From the Guidelines
Labyrinthitis is characterized by physical findings on HEENT examination, including nystagmus, a normal external ear and tympanic membrane, and possible positive head-thrust test and fistula test, which help distinguish it from other vestibular disorders. The patient's symptoms of vertigo, hearing changes, and imbalance, combined with these physical findings, are crucial for diagnosis, as imaging studies are often normal in uncomplicated labyrinthitis 1.
Some key points to consider in the physical examination of patients with labyrinthitis include:
- Nystagmus, which is often horizontal or rotatory and may be more pronounced when looking away from the affected side
- A normal external ear, tympanic membrane, and ear canal, unless there is a concurrent middle ear infection
- A normal throat and nose examination
- Possible positive head-thrust test, which can elicit corrective eye movements
- Possible positive fistula test, which can elicit vertigo and nystagmus in some cases
- Difficulty maintaining balance during the examination
- Visible distress and reluctance to move the head during examination due to severe vertigo.
It is essential to note that the history and physical examination should evaluate for neurologic, other neurotologic/otologic, oncologic, inflammatory, or infectious or vascular causes, as outlined in Table 5 of the clinical practice guideline: Ménière's disease 1. The diagnosis of labyrinthitis is primarily clinical, and a thorough otologic history and physical examination are necessary to establish the diagnosis and rule out other causes of vertigo and dizziness.
From the Research
Physical Findings on HEENT Exam in Labyrinthitis
The physical findings on HEENT (Head, Ears, Eyes, Nose, and Throat) exam in patients with labyrinthitis may include:
- Nystagmus, which is an involuntary movement of the eyes, as reported in a study on nystagmus patterns in patients with serous labyrinthitis 2
- Vertigo and hearing loss, which are common symptoms of labyrinthitis, as noted in a study on suppurative labyrinthitis associated with otitis media 3
- Abnormalities in the inner ear, such as labyrinthitis ossificans, which can be detected using magnetic resonance imaging (MRI) 4
- Vestibular symptoms, such as imbalance and vertigo, which can occur in patients with labyrinthitis, including those with cochlear implants 5
- Direction-changing positional nystagmus (DCPN), which can be elicited by a head-roll test in patients with acute otitis media complicated by serous labyrinthitis 6
Specific Findings
Some specific findings on HEENT exam in patients with labyrinthitis include:
- Direction-fixed irritative-type nystagmus, which is the most common pattern of nystagmus in patients with serous labyrinthitis 2
- Geotropic or apogeotropic type of DCPN, which can be observed in patients with acute otitis media complicated by serous labyrinthitis 6
- Decreased signal intensity in the inner ear on T2-weighted MRI, which is consistent with labyrinthitis ossificans 4
- Enhancement of the inner ear on postcontrast 3D FLAIR MRI, which can indicate inflammation and breakdown of the blood-labyrinth barrier 6