Labyrinthitis

Basics

Description

  • Inflammation of the membranous labyrinth of the inner ear
  • Can cause vertigo, nausea, vomiting, tinnitus, and/or loss of hearing
  • Vestibular neuritis has similar presentation without hearing loss/tinnitus
  • Benign, self-limited
  • Unilateral vestibular dysfunction with nystagmus
  • Peak onset 30–60 yr old; 2× more in females
  • Often preceded by viral/bacterial infection
  • Can be associated with autoimmune disease and HIV
  • Symptoms predominantly with head movement but can persist at rest
  • Recovery phase gradual over weeks to months

Etiology

  • Vertigo can be peripheral or central
  • Dangerous causes: Stroke, vertebral artery dissection, hemorrhage, neoplasm, demyelinating disease
  • 2nd most common causes of peripheral vertigo include benign paroxysmal positional vertigo (BPPV) and labyrinthitis
  • Consider Ménière disease if patient’s symptoms are recurrent
  • Labyrinthitis:
    • Viral: Most likely secondary to viral URI, however viral labyrinthitis can cause congenital or acquired hearing loss
    • Bacterial: Usually a consequence of bacterial meningitis or otitis media:
      • Can be suppurative (direct bacterial invasion) or serous
      • If suppurative: Prompt antibiotic administration and ENT consult
    • Autoimmune: Rare complication of Wegener or polyarteritis nodosa
    • Vascular ischemia
    • HIV and syphilis have been associated with labyrinthitis
  • BPPV:
    • Dislodgement of otoconia debris:
      • Most often idiopathic
      • Can be posttraumatic or secondary to trauma, labyrinthitis, vestibular neuritis, or ischemia

Pediatric Considerations

  • Labyrinthitis secondary to maternal CMV or rubella can cause congenital hearing loss
  • BPPV:
    • Onset 1–5 yr of age
    • Symptoms: Abrupt onset of crying, nystagmus, diaphoresis, emesis, ataxia
    • Recurrences for up to 3 yr
    • Migraine–BPPV complex is the most common etiology of pediatric vertigo
  • Ménière disease; rare before 10 yr of age

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