What are the signs and symptoms of an inner ear infection?

Signs and Symptoms of Inner Ear Infection

Inner ear infections present with distinct symptoms including vertigo (spinning sensation), hearing loss, tinnitus, and balance problems, which require prompt medical attention to prevent complications such as permanent hearing loss.

Types of Ear Infections and Their Locations

It's important to distinguish between different types of ear infections as they affect different anatomical areas:

1. Outer Ear Infection (Otitis Externa)

   • Affects the ear canal
   • Not a true inner ear infection

2. Middle Ear Infection (Otitis Media)

   • Affects the space behind the eardrum
   • Most common type, especially in children
   • Not a true inner ear infection

3. Inner Ear Infection (Labyrinthitis/Vestibular Neuritis)

   • Affects the labyrinth (cochlea and vestibular system)
   • True inner ear infection

Signs and Symptoms of Inner Ear Infection

Primary Symptoms

• Vertigo - false sensation of rotation or spinning 1
• Hearing loss - often sudden or rapidly progressive 2
• Tinnitus - ringing or buzzing in the ears
• Aural fullness - feeling of pressure in the ear 1

Associated Symptoms

• Nausea and vomiting - often severe due to vestibular disturbance 1
• Balance problems - difficulty maintaining equilibrium
• Disequilibrium - lasting for days after acute vertigo episode 1

Distinguishing Features

• Duration of vertigo - typically lasts 12-36 hours with decreasing disequilibrium for 4-5 days 1
• No loss of consciousness - fainting is never a symptom of inner ear disorders 1
• Not position-dependent - unlike BPPV, inner ear infections cause spontaneous vertigo 1

Causes and Pathophysiology

Inner ear infections can be:

1. Bacterial - Less common but potentially more serious 2

   • Can lead to purulent labyrinthitis
   • Associated with more severe long-term sequelae
   • Often follows middle ear infections

2. Viral - More common 2

   • Can follow upper respiratory infections
   • May cause less permanent damage than bacterial infections
   • Common viruses include herpes simplex, varicella zoster, and adenovirus 2

Diagnostic Considerations

When evaluating potential inner ear infections, clinicians should:

• Confirm true vertigo - distinguish from vague "dizziness" which may indicate other conditions 1
• Assess hearing - conduct proper hearing assessment to detect sensorineural hearing loss 1
• Evaluate timing - determine if symptoms are episodic or continuous 1
• Rule out other causes - consider other conditions that may mimic inner ear infection:
  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Ménière's disease
  • Vestibular migraine
  • Cerebellopontine angle tumors
  • Stroke 1

Complications

Untreated inner ear infections may lead to:

• Permanent hearing loss - especially with bacterial infections 2
• Persistent balance problems - affecting quality of life
• Spread of infection - potentially causing meningitis or other intracranial complications 3

When to Seek Medical Attention

Immediate medical attention is warranted for:

• Sudden hearing loss
• Severe vertigo with inability to stand or walk
• Symptoms following head trauma
• Neurological symptoms (headache, visual changes, weakness)
• High fever with ear symptoms

Prevention

To reduce the risk of inner ear infections:

• Treat middle ear infections promptly
• Maintain good upper respiratory health
• Avoid excessive moisture in ears
• Complete full course of antibiotics when prescribed 4

Inner ear infections require prompt diagnosis and treatment to prevent permanent damage to hearing and balance function. The combination of vertigo, hearing loss, and tinnitus should raise suspicion for inner ear involvement rather than more common middle or outer ear infections.