, and a general ill feeling are common due to the distorted balance signals that the brain receives from the inner ear.

This can also be brought on by pressure changes such as those experienced while flying or scuba diving.^[2][3][4]

Recovery

Recovery from acute labyrinthine inflammation generally takes from one to six weeks; however, it is not uncommon for residual symptoms (dysequilibrium and/or dizziness) to last for many months or even years^[5] if permanent damage occurs.

Recovery from a permanently damaged inner ear typically follows three phases:

1. An acute period, which may include severe vertigo and vomiting
2. approximately two weeks of subacute symptoms and rapid recovery
3. finally a period of chronic compensation which may last for months or years.

Labyrinthitis and anxiety

Chronic anxiety is a common side effect of labyrinthitis which can produce tremors, heart palpitations, panic attacks, derealization and depression. Often a panic attack is one of the first symptoms to occur as labyrinthitis begins. While dizziness can occur from extreme anxiety, labyrinthitis itself can precipitate a panic disorder. Three models have been proposed to explain the relationship between vestibular dysfunction and panic disorder:^[6]

• Psychosomatic model: vestibular dysfunction which occurs as a result of anxiety.

• Somatopsychic model: panic disorder triggered by misinterpreted internal stimuli (e.g., stimuli from vestibular dysfunction), that are interpreted as signifying imminent physical danger. Heightened sensitivity to vestibular sensations leads to increased anxiety and, through conditioning, drives the development of panic disorder.

• Network alarm theory: panic which involves noradrenergic, serotonergic, and other connected neuronal systems. According to this theory, panic can be triggered by stimuli that set off a false alarm via afferents to the locus ceruleus, which then triggers the neuronal network. This network is thought to mediate anxiety and includes limbic, midbrain and prefrontal areas. Vestibular dysfunction in the setting of increased locus ceruleus sensitivity may be a potential trigger.

Treatment

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 ^[7].

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,^{[citation needed]} 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 increase dizziness^[8].

Some evidence suggests that viral labyrinthitis should be treated in its early stages with corticosteroids such as prednisone, and possibly antiviral medication such as valacyclovir and that this treatment should be undertaken as soon as possible to prevent permanent damage to the inner ear.^{[citation needed]}

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. 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.

One study found that patients who believed their illness was out of their control showed the slowest progression to full recovery, long after the initial vestibular injury had healed.^[5] The study revealed that the patient who compensated well was one who, at the psychological level, was not afraid of the symptoms and had some positive control over them. Notably, a reduction in negative beliefs over time was greater in those patients treated with rehabilitation than in those untreated. "Of utmost importance, baseline beliefs were the only significant predictor of change in handicap at 6 months followup."

See also

• Balance disorder
• Dizziness
• Vestibular system
• Vestibular neuronitis

References

1. ^ labyrinthitis at Dorland's Medical Dictionary
2. ^ Martin-Saint-Laurent A, Lavernhe J, Casano G, Simkoff A (March 1990). "Clinical aspects of inflight incapacitations in commercial aviation". Aviation, Space and Environmental Medicine 61 (3): 256–60. PMID 2317181. 
3. ^ Farmer, Jr JC (ed). (1973). "Labyrinthine Dysfunction During Diving". 1st Undersea and Hyperbaric Medical Society Workshop. (Undersea and Hyperbaric Medical Society) UHMS Publication Number WS6-15-74.: 11. http://archive.rubicon-foundation.org/4291. Retrieved 2009-03-11. 
4. ^ Kennedy RS (March 1974). "General history of vestibular disorders in diving". Undersea Biomedical Research 1 (1): 73–81. PMID 4619861. http://archive.rubicon-foundation.org/2663. Retrieved 2009-03-11. 
5. ^ ^{a b} Bronstein, Adolfo (February 2002). "Visual and psychological aspects of vestibular disease". Current Opinion in Neurology 15 (1): 1–3. doi:10.1097/00019052-200202000-00001. 
6. ^ Simon, NM; Pollack MH, Tuby KS, and Stern TA. (June 1998). "Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety". Ann Clin Psychiatry 10 (2): 75–80. doi:10.3109/10401239809147746. http://www.ncbi.nlm.nih.gov/pubmed/9669539. Retrieved 2008-05-03. 
7. ^ Solomon D and Shepard NT (2002), Chronic Dizziness, Current Treatment Options in Neurology, 4:281–288
8. ^ Staab J and Ruckenstein M (2005), Chronic Dizziness and Anxiety, Arch Otolaryngol Head Neck Surg, 131:675-679

External links

• DizzyTimes.com
• Dr. Rauch's Online Otology Clinic — video clips
• 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
• Labyrinthitis and vestibular neuritis

v • d • e Diseases of the ear and mastoid process (H60-H99, 380-389) External ear Otitis externa Middle ear and mastoid Otitis media · Mastoiditis (Bezold's abscess, Gradenigo's syndrome) Cholesteatoma · Perforated eardrum Inner ear and central pathways Common pathway Labyrinthitis/Otitis interna Equilibrioception Vertigo/Balance disorder: peripheral (Ménière's disease, BPPV, Vestibular neuronitis, Perilymph fistula) · central (Central positional nystagmus) Hearing Hearing impairment Conductive hearing loss (Otosclerosis, Superior canal dehiscence) · Sensorineural hearing loss (Presbycusis, Central hearing loss) Excessive response Tinnitus · Hyperacusis/Phonophobia Deafblindness Wolfram syndrome · Usher syndrome Other Acquired auditory processing disorder ear navs: anat/physio/dev, noncongen/congen, eponymous signs, proc

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