Treatment for Labyrinthitis
The treatment for labyrinthitis should focus on vestibular suppressants for short-term management of acute vertigo attacks, not as long-term therapy, along with supportive care and vestibular rehabilitation for chronic symptoms. 1
Pharmacological Management
First-line Treatment
- Vestibular suppressants are recommended for short-term management of acute vertigo attacks in labyrinthitis 1
- Antihistamines such as meclizine are indicated for the treatment of vertigo associated with diseases affecting the vestibular system 2
- Dimenhydrinate may be used as it has a depressant action on hyperstimulated labyrinthine function 3
- Benzodiazepines may be used cautiously for severe symptoms to alleviate both vertigo and associated anxiety, but with awareness of dependency risk 1
Duration of Treatment
- Vestibular suppressants should be used only for acute management and not as long-term therapy 1
- Patients should be reassessed within 1 month after initial treatment to document resolution or persistence of symptoms 1
Special Considerations
- If labyrinthitis is related to bacterial infection (as in tympanogenic labyrinthitis), appropriate antibiotic therapy should be administered 4, 5
- In cases with inflammatory component, corticosteroids may be beneficial as demonstrated in case reports 4
- For labyrinthitis associated with or progressing to Ménière's disease, sodium restriction (1500-2300 mg daily) may be recommended 1, 6
Non-Pharmacological Management
Vestibular Rehabilitation
- Self-administered or clinician-guided vestibular rehabilitation should be offered for chronic imbalance following the acute phase of labyrinthitis 1, 6
- Vestibular rehabilitation is NOT recommended during acute vertigo attacks 6
Lifestyle Modifications
- Identification and management of potential triggers such as stress, caffeine, and alcohol consumption may be beneficial 1
- Patient education about the condition, its natural course, and potential for recurrence is essential 1
Prognosis and Follow-up
- Persistent symptoms require evaluation for unresolved labyrinthitis or underlying peripheral vestibular or central nervous system disorders 1
- Prognosis for complete recovery varies; studies show that up to 72.5% of patients may still experience balance problems after a median follow-up of 61 months 7
- Subjective hearing recovery occurs in only about 20% of cases with idiopathic labyrinthitis 7
Differential Diagnosis Considerations
- It's important to distinguish labyrinthitis from other vestibular disorders with similar presentations:
- Benign paroxysmal positional vertigo (BPPV): characterized by positional vertigo lasting less than a minute without associated hearing loss 6
- Vestibular neuritis: presents with acute prolonged vertigo without hearing loss, tinnitus, or aural fullness 6
- Ménière's disease: characterized by episodic vertigo with fluctuating hearing loss, tinnitus, and aural fullness 6