What is the treatment for labyrinthitis?

Treatment for Labyrinthitis

The treatment of labyrinthitis should focus on symptomatic relief with vestibular suppressants during acute attacks, a short course of corticosteroids, and vestibular rehabilitation for chronic symptoms.

Acute Phase Management

Symptomatic Treatment

• Vestibular suppressants for acute vertigo attacks:
  • Antihistamines (e.g., meclizine)
  • Benzodiazepines (e.g., lorazepam)
  • Dopamine receptor antagonists (e.g., prochlorperazine, metoclopramide) 1
  • Prokinetic antiemetics (e.g., domperidone) may help manage nausea without significantly interfering with vestibular compensation 1

Anti-inflammatory Treatment

• Corticosteroids (short course):
  • Oral prednisone or methylprednisolone for 7-14 days with tapering dose
  • May be beneficial in reducing inflammation and improving outcomes 1
  • For severe cases with significant hearing loss, higher doses may be considered

Supportive Care

• Bed rest during severe vertigo episodes
• Adequate hydration
• Avoidance of sudden head movements that may trigger vertigo
• Patient education about fall risk and safety precautions 1

Subacute and Chronic Phase Management

Vestibular Rehabilitation

• Should be offered for patients with chronic imbalance following labyrinthitis 2
• Improves central compensation and reduces long-term symptoms
• Can be self-administered or clinician-guided 1
• Particularly beneficial for elderly patients 1

Important Considerations

• Do not recommend vestibular rehabilitation during acute vertigo attacks as it may worsen symptoms 2
• Regular follow-up to assess improvement and adjust treatment as needed
• Assess for potential complications such as permanent hearing loss

Special Considerations

For Persistent or Severe Cases

• Intratympanic steroid injections may be considered for cases not responsive to oral steroids 2
• Recent evidence suggests that infliximab might be beneficial in corticosteroid-dependent cases of inflammatory labyrinthitis 3, though this is not yet standard practice

For Cases with Bacterial Etiology

• If bacterial labyrinthitis is suspected (e.g., following acute otitis media):
  • Appropriate antibiotic therapy based on likely pathogens
  • More aggressive corticosteroid treatment
  • Consider ENT consultation for possible surgical intervention if mastoiditis is present 4

Prognosis and Follow-up

• Patients should be informed that complete recovery may take weeks to months
• Long-term prognosis varies:
  • Recent research indicates that 72.5% of patients may still experience balance problems after a median follow-up of 61 months 5
  • Only about 20% experience complete subjective hearing recovery 5

Patient Education

• Explain the natural course of the disease and expected recovery timeline
• Educate about increased fall risk, especially in elderly patients 1
• Advise on home safety assessment to prevent falls 1
• Recommend regular physical activity to improve overall balance and coordination 1
• Instruct on early recognition of recurrent symptoms for prompt treatment 1

By following this treatment approach, most patients with labyrinthitis will experience significant improvement in their symptoms, though complete resolution may take time and some may have persistent balance or hearing issues.