Labyrinthitis

Labyrinthitis is an inflammation of the labyrinth, a complex system of fluid-filled channels in the inner ear.

Vestibular neuritis, on the other hand, refers to the inflammation of the vestibular nerve, which transmits signals related to motion and position to the brain.

Both conditions result in vertigo (a sensation of spinning), potential hearing loss, and tinnitus (ringing in the ears). They may occur as isolated episodes, recurrent attacks, or a persistent condition lasting three to six weeks.

Symptoms can include nausea, vomiting, and nystagmus (rapid involuntary eye movements).

Labyrinthitis and Vestibular Neuritis

Labyrinthitis is an inflammation of the labyrinth, a complex system of fluid-filled channels in the inner ear. Vestibular neuritis, on the other hand, refers to the inflammation of the vestibular nerve, which transmits signals related to motion and position to the brain. Both conditions result in vertigo (a sensation of spinning), potential hearing loss, and tinnitus (ringing in the ears). They may occur as isolated episodes, recurrent attacks, or a persistent condition lasting three to six weeks. Symptoms can include nausea, vomiting, and nystagmus (rapid involuntary eye movements).

Diagram of the inner ear

Signs and Symptoms

The primary symptoms of labyrinthitis and vestibular neuritis are severe vertigo and nystagmus. Additional symptoms include nausea, anxiety, general malaise, tinnitus, ear ache, and a sensation of fullness in the ear. These symptoms arise from distorted balance signals received by the brain due to the inflammation of the inner ear structures.

Causes

The exact cause of labyrinthitis and vestibular neuritis is often unclear. They may result from viral infections such as the herpes simplex type 1 virus, bacterial infections, head injuries, extreme stress, allergies, or reactions to medication. Approximately 30% of affected individuals report having had a common cold prior to the onset of symptoms. The condition can also be triggered by pressure changes experienced during activities like flying or scuba diving.

Mechanism

The vestibular system consists of three semicircular canals that provide sensory input related to rotational and linear motion. The brain integrates this sensory input with visual cues to maintain balance. The vestibulo-ocular reflex helps maintain visual focus during head movements. Inflammation of the inner ear disrupts these processes, leading to the symptoms of vertigo and nystagmus.

Treatment

Physical Therapy

Treatment for vestibular neuritis often includes vestibular rehabilitation, which aims to reduce or eliminate residual dizziness. This involves exercises that combine head and eye movements, postural changes, and walking. These exercises promote compensatory changes in the central vestibular system (brainstem and cerebellum).

Common rehabilitation strategies include:

• Gaze Stability Exercises: Moving the head side-to-side while keeping the eyes fixed on a stationary object.
• Habituation Exercises: Performing movements that provoke symptoms to reduce the negative vestibular response over time.
• Functional Retraining: Activities such as postural control, relaxation, and balance training.

Repetition and progression of these exercises challenge the vestibular system, leading to gradual improvement in symptoms.

Medication

While vestibular neuritis generally resolves on its own, symptomatic treatment may include antihistamines like cinnarizine and medications such as prochlorperazine to alleviate vertigo and nausea. Glucocorticoids have been studied but do not significantly affect long-term outcomes.

Mental Health Management

Mood disorders such as anxiety and depression can hinder recovery from labyrinthitis. Treatment may include addressing these co-occurring conditions, often with short-term benzodiazepine therapy to manage severe anxiety episodes.

Prognosis

Recovery from acute labyrinthine inflammation generally takes one to six weeks, though residual symptoms may persist for a couple of months. The recovery process typically involves an initial acute phase with severe vertigo and vomiting, followed by a sub-acute phase with milder symptoms and rapid recovery over approximately two weeks.

Epidemiology

Labyrinthitis affects around 35 million people annually (approximately 3.5 cases per 100,000 people). It commonly occurs in individuals between 30 and 60 years of age, with no significant gender differences. Most sufferers experience a single attack and fully recover. Vestibular rehabilitation has been shown to significantly improve symptom control in people with vestibular neuritis.

Self-assessment MCQs (single best answer)

What is labyrinthitis?

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Which symptom is primary in both labyrinthitis and vestibular neuritis?

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Approximately what percentage of individuals affected by labyrinthitis report a prior common cold?

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What is the primary goal of vestibular rehabilitation?

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Which medication is commonly used to alleviate vertigo and nausea in vestibular neuritis?

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What is the estimated annual global incidence of labyrinthitis?

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Which age group is most commonly affected by labyrinthitis?

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What is a common rehabilitation strategy for vestibular neuritis?

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Which of the following is NOT a usual cause of labyrinthitis and vestibular neuritis?

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Which of the following is NOT a typical symptom of labyrinthitis?

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