From the Guidelines
Labyrinthitis symptoms typically include sudden severe vertigo, profound hearing loss, and prolonged vertigo lasting more than 24 hours, accompanied by nausea and vomiting. According to the clinical practice guideline on Ménière's disease 1, labyrinthitis is characterized by vertigo, nausea, and hearing loss, which are not episodic or fluctuating. The symptoms of labyrinthitis can be distinguished from other causes of vertigo, such as benign paroxysmal positional vertigo, vestibular migraine, and vestibular neuritis, based on their clinical presentation and duration.
Some key features of labyrinthitis include:
- Sudden onset of severe vertigo
- Profound hearing loss
- Prolonged vertigo lasting more than 24 hours
- Nausea and vomiting
- No episodic or fluctuating symptoms
It is essential to note that labyrinthitis can be caused by viral or bacterial infections, and its symptoms can be severe in the first few days. If you experience these symptoms, especially with sudden hearing loss, you should seek medical attention promptly. Treatment typically includes vestibular suppressants, anti-nausea medications, and sometimes a short course of corticosteroids, as well as rest and avoidance of sudden head movements that may trigger vertigo 1. As symptoms improve, vestibular rehabilitation exercises may help speed recovery by retraining your brain to compensate for inner ear changes.
From the Research
Labyrinthitis Symptoms
- Sudden hearing loss and concurrent vertigo are common symptoms of labyrinthitis 2
- Vestibular weakness is often present at presentation 2
- Balance problems and activity avoidance behavior may persist in some patients 2
- Subjective hearing recovery is possible, but only occurs in a small percentage of cases 2
- Labyrinthitis can also cause positional vertigo and progressive bilateral sensorineural hearing loss 3
- Inflammatory labyrinthitis can cause a fluctuant vestibulo-cochlear syndrome associated with an impairment of the blood-labyrinthine barrier (BLB) on delayed FLAIR MRI sequences 4
- Dizziness and hearing loss can be symptoms of labyrinthitis, with some patients experiencing significant improvements in symptoms with treatment 4, 5
Types of Labyrinthitis
- Idiopathic labyrinthitis: characterized by sudden hearing loss and concurrent vertigo, with no clear viral, bacterial, or autoimmune pathogenesis 2
- Inflammatory labyrinthitis: defined as a fluctuant vestibulo-cochlear syndrome associated with an impairment of the blood-labyrinthine barrier (BLB) on delayed FLAIR MRI sequences 4
- Labyrinthitis ossificans: the pathological ossification of the membranous labyrinthine spaces in response to an insult to the inner ear involving membranous labyrinth or the endosteum of the otic capsule 3
Treatment and Prognosis
- Systemic and intratympanic corticosteroids are the gold standard treatment for inflammatory labyrinthitis, but their effect is frequently insufficient 4
- Infliximab may be of value in the treatment of bilateral inflammatory labyrinthitis, with significant improvements in vestibulo-cochlear function and reduction in corticosteroid dose 4
- Combination treatment consisting of prednisolone and acyclovir may result in earlier hearing recovery and less extensive cochlear destruction in experimental HSV-1 viral labyrinthitis 5
- Early recognition and treatment of subclinical forms of labyrinthitis are crucial for efficacious treatment and prevention of long-term complications 6