What is the treatment for labyrinthitis (inner ear infection)?

From the Guidelines

Treatment for an inner ear infection should prioritize identifying and addressing the underlying cause, with a focus on early diagnosis and management to prevent long-term complications, as up to 90% of sudden sensorineural hearing loss (SSNHL) is idiopathic at presentation and may be attributed to vascular, viral, or multiple etiologies 1. When considering treatment options, it's essential to note that the comparative efficacy of various treatments, including systemic and topical steroids, antiviral agents, and other medications, is not well established due to the commonly unknown definitive etiology of the condition 1. Key considerations in managing inner ear infections include:

• Identifying nonidiopathic causes of SSNHL, such as vestibular schwannoma, stroke, and malignancy, to address them promptly 1
• Recognizing that a significant proportion of SSNHL cases may recover spontaneously, with prognosis dependent on factors like patient age, presence of vertigo, degree of hearing loss, and time to treatment 1
• Providing long-term follow-up to identify underlying causes that may not be evident initially and to manage persistent symptoms like tinnitus from an otolaryngological, audiological, and psychological perspective 1 Given the complexity and variability in presentation and outcome, a tailored approach to each patient, focusing on early intervention, comprehensive evaluation, and ongoing management, is crucial to optimize outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Treatment Options for Inner Ear Infections

• The treatment for inner ear infections, also known as acute otitis media (AOM), typically involves the use of antibiotics, although the effectiveness of antibiotics in treating AOM is still a topic of debate 2, 3.
• According to a study published in the Cochrane database of systematic reviews, antibiotics may reduce the risk of pain at two to three days, but do not reduce the risk of pain at 24 hours or at four to seven days 2.
• Another study published in the Danish medical journal found that the number needed to treat (NNT) to reduce pain varied from seven to 28, and that adverse events (AE) were seen in every 13th patient treated with antibiotics 3.
• The American Academy of Pediatrics recommends that children with AOM be treated with antibiotics if they are younger than two years of age, have severe symptoms, or have a high risk of complications 4, 5.
• However, for most children with mild disease in high-income countries, an expectant observational approach seems justified, and clinical management should emphasize advice about adequate analgesia and the limited role for antibiotics 2.

Antibiotic Recommendations

• Amoxicillin at conventional or high doses (80-90 mg/kg/day) remains an appropriate choice for first-line therapy for AOM 4.
• For patients in whom amoxicillin is unsuccessful, second-line therapy should have demonstrated activity against penicillin-resistant S. pneumoniae as well as beta-lactamase-producing pathogens, and options include high-dose amoxicillin/clavulanate (90 mg/kg/day based on the amoxicillin component) and ceftriaxone 4.
• The pneumococcal conjugate vaccine has been shown to be effective in reducing the incidence of AOM, and should be administered to all children less than two years old and those at risk for recurrent AOM 4, 5.