In labyrinthitis a viral or bacterial infection causes inflammation in your inner ear. This affects your hearing and your balance. Labyrinthitis is similar to another condition called vestibular neuritis, in which only the balance system is affected and there isn't any hearing loss.
Labyrinthitis usually only affects one ear, but it can sometimes occur in both ears. You usually only get labyrinthitis once, but for a few people it can come back again. Doctors aren’t sure exactly how many people get labyrinthitis each year in the UK. Most people who get it are adults between the ages of 30 and 60, but occasionally children can be affected.
The structures of the inner ear
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
- feel sick (nauseous) or be sick (vomit)
- have reduced hearing – this ranges from mild, to losing your hearing altogether
- have tinnitus (a ringing sound in your ears)
- feel dizzy and unbalanced
- have a discharge from your ear
Although not necessarily caused by labyrinthitis, see your GP if you have these symptoms.
Labyrinthitis is often linked with a viral infection of your respiratory tract, like a cold or flu. So you may have symptoms of these, such as a sore throat, runny nose and fever as well.
Also, your eyes may shake very slightly (nystagmus), but it's often only noticed when examined by a healthcare professional.
The symptoms of labyrinthitis may come on suddenly, for example when you wake up or during the course of the day. They may be severe enough to make you stay in bed.
Usually your symptoms of vertigo and sickness gradually improve over several days, although they may continue for several weeks. You may feel unsteady for several weeks or months after getting labyrinthitis, but this usually improves over time or with treatment. Hearing loss often recovers, but this may depend upon the type of infection you have.
Diagnosis of labyrinthitis
Your doctor will ask you to describe your symptoms. They may also ask you about other medical problems you’ve had in the past. Tell your GP about any medicines you’re taking.
Your doctor will look into your ear using an instrument called an otoscope. This checks for signs of inflammation and infection in your outer or middle ear which might have spread to your inner ear. (Your inner ear is too far inside to be seen like this). Your doctor may look at your eyes and test your balance. They may also test your hearing – often with a tuning fork. They may also move your head into certain positions to see if your dizziness is triggered.
If your doctor thinks you have labyrinthitis they may refer you to a specialist for further investigation. This may be an ear, nose and throat (ENT) specialist or an audiovestibular specialist. An audiovestibular specialist is a doctor who specialises in identifying and treating conditions that affect hearing and balance. You may be offered a range of tests to check your hearing and to see how well your vestibular (balance) system is working.
You probably won’t be offered blood tests unless your doctor thinks that you may have a bacterial infection. This is more likely in a young child.
Treatment of labyrinthitis
In most cases labyrinthitis is a self-limiting condition – it usually gets better on its own eventually. Most people can be treated at home through self-help together with medicines to relieve symptoms. Very occasionally, some people may need to be admitted to hospital if their vomiting is very severe.
At first, when the vertigo and sickness are worst, you may need to rest in bed. During an attack of vertigo it may help if you lie still and close your eyes until it passes. Remember to keep up your fluid levels by drinking enough water, especially if you’ve been vomiting.
It’s important that you don’t drive, work at heights or operate machinery when you are having symptoms of labyrinthitis (see our frequently asked questions for more information).
If your symptoms get worse while you’re at home or you develop new symptoms contact your GP.
Your doctor can prescribe medicines to help with vertigo, nausea and vomiting. Some of these medicines can cause drowsiness so you may not be able to drive. Speak to your doctor about how your medicine may affect you and always read the patient information leaflet that comes with your medicine.
Your doctor may also recommend a short course of corticosteroid tablets. These are medicines which reduce inflammation.
Antibiotics don’t work for viral labyrinthitis, but if you have bacterial labyrinthitis you’ll need them. Your doctor may take a swab from your ear and send it to a laboratory for testing. This helps them prescribe the right antibiotic. Depending on how severe your infection is these might be given as ear drops, tablets or intravenously (into your vein).
Vestibular rehabilitation therapy
If you’re still feeling dizzy and unsteady after a number of weeks, your doctor may suggest vestibular rehabilitation therapy. This consists of a range of specially designed exercises supervised by a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility). These exercises teach your brain to use the information from your eyes, joints and muscles to compensate for the confusing information from your inner ear. Vestibular rehabilitation therapy can help with your balance and walking and make everyday activities easier. Initially you may feel more unsteady, but this will improve over time. Speak to your GP for more information about vestibular rehabilitation. For more information see our FAQ about vestibular rehabilitation.
Causes of labyrinthitis
Labyrinthitis is an inflammation of your inner ear, usually due to an infection. Some possible causes are listed below.
- Viral infections. These are the most common cause of labyrinthitis, with the virus usually being one of the upper respiratory tract viruses, such as those that cause a cold or flu. But many other viruses including the varicella zoster virus (that causes shingles), mumps, measles and rubella viruses may cause labyrinthitis.
- Bacterial infections. Middle ear infections (otitis media) or meningitis caused by bacteria can lead to labyrinthitis. Bacterial labyrinthitis is more common in children than in adults.
- Autoimmune conditions. If you have an autoimmune condition, your immune system mistakenly attacks some of your body's healthy tissues, causing inflammation and damage. This is an uncommon cause of labyrinthitis.
Complications of labyrinthitis
Labyrinthitis often settles without complications. Some people, however, continue to feel unsteady even after the initial spinning and dizziness have gone away. This can last a long time – weeks or even months.
Sometimes labyrinthitis can cause permanent hearing loss and lasting damage to the balance system in your inner ear. Whether this happens may depend upon the type of labyrinthitis you have. Ask your doctor about the chance of having long term problems in your particular circumstances.
Can I drive if I have labyrinthitis?
You shouldn’t drive if you are having symptoms such as dizziness and vertigo. If you have a driving license you must tell the DVLA (Driver and Vehicle Licensing Agency) that you have labyrinthitis.
If you have symptoms of labyrinthitis such as dizziness and vertigo you shouldn’t drive, work at heights or operate machinery. This is for your safety, and the safety of others.
Labyrinthitis is considered a notifiable medical condition by the DVLA – this means that you must, by law, inform them if you have it. You do this by filling in a form from the DVLA (see resources section for contact details). You will be giving them information about your symptoms and also giving them permission to contact your doctor to find out more. The DVLA will assess your case and let you know whether there will be any restrictions on your driving. The decision will depend upon your individual circumstances.
You should also tell your motor insurer about any new medical condition, such as labyrinthitis, which may affect your driving.
Is feeling dizzy the same as having vertigo?
No. Vertigo is just one specific form of dizziness. You can feel dizzy without having vertigo.
If you feel dizzy, it means that you may feel light-headed or unsteady. People often feel light-headed or dizzy before they faint. It can be a reaction to a strong emotion, to standing still for a long time or to standing up too quickly. Dizziness and fainting are very common and aren't often serious. However, you should still be checked by your GP if you faint for no obvious reason or feel dizzy.
Many other things can also make you feel dizzy, such as problems with your heart, blood (eg anaemia) and some conditions related to your brain. It can also be a side-effect of some types of medicine.
Vertigo is just one specific type of dizziness. If you have vertigo, it means you have the feeling that you, or things around you, are moving even when you are still. For instance you may feel as though the room is spinning around you. It’s not usually linked to fainting. Vertigo is usually caused by a problem with your inner ear.
What do vestibular rehabilitation exercises involve?
There’s a range of different vestibular rehabilitation exercises which may help with persistent dizziness and unsteadiness. Your doctor or physiotherapist will show you which will be most useful for you.
Vestibular rehabilitation starts with very simple exercises, such as moving your eyes and head. You then gradually progress to more complicated exercises involving your whole body. This trains your brain to use information from your eyes and body to compensate for confusing information from your inner ear.
One of the most common types of rehabilitation exercises for labyrinthitis are called Cawthorne-Cooksey exercises. These include the following.
- Move only your eyes from side to side and up and down when you're in bed or sitting down. Then just move your head, first with your eyes open and then closed.
- Shrug and circle your shoulders while sitting down, and then bend forwards to pick up objects when you're sitting.
- Stand up from a sitting position with your eyes open and then closed. Then throw a small ball from hand to hand when you're standing.
- Walk across a room with your eyes open, then walk up and down steps with your eyes open.
You should only do these exercises if you have been shown how to do them by a healthcare professional. They’ll guide you through them, letting you know when to move from one exercise to a more difficult one.
These exercises can improve your balance and help you return to your usual activities more quickly.
Is labyrinthitis contagious?
Labyrinthitis itself isn’t contagious. However, infections that may trigger the condition can be.
You can't catch labyrinthitis directly from someone else who has the condition.
However, viral infections, such as flu, that are thought to trigger labyrinthitis are contagious and can be spread from one person to another. It's therefore possible that you can catch the virus from someone who has had labyrinthitis and go on to develop the condition yourself. For further information, see causes of labyrinthitis.
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