Labyrinthitis

Published by Bupa's Health Information Team, October 2010.

This factsheet is for people who have labyrinthitis, or who would like information about it.

Labyrinthitis is a rare condition that affects the hearing and balance systems in the inner ear. The condition normally goes away after a few weeks, but can sometimes go on for much longer and cause permanent hearing loss. Labyrinthitis is often confused with a much more common condition called 'vestibular neuritis'. In this condition, only the balance system is affected and there isn't any hearing loss.

About labyrinthitis

Your ear is made up of three parts: the outer ear, the middle ear and the inner ear. The inner ear consists of a system of fluid-filled tubes (the labyrinth). This is made up of the cochlea, which senses sound, and the vestibular apparatus, which senses movement of your head.

When you turn your head, the change in position and direction is sensed by the vestibular apparatus, which then sends messages to your brain. Your brain also uses messages sent from your eyes, joints and muscles to get information about the position of your body. However, if any one of these sources of information suddenly becomes disrupted, your brain can't co-ordinate the messages properly and your balance will be affected.

In labyrinthitis, inflammation of your inner ear disrupts the messages that are sent from your ear to your brain, causing the information to go 'bad'. When this happens, all other 'good' information that is sent between your eyes, muscle and joints can't be co-ordinated and will cause you to feel dizzy.

How labyrinthitis develops

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Symptoms of labyrinthitis

If you have labyrinthitis, you may:

• have vertigo - this is the sensation that you, or things around you are spinning, even when you're still
  
• have hearing loss or tinnitus (a ringing sound in your ears)
  
• feel giddy (unbalanced)
  
• have a feeling of fullness in your ears
  
• have pain in your ear
  
• feel very tired
  
• have a high fever
  
• feel sick (nausea) or be sick (vomiting)

Also, your eyes may shake very slightly (nystagmus), but it's usually only your GP who notices this.

The symptoms of labyrinthitis can come on suddenly and usually improve within a few days. However, if you have hearing loss, this is usually permanent. You may also feel unsteady for months or even years afterwards, but this usually improves over time.

Although not necessarily a result of labyrinthitis, if you have these symptoms, you should see your GP.

Complications of labyrinthitis

Labyrinthitis can cause permanent hearing loss and lasting damage to the balance system in your inner ear. Although your brain can try to compensate for the damage, you may continue to feel unsteady, even after the initial spinning and dizziness has gone away.

Causes of labyrinthitis

Doctors don't always know exactly how or why labyrinthitis develops. Some possible causes are listed below.

• Viral infection. About half of people have a cold or flu before developing labyrinthitis. The herpes zoster virus and mumps virus are also thought to cause the condition.
  
• Bacterial infection. Middle ear infections (otitis media) or meningitis caused by bacteria can lead to labyrinthitis.
  
• Autoimmune conditions. Normally, your body's immune system produces white blood cells and proteins called antibodies to fight infection. If you have an autoimmune condition, your immune system wrongly attacks healthy tissues, as it doesn't recognise them, and causes inflammation.

Sometimes, having a stroke, a transient ischaemic attack ('mini stroke'), a head injury, or taking certain types of antibiotics can cause symptoms of labyrinthitis such as vertigo.

Diagnosis of labyrinthitis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will look into your ear using an instrument called an otoscope. This is used to check for signs of inflammation and infection in your outer or middle ear. He or she may also look at your eyes and test your balance.

If your symptoms need further investigation, or if you don't feel better after a few weeks, your GP may refer you to an ear, nose and throat (ENT) specialist or an audiovestibular specialist (a doctor who specialises in identifying and treating conditions that affect hearing and balance). You may need to have:

• hearing tests
  
• balance tests
• blood tests
• an MRI (magnetic resonance imaging) scan or a CT (computerised tomography) scan

Treatment of labyrinthitis

Initially, you will need to rest and maintain your fluid levels by drinking enough water. Your GP is likely to prescribe you anti-sickness medication to help with nausea and vomiting.

Hospital treatment

You may need to go to hospital if your vomiting is severe and have a drip inserted into a vein in your hand or arm (intravenous) to give you fluids.

If you have bacterial labyrinthitis, you may need to have intravenous antibiotics. Your doctor may take a sample of the bacteria from your ear and send it to a laboratory for testing. This will enable him/her to prescribe an appropriate antibiotic.

Vestibular rehabilitation therapy

If you continue to feel unsteady after a number of months, your doctor may advise you to try vestibular rehabilitation therapy. The exercises you do as part of the therapy can improve your brain's ability to sort out the 'good' information from the 'bad', which may help with your balance and walking skills. Initially you may feel more unsteady, but this will improve over time. Speak to your doctor for further advice and information about vestibular rehabilitation.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.