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Labyrinthitis and vestibular neuritis

Labyrinthitis and vestibular neuritis are infections that cause inflammation of your inner ear. They can make you feel sick and dizzy, and cause problems with your balance. Labyrinthitis can also affect your hearing.

How labyrinthitis develops
Labyrinthitis affects the hearing and balance systems in the inner ear

What are labyrinthitis and vestibular neuritis?

If you have labyrinthitis or vestibular neuritis, a viral or bacterial infection is causing inflammation in your inner ear. The conditions are very similar but if you have vestibular neuritis, only your balance is affected. If you have labyrinthitis, you will have some hearing loss too.

Vestibular neuritis is more common than labyrinthitis. With both conditions, the symptoms usually go away after a few weeks but can sometimes last for much longer. Occasionally, labyrinthitis can cause permanent hearing loss in the affected ear.

Labyrinthitis and vestibular neuritis can affect both adults and children. Most people who have labyrinthitis are adults between 30 and 60. Vestibular neuritis is most common in adults between 40 and 50.

The structures of the inner ear

Your ear is made up of three parts: your outer ear, your middle ear and your inner ear. Your inner ear contains a system of fluid-filled tubes. These include your cochlea, which senses sound, and your vestibular system, which senses movement of your head and helps with balance. The vestibular system consists of the vestibule and the semicircular canals. Together these fluid-filled structures are known as the labyrinth. Your vestibular nerve passes through your inner ear, taking messages to your brain.

If you have vestibular neuritis, only your vestibular nerve is affected, which causes problems with balance. If you have labyrinthitis, your labyrinth is affected too, which causes hearing loss as well.

Symptoms of labyrinthitis and vestibular neuritis

Some of the symptoms of labyrinthitis and vestibular neuritis can be very similar. 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)
  • feel dizzy and unbalanced

If you have labyrinthitis, you may also have reduced hearing. This ranges from mild loss to losing your hearing altogether. You may also have tinnitus (a ringing sound in your ears). You won’t have hearing loss or tinnitus if you have vestibular neuritis.

You can have some or all of these symptoms for a number of reasons though, so you should make an appointment with your GP to check the cause. Ménière’s disease can cause similar symptoms to labyrinthitis. This is caused by changes in the amount of fluid in the labyrinth in the inner ear. If you have Ménière’s disease, your hearing loss (and other symptoms) will come and go quite quickly, but it can cause permanent hearing and balance problems.

Labyrinthitis and vestibular neuritis are often triggered by a viral infection of your respiratory tract, such as a cold or flu. For this reason, you may also have other symptoms such as a sore throat, runny nose and raised temperature (fever). If you have a middle ear infection, you may also have discharge (fluid) coming out of your ears.

Your eyes may shake very slightly (called nystagmus), but this isn’t always noticeable unless you’re being examined by a healthcare professional.

The symptoms of labyrinthitis and vestibular neuritis may come on suddenly. You may notice them when you wake up in the morning or during the course of the day. Your symptoms may be bad enough to make you stay in bed.

Usually the vertigo and sickness get better within a few days. But sometimes they continue for several weeks. If you have labyrinthitis, your hearing loss should get back to normal afterwards, but this may depend on what’s caused your infection.

Diagnosis of labyrinthitis and vestibular neuritis

Labyrinthitis and vestibular neuritis are usually diagnosed from their symptoms alone, without any other tests.

Your GP will ask you to describe your symptoms – when you notice them, how long they last and how much they’re affecting your usual activities. This will help your GP decide what’s causing your symptoms. Vestibular neuritis doesn’t cause hearing loss or tinnitus (ringing sounds in your ears), but labyrinthitis usually does cause these symptoms. Your GP may also ask you about other medical problems you’ve had in the past. Tell your GP about any medicines you’re taking.

Your GP will look into your ear using a device called an otoscope. This is to check for signs of inflammation and infection in your outer or middle ear which may have spread to your inner ear. Your GP 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 this triggers your dizziness or vertigo.

If your GP isn’t sure what’s causing your symptoms, they may refer you to a specialist for further tests. 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. An MRI (magnetic resonance imaging) scan or a CT (computerised tomography) scan can help rule out other causes of persistent vertigo and hearing loss.

Treatment of labyrinthitis and vestibular neuritis

Most people with vestibular neuritis can be treated at home with self-help measures and prescribed medicines to ease their symptoms. But very occasionally, you may need to be admitted to hospital if your vomiting (sickness) is very bad.

Your vertigo and balance problems should clear up after around six weeks. If not, you may need to see a physiotherapist. For more information, see our section: Vestibular rehabilitation therapy, and the FAQ: What are vestibular rehabilitation exercises?

If your GP suspects you have labyrinthitis, particularly with significant hearing loss, he or she will refer you to a specialist doctor straight away. You may need immediate treatment to stop your hearing loss getting any worse.

Self-help for labyrinthitis and vestibular neuritis

At first, when your vertigo and sickness are at their worst, you may need to rest in bed. When you have an attack of vertigo, it may help if you lie still and close your eyes until your symptoms go away. But be as active as you can as soon as possible because this will help you to recover more quickly. Keep your fluid levels up by drinking plenty of water, especially if you’re being sick.

Vestibular neuritis symptoms may come and go while you’re recovering, especially if you drink alcohol, are feeling tired or catch a cold. It’s important that you don’t drive or operate machinery while you have symptoms or are taking medicines for your symptoms. See our FAQ: Can I drive with labyrinthitis and vestibular neuritis?

If your symptoms get worse while you’re at home or you develop new symptoms, contact your GP.

Medicines for labyrinthitis and vestibular neuritis

Your doctor can prescribe medicines such as prochlorperazine, betahistine dihydrochloride or antihistamines to help with bad vertigo, nausea and vomiting. You usually only take these medicines for a short time because otherwise they may slow down your recovery.

Some of these medicines can cause drowsiness, so you shouldn’t drive, cycle or operate machinery while taking them, even if your vertigo seems better. Speak to your doctor about how your medicine may affect you and always read the patient information leaflet that comes with your medicine.

If your labyrinthitis causes severe sudden hearing loss, your doctor may prescribe a short course of high-dose corticosteroid tablets. These medicines reduce inflammation.

Antibiotics don’t work for vestibular neuritis or labyrinthitis, but if you have an underlying bacterial middle ear infection, they may be prescribed to help with that.

Vestibular rehabilitation therapy

If you’re still feeling dizzy and unsteady after a few weeks, your doctor may suggest you have vestibular rehabilitation therapy. This involves doing a range of specially designed exercises supervised by a physiotherapist. 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. At first, you may feel more unsteady but this will get better over time so it’s important to keep doing the exercises. Ask your GP for more information, and see our FAQ: What are vestibular rehabilitation exercises?

Causes of labyrinthitis and vestibular neuritis

Labyrinthitis and vestibular neuritis are caused by inflammation of your inner ear, usually due to an infection. They have various possible causes.

  • Viral infections are the most common causes. Labyrinthitis and vestibular neuritis are usually linked to an upper respiratory tract viral infection, such as a cold or flu. But many other viruses including the varicella zoster virus (that causes shingles), and the mumps, measles and rubella viruses may cause them.
  • Bacterial infections are usually a complication of a middle ear infection (otitis media) or meningitis caused by bacteria. These are more common in children than in adults.
  • Autoimmune labyrinthitis is less common. If you have an autoimmune condition, your immune system mistakenly attacks some of your body's healthy tissues, causing inflammation and damage.
  • Labyrinthitis can be triggered by damage to the cochlea inside your inner ear. This may be caused by an underlying disease, such as meningitis, circulatory problems or Ménière’s disease.

Complications of labyrinthitis and vestibular neuritis

Labyrinthitis and vestibular neuritis often go away without any complications. Your vertigo should get better within a few days. But some people continue to feel unsteady even after the initial spinning and dizziness have gone away. This can last a long time – weeks or even months. It can make you more likely to fall over.

Sometimes, labyrinthitis can cause permanent hearing loss. It can also cause lasting damage to the balance system in your inner ear. Whether or not this happens may depend on which type of labyrinthitis you have. This is more likely to happen if you have a bad case of bacterial labyrinthitis. You can ask your doctor if you’re likely to have any long-term problems, but this may not be easy to predict.

FAQ: Can I drive with labyrinthitis or vestibular neuritis?

You shouldn’t drive if you have symptoms of labyrinthitis or vestibular neuritis, such as dizziness and vertigo. You also shouldn’t operate any machinery. This is for your safety and the safety of others.

You must tell the DVLA (Driver and Vehicle Licensing Agency) if you have labyrinthitis or vestibular neuritis. You’ll need to fill in a form – you can download the form from the DVLA website (see our section: Other helpful websites for contact details). You’ll need to give the DVLA information about your symptoms and also permission to contact your doctor to find out more.

The DVLA will assess your case and let you know if there’ll be any restrictions on your driving. The decision will depend on your individual circumstances. You may need to have a driving assessment. You can usually keep driving while the DVLA is looking at your application. But speak to your doctor and see how you feel, as you may not feel well enough to drive.

You should also tell your motor insurer about your labyrinthitis and vestibular neuritis.

FAQ: Is feeling dizzy the same as having vertigo?

If you feel dizzy, it means you may feel light-headed or unsteady. Vertigo is one specific type of dizziness. If you have vertigo, it means you feel that you or things around you are moving even when you’re still. You can feel dizzy without having vertigo.

People often feel light-headed or dizzy before they faint. This 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. But you should still be checked by your GP if you faint or feel dizzy for no obvious reason.

Many things can make you feel dizzy, such as problems with your heart, blood (e.g. anaemia) and some conditions related to your brain. Dizziness can also be a side-effect of some medicines. Vertigo has many causes too, including ear infections, diseases of your ear and problems with your nervous system.

FAQ: What are vestibular rehabilitation exercises?

Vestibular rehabilitation exercises may help with persistent dizziness and unsteadiness. These can improve your balance and help you return to your usual activities more quickly. Your doctor or physiotherapist will show you which exercises can help you get your balance back. You usually start off with very simple exercises, such as moving your eyes and head. Once you’re able to do these, you 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. Eventually, you’ll be able to walk across a room or go up and down the stairs without noticing any balance problems.

You should only do these exercises if you’ve 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. Your dizziness may feel worse when you first start the exercises, but this feeling will disappear.

FAQ: Are labyrinthitis and vestibular neuritis contagious?

Labyrinthitis and vestibular neuritis aren’t contagious. This means you can’t catch the infections directly from someone who already has them. But you may catch infections such as a cold or flu that trigger viral labyrinthitis or vestibular neuritis.

Someone may have cold or flu symptoms before their labyrinthitis or vestibular neuritis or at the same time. You can catch the cold or flu from droplets in the air or touching an infected surface. If you do, you may go on to develop labyrinthitis or vestibular neuritis yourself (but it is unlikely).

FAQ: Can I fly with labyrinthitis or vestibular neuritis?

Travelling with labyrinthitis, vestibular neuritis or any ear infection isn’t ideal. The changes in air pressure, motion changes and flickering lights can make symptoms worse. It doesn’t mean you definitely can’t travel but it’s a good idea to ask your doctor about this if you’re planning to fly. Here are some ways to manage discomfort when flying.

  • Take sunglasses to help with visual disturbances.
  • Try to stay awake during the descent – this is when most people are affected by air pressure changes.
  • Manage air pressure changes and help your ears pop by swallowing water or sucking a sweet or chewing gum. You can also pinch your nose and blow gently through your nose until your ears pop.
  • Take decongestant medicines (these aren’t suitable for some people though).

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    Further information

    Sources

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    • Labyrinthitis. BMJ Best Practice. bestpractice.bmj.com, last updated November 2017
    • Vestibular neuritis and labyrinthitis. PatientPlus. patient.info/patientplus, last checked November 2016
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    • Ear anatomy. Medscape. emedicine.medscape.com, updated June 2016
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    • Ears. Oxford Handbook of Geriatric Medicine (online). Oxford Medicine Online. oxfordmedicine.com, published July 2012
    • Vestibular neuronitis (viral labyrinthitis). The MSD Manuals. www.msdmanuals.com, last full revision/review January 2017
    • Nausea and labyrinth disorders. NICE British National Formulary. bnf.nice.org.uk, last updated November 2017
    • Prochlorperazine medicinal forms. NICE British National Formulary. bnf.nice.org.uk, last updated November 2017
    • Promethazine teoclate. NICE British National Formulary. bnf.nice.org.uk, last updated November 2017
    • Corticosteroids and corticosteroid replacement therapy. PatientPlus. patient.info/patientplus, last checked January 2015
    • Vestibular Rehabilitation Exercises. Brain & Spine Foundation. www.brainandspine.org.uk, last checked June 2017
    • Autoimmune disease of the inner ear. Medscape. emedicine.medscape.com, updated December 2016
    • Neurology. Oxford Handbook of Clinical Medicine (online). Oxford Medicine Online. oxfordmedicine.com, published September 2017
    • Labyrinthitis and driving. Driver and Vehicle Licensing Agency. www.gov.uk, accessed November 2017
    • What happens after you tell the DVLA. Driver and Vehicle Licensing Agency. www.gov.uk, accessed November 2017
    • Dizziness, giddiness and feeling faint. PatientPlus. patient.info/patientplus, last checked June 2014
    • Vertigo. PatientPlus. patient.info/patientplus, last checked October 2016
    • Common cold (coryza). PatientPlus. patient.info/patientplus, last checked November 2016
    • Features of vestibular neuritis and labyrinthitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2010
    • Ménière’s disease. PatientPlus. patient.info/patientplus, last checked May 2015
    • Vestibular neuritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2017
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    Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, May 2018
    Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
    Next review due May 2021

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