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Labyrinthitis

Published by Bupa's health information team, August 2008.

This factsheet is for people who have labyrinthitis, or who would like information about it.

Labyrinthitis is an inflammation of your inner ear (the labyrinth), which can cause severe dizziness. The condition normally goes away after a few weeks, but in rare cases can persist for longer.

• Animation - How labyrinthitis develops
• About labyrinthitis
• Symptoms of labyrinthitis
• Complications of labyrinthitis
• Causes of labyrinthitis
• Diagnosis of labyrinthitis
• Treatment of labyrinthitis
• Questions and answers
• Related topics
• Sources

How labyrinthitis develops

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About labyrinthitis

Your ear is made up of three parts: the outer ear, the middle ear and the inner ear. The inner ear consists of a system of fluid-filled tubes (the labyrinth), which is made up of the cochlea, which senses sound, and the vestibule and semicircular canals, which sense movement of your head.

The structures of the inner ear

When you move your head, fluid moves around the semicircular canals, bending the tiny hairs that line the canal walls. This triggers nerve messages to be sent to your brain, giving your brain information about the change in position or movement of your head.

Your body also uses information from your eyes, joints and muscles, as well as from your inner ear, to get information about the position of your body. Your balance is dependent on your brain accurately combining all of these sources. If one is suddenly disrupted, you will feel dizzy.

In labyrinthitis, inflammation of the inner ear disrupts the messages that are sent from the ear to the brain. These do not coordinate with the information from your eyes, muscles and joints, causing dizziness.

Symptoms of labyrinthitis

If you have labyrinthitis, you may:

• have vertigo - this is the sensation that you, or things around you are moving, even when you are standing still
• feel giddy (unbalanced)
• have tinnitus (a ringing sound in your ears)
• feel exhausted
• feel sick or be sick
• have problems with hearing
• get an involuntary shaking of your eye (nystagmus) - this may only be noticed by your doctor

Labyrinthitis can come on suddenly and the vertigo may be so severe, that you feel unable to get out of bed for the first few days. The vertigo may last for up to two to three weeks, but your balance should gradually improve over this time.

Although not necessarily a result of labyrinthitis, if you have these symptoms, you should see your GP.

Complications of labyrinthitis

In some people with labyrinthitis, the problems with hearing or effects on balance can persist for longer than a few weeks, or may even become permanent. Bacterial labyrinthitis in particular can lead to permanent hearing loss or loss of balance control.

Causes of labyrinthitis

The exact reason why you may have developed labyrinthitis cannot always be determined. There are many things that can cause your inner ear to become inflamed, including:

• viral infections, such as the flu or a cold - many people with labyrinthitis seem to develop the condition after a viral infection, so viruses are often thought to play a part in triggering labyrinthitis
• bacterial infection, which often includes middle ear infection (otitis media)
• allergy and autoimmune disorders
• certain medicines, including some types of antibiotic
• alcohol abuse
• transient ischaemic attacks ("mini-strokes")

Damage to the labyrinth, for example, from head injury, can also result in symptoms similar to labyrinthitis.

Diagnosis of labyrinthitis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will look into your ear using an instrument called an otoscope, to check for signs of inflammation and infection in your outer or middle ear. He or she should also do some tests to check your balance.

If your GP thinks your symptoms need further investigation or if you do not feel better after a few weeks, he or she may refer you to an audiovestibular physician or an ear, nose and throat (ENT) surgeon. You may be asked to have some of the following tests, which you can have as an outpatient in hospital:

• hearing tests
• balance tests
• blood tests
• an MRI (magnetic resonance imaging) scan - this uses magnets and radiowaves to produce images of the structures inside your ear

Treatment of labyrinthitis

Your brain is able to naturally adjust and compensate for its loss in ability to control balance. This means that if you have labyrinthitis, your symptoms will usually go away on their own within a few weeks. To help the compensation process, it is important to stay as active as possible while you recover.

Any treatment you have will be aimed at helping to control your symptoms, while making sure that it doesn't interfere with the natural compensation of your brain.

Medicines

Depending on the severity of your dizziness, your GP might prescribe a type of drug called a vestibular sedative (eg cyclizine or prochlorperazine). You will probably just be given this for a short period of time to help reduce your vertigo symptoms, as taking medicine can prolong the time it takes for your body to readjust.

If you have bacterial labyrinthitis, your GP will usually prescribe an antibiotic. Your GP may take a sample of the bacteria from your ear, and send it to a laboratory for testing. This will enable him/her to prescribe an appropriate antibiotic to get rid of your infection.

Vestibular rehabilitation therapy

Rehabilitation exercises can speed up the brain's natural ability to adjust to problems with balance. Your doctor may suggest you do these exercises to help with your recovery if your symptoms persist for a number of months. They may include exercises to:

• help 'desensitise' your body to the symptoms
• learn how to coordinate your eye and head movements
• improve your balance and walking skills

These exercises may be organised by your local ear, nose and throat or physiotherapy department.

Related topics

• Hearing loss
• Middle ear infection in children

Sources

• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005:928-929
• Labyrinthitis and vestibular neuritis. Vestibular Disorders Association. www.vestibular.org, accessed 15 May 2008
• Sudden sensorineural hearing loss. Deafness Research UK. www.deafnessresearch.org.uk, accessed 15 May 2008
• Roland NJ, McRae RDR, McCombe AW. Key topics in otolaryngology. Oxford: Bios Scientific Publishers Ltd, 1995:144-147
• Dizziness and vertigo. ENT.UK - the British Association of Otorhinolaryngologists - Head & Neck Surgeons. www.entuk.org, accessed 15 May 2008
• Ludman H. ABC of otolaryngology. 4th ed. London: BMJ Publishing Group, 1997
• Autoimmune inner ear disease. Vestibular Disorders Association. www.vestibular.org, accessed 26 June 2008
• Kasper DL, Fauci AS, Longo DL, et al., Harrison's Principles of Internal Medicine. 16 ed. McGraw-Hill, 2005
• Sillier SL, Hollohan V. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews, 2007(4): Art. No.: CD005397

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. It has also been reviewed by Deafness Research UK. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2008.