### Date : 2024-06-24 12:55 ### Topic : Labyrinthitis #medicine #neurology #ENT ---- ### Labyrinthitis Overview **Labyrinthitis** is an inner ear disorder characterized by inflammation of the labyrinth, a structure that includes the cochlea and the vestibular system. This condition can cause symptoms of vertigo, hearing loss, and imbalance. **Unlike [[Vestibular Neuritis]], labyrinthitis involves both the vestibular and auditory systems, leading to both balance and hearing disturbances.**  <Photo from: https://en.wikipedia.org/wiki/Inner_ear> ### Etiology **Possible Causes:** - **Viral Infections:** Often following a respiratory infection; the most common cause. - **Bacterial Infections:** Can result from a middle ear infection (otitis media) or meningitis spreading to the inner ear. - **Autoimmune Disorders:** Conditions that involve the body's immune system attacking its own tissues. - **Other Causes:** Head injury, allergies, or certain medications. ### Pathophysiology 1. **Infection or Inflammation:** - Viral or bacterial infection leads to inflammation of the labyrinth. - Inflammation affects both the cochlea (responsible for hearing) and the vestibular system (responsible for balance). 2. **Disruption of Function:** - **Cochlear Involvement:** Leads to sensorineural hearing loss due to damage to the cochlea or the auditory nerve. - **Vestibular Involvement:** Results in vertigo, dizziness, and imbalance due to impaired transmission of balance information to the brain. ### Clinical Features **Symptoms:** - **Vertigo:** Sudden onset of severe spinning sensation, lasting for hours to days. - **Hearing Loss:** Sensorineural hearing loss in one ear, which may be temporary or permanent. - **Tinnitus:** Ringing or buzzing noise in the affected ear. - **Nausea and Vomiting:** Often accompany vertigo. - **Imbalance:** Difficulty maintaining balance, especially when walking or standing. - **Nystagmus:** Involuntary, rhythmic eye movements, often horizontal or rotary. **Differentiation from Vestibular Neuritis:** - **Labyrinthitis:** Involves both hearing loss and vertigo. - **[[Vestibular Neuritis]]:** Primarily causes vertigo without hearing loss. ### Diagnosis **Clinical Evaluation:** - **History:** Sudden onset of vertigo and hearing loss, often following a recent infection. - **Physical Examination:** Observing nystagmus and assessing balance and coordination. **Diagnostic Tests:** - **Audiometry:** To assess the degree and type of hearing loss. - **Head Thrust Test:** To evaluate vestibular function; a positive test indicates vestibular hypofunction. - **Imaging:** MRI or CT scan to rule out central causes of vertigo and assess for inner ear inflammation or other abnormalities. **Laboratory Tests:** - **Blood Tests:** To identify signs of infection or inflammation. - **Cultures:** From the ear or cerebrospinal fluid if a bacterial infection is suspected. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 40 - **Occupation:** School Teacher **Medical History:** - Recent upper respiratory infection. - Sudden onset of severe vertigo, nausea, and unilateral hearing loss. **Clinical Evaluation:** - **Symptoms:** Severe vertigo, hearing loss in the right ear, and tinnitus. - **Physical Examination:** Horizontal nystagmus observed; positive head thrust test on the right side. - **Audiometry:** Sensorineural hearing loss in the right ear. **Diagnosis:** Based on clinical presentation and test results, Jee Hoon Ju is diagnosed with viral labyrinthitis. ### Management 1. **Symptomatic Treatment:** - **Vestibular Suppressants:** Medications such as meclizine or diazepam to reduce vertigo and nausea during the acute phase. - **Antiemetics:** To control nausea and vomiting (e.g., ondansetron, promethazine). 2. **Antiviral or Antibiotic Therapy:** - **Viral Labyrinthitis:** Typically self-limiting; antiviral medications are not usually necessary. - **Bacterial Labyrinthitis:** Requires prompt treatment with antibiotics to address the infection. 3. **Corticosteroids:** - **Anti-inflammatory Effect:** May be used to reduce inflammation and improve hearing recovery, especially in severe cases. 4. **Vestibular Rehabilitation Therapy (VRT):** - **Exercises:** Designed to promote central compensation and improve balance and coordination. - **Gaze Stabilization:** Exercises to help the brain adapt to the loss of vestibular function. - **Balance Training:** Exercises to enhance proprioception and stability. 5. **Follow-Up Care:** - **Audiology:** Regular hearing assessments to monitor recovery or progression of hearing loss. - **ENT Specialist:** Follow-up to manage ongoing symptoms and prevent complications. ### Prognosis - **Recovery:** Many patients experience significant improvement within a few weeks to months. Hearing loss may persist in some cases. - **Complications:** Persistent balance issues or chronic dizziness may occur. Rarely, permanent hearing loss or chronic labyrinthitis can develop. ### Conclusion Labyrinthitis is an inflammatory condition of the inner ear that affects both balance and hearing. It is most commonly caused by viral infections but can also result from bacterial infections. Diagnosis is based on clinical presentation and diagnostic tests, and management includes symptomatic treatment, vestibular rehabilitation, and, if necessary, antiviral or antibiotic therapy. Understanding the pathophysiology and appropriate management strategies can help alleviate symptoms and improve outcomes for patients with labyrinthitis.