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Labyrinthitis is a topic covered in the 5-Minute Emergency Consult.

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  • Inflammatory disorder of the inner ear
  • Inflammation decreases afferent firing from the labyrinth
    • CNS interprets the decreased signal as head rotation away from the diseased labyrinth
    • The imbalance in firing from the labyrinth results in spontaneous nystagmus with fast phase away from the pathologic side
  • Form of unilateral vestibular dysfunction that typically cause balance disorders and vertigo, and may be associated with hearing loss and tinnitus
  • Peak onset 30–60 yr old
  • Associated with upper respiratory tract infection in 50% of patients
  • Symptoms predominantly with head movement but can persist at rest
  • Recovery phase gradual over weeks to months


  • 3 most common causes of peripheral vertigo include, benign paroxysmal positional vertigo (BPPV), Ménière disease, and labyrinthitis
  • Labyrinthitis:
    • Serous: Viral or bacterial
    • Suppurative: Bacterial
    • Autoimmune: Wegener or polyarteritis nodosa
    • Vascular ischemia
    • Head injury or ear trauma
    • Medications:
      • Aminoglycosides, loop diuretics, antiepileptics (phenytoin)
    • Allergies
    • Chronic
  • BPPV:
    • Dislodgement of otoconia debris:
      • Idiopathic: 49%
      • Post-traumatic: 18%
      • Sequela of labyrinthitis: 15%
      • Sequela of ischemic insult

Pediatric Considerations
  • Suppurative and serous labyrinthitis:
    • Usually secondary to acute otitis media, mastoiditis, or meningitis
  • 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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Rosen, Peter, et al., editors. "Labyrinthitis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307466/all/Labyrinthitis.
Labyrinthitis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307466/all/Labyrinthitis. Accessed April 25, 2019.
Labyrinthitis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307466/all/Labyrinthitis
Labyrinthitis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307466/all/Labyrinthitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Labyrinthitis ID - 307466 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307466/all/Labyrinthitis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -