What is the treatment for labyrinthitis?

Treatment for Labyrinthitis

The most effective treatment for labyrinthitis includes vestibular suppressant medications for acute symptoms, corticosteroids for inflammation, and vestibular rehabilitation for chronic imbalance.

Acute Phase Management

First-Line Treatment

• Vestibular suppressants for symptomatic relief during acute vertigo attacks:
  • Dimenhydrinate: Acts by depressing hyperstimulated labyrinthine function 1
  • Other options: meclizine, benzodiazepines (short-term use only)
  • Important: Use these medications only for short-term management (first several days) as prolonged use may impede central vestibular compensation 2

Anti-inflammatory Treatment

• Corticosteroids should be initiated early, ideally within the first 14 days of symptom onset:
  • Oral prednisone: 1 mg/kg/day (maximum 60 mg daily) for 10-14 days, followed by a taper
  • Studies suggest that a course of oral steroids accelerates the recovery of vestibular function 2

Antiemetics

• For management of nausea and vomiting:
  • Ondansetron, promethazine, or metoclopramide as needed

Subacute and Chronic Management

Vestibular Rehabilitation

• Vestibular rehabilitation therapy should be offered for patients with chronic imbalance after the acute phase 3
• Early resumption of normal activity should be encouraged to promote central compensation 2
• Customized exercise program to improve balance and reduce dizziness

Intratympanic Steroid Injections

• For patients with persistent symptoms not responsive to oral medications:
  • Dexamethasone 24 mg/mL (compounded) or 10 mg/mL (stock) injected into the middle ear space
  • Up to 4 injections over a 2-week period may be administered 4

Special Considerations

Bacterial Labyrinthitis

• If bacterial infection is suspected (especially with history of otitis media):
  • Culture and sensitivity-guided antibiotic therapy
  • Intravenous antibiotics may be required for severe cases 5
  • Consider imaging (MRI with CISS sequence) to evaluate labyrinthine enhancement 5

Poor Prognostic Factors

• Patients should be counseled that prognosis for complete recovery varies:
  • Up to 72.5% of patients may experience persistent balance problems 6
  • Subjective hearing recovery may only occur in approximately 20% of cases 6

Follow-up Care

• Audiometric evaluation after completion of treatment and at regular intervals
• Consider audiologic rehabilitation if hearing does not fully recover

Caution

• Avoid prolonged use of vestibular suppressants as they may delay central compensation
• Patients with significant vascular risk factors should be evaluated for possible stroke when presenting with acute vestibular syndrome 2

Treatment Algorithm

1. Acute phase (first 1-2 weeks): Vestibular suppressants + corticosteroids + antiemetics as needed
2. Subacute phase (2-4 weeks): Taper vestibular suppressants, continue steroids if needed, begin vestibular rehabilitation
3. Chronic phase (>4 weeks): Vestibular rehabilitation, consider intratympanic steroids for persistent symptoms