Labyrinthitis

Some sources consider vestibular neuritis and labyrinthitis to be the same thing (some differentiate based on auditory symptoms)

Background

Infection of cochlear and vestibular apparatus (from middle ear via round/oval windows)
Acute suppurative labyrinthitis is only cause of peripheral vertigo requiring urgent treatment
Some sources consider vestibular Neuritis and labyrinthitis to be the same thing
- Some differentiate based on auditory symptoms

Clinical Features

Peripheral vertigo + hearing loss + middle ear findings
- Severity depends on type of labyrinthitis:
  - Acute suppurative labyrinthitis
    - Caused by extension of infection from otitis media, meningitis, mastoiditis
    - Signs of toxicity
  - Serous labyrinthitis
    - Caused by inflammatory response to nearby infections (including viral)
    - Clinical course similar to Vestibular Neuritis (Neuronitis)

Differential Diagnosis

Vertigo

Vestibular/otologic
- Benign Paroxysmal Positional Vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- Meniere's disease
- Ear foreign body
- Otic barotrauma
Neurologic
- Cerebellar stroke
- Vertebrobasilar insufficiency
- Lateral Wallenberg syndrome
- Anterior inferior cerebellar artery syndrome
- Neoplastic: cerebellopontine angle tumors
- Basal ganglion diseases
- Vertebral Artery Dissection
- Multiple sclerosis
- Infections: neurosyphilis, tuberculosis
- Epilepsy
- Migraine (basilar)
Other
- Hematologic: anemia, polycythemia, hyperviscosity syndrome
- Toxic
  - Alcohol
  - Aminoglycosides
- Chronic renal failure
- Metabolic
  - Thyroid Disease
  - Hypoglycemia

Evaluation

Management

Suppurative form requires antibiotics
Prochlorperazine 10mg PO q6 PRN for nausea/vomiting
Lorazepam OR diazepam as vestibular depressant
Bed rest and hydration
Corticosteroids controversial especially in concomitant suppurative form

Disposition

Suppurative form require admission for definitive ENT treatment

See Also

References

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