Labyrinthitis: Difference between revisions
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==Background== | ==Background== | ||
*Inflammation of the inner ear (cochlear and vestibular apparatus) | *Inflammation of the inner ear (cochlear and vestibular apparatus) | ||
* | *Key distinction from [[Vestibular Neuritis (Neuronitis)|vestibular neuritis]]: Labyrinthitis includes hearing loss in addition to vertigo | ||
*Types: | *Types: | ||
** | **Viral/serous: Most common; follows viral URI; self-limited (similar course to vestibular neuritis) | ||
** | **Suppurative (bacterial): Extension from [[otitis media]], [[meningitis]], or [[mastoiditis]] — requires urgent treatment | ||
==Clinical Features== | ==Clinical Features== | ||
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*Unidirectional horizontal nystagmus (fast phase away from affected ear) | *Unidirectional horizontal nystagmus (fast phase away from affected ear) | ||
*Normal neurologic exam otherwise | *Normal neurologic exam otherwise | ||
* | *Suppurative form: Fever, otorrhea, signs of systemic toxicity, concurrent [[otitis media]] or [[mastoiditis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
* | *[[HINTS Exam]]: Differentiates peripheral from central cause of acute vestibular syndrome | ||
**HI: Head impulse test (positive/corrective saccade = peripheral) | **HI: Head impulse test (positive/corrective saccade = peripheral) | ||
**N: Nystagmus (unidirectional = peripheral; direction-changing = central) | **N: Nystagmus (unidirectional = peripheral; direction-changing = central) | ||
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*Hearing assessment (bedside finger rub; formal audiometry outpatient) | *Hearing assessment (bedside finger rub; formal audiometry outpatient) | ||
*Assess for otitis media/mastoiditis on otoscopy | *Assess for otitis media/mastoiditis on otoscopy | ||
* | *CT/MRI brain: If HINTS concerning for central cause, or if suppurative form suspected | ||
==Management== | ==Management== | ||
* | *Viral/serous: | ||
**Vestibular suppressants (short-term, 24-72 hours only): [[meclizine]] 25 mg PO q6h, [[diazepam]] 2-5 mg PO q8h, or [[promethazine]] | **Vestibular suppressants (short-term, 24-72 hours only): [[meclizine]] 25 mg PO q6h, [[diazepam]] 2-5 mg PO q8h, or [[promethazine]] | ||
**Antiemetics: [[ondansetron]], [[prochlorperazine]] | **Antiemetics: [[ondansetron]], [[prochlorperazine]] | ||
**Early vestibular rehabilitation (encourage mobilization after acute phase) | **Early vestibular rehabilitation (encourage mobilization after acute phase) | ||
**Corticosteroids controversial but may hasten recovery | **Corticosteroids controversial but may hasten recovery | ||
* | *Suppurative: IV antibiotics targeting middle ear pathogens; urgent ENT consult | ||
==Disposition== | ==Disposition== | ||
*Viral: discharge with vestibular suppressants (limit to 3 days), antiemetics, PCP/ENT follow-up | *Viral: discharge with vestibular suppressants (limit to 3 days), antiemetics, PCP/ENT follow-up | ||
*Suppurative: admit for IV antibiotics and ENT evaluation | *Suppurative: admit for IV antibiotics and ENT evaluation | ||
* | *Return if: New neurologic symptoms, severe headache, inability to tolerate PO | ||
==See Also== | ==See Also== | ||
Latest revision as of 09:35, 22 March 2026
Some sources consider vestibular neuritis and labyrinthitis to be the same condition; differentiation is based on the presence of auditory symptoms.
Background
- Inflammation of the inner ear (cochlear and vestibular apparatus)
- Key distinction from vestibular neuritis: Labyrinthitis includes hearing loss in addition to vertigo
- Types:
- Viral/serous: Most common; follows viral URI; self-limited (similar course to vestibular neuritis)
- Suppurative (bacterial): Extension from otitis media, meningitis, or mastoiditis — requires urgent treatment
Clinical Features
- Acute, continuous peripheral vertigo (not positional)
- Unilateral sensorineural hearing loss and/or tinnitus (distinguishes from vestibular neuritis)
- Nausea/vomiting
- Unidirectional horizontal nystagmus (fast phase away from affected ear)
- Normal neurologic exam otherwise
- Suppurative form: Fever, otorrhea, signs of systemic toxicity, concurrent otitis media or mastoiditis
Differential Diagnosis
Vertigo
- Vestibular/otologic
- Benign paroxysmal positional vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- Ménière's disease
- Ear foreign body
- Otic barotrauma
- Otosclerosis
- 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
- Chronic renal failure
- Metabolic
Evaluation
- HINTS Exam: Differentiates peripheral from central cause of acute vestibular syndrome
- HI: Head impulse test (positive/corrective saccade = peripheral)
- N: Nystagmus (unidirectional = peripheral; direction-changing = central)
- TS: Test of skew (vertical skew deviation = central)
- Hearing assessment (bedside finger rub; formal audiometry outpatient)
- Assess for otitis media/mastoiditis on otoscopy
- CT/MRI brain: If HINTS concerning for central cause, or if suppurative form suspected
Management
- Viral/serous:
- Vestibular suppressants (short-term, 24-72 hours only): meclizine 25 mg PO q6h, diazepam 2-5 mg PO q8h, or promethazine
- Antiemetics: ondansetron, prochlorperazine
- Early vestibular rehabilitation (encourage mobilization after acute phase)
- Corticosteroids controversial but may hasten recovery
- Suppurative: IV antibiotics targeting middle ear pathogens; urgent ENT consult
Disposition
- Viral: discharge with vestibular suppressants (limit to 3 days), antiemetics, PCP/ENT follow-up
- Suppurative: admit for IV antibiotics and ENT evaluation
- Return if: New neurologic symptoms, severe headache, inability to tolerate PO