Labyrinthitis and vestibular neuritis

Labyrinthitis and vestibular neuritis are conditions that cause inflammation of your inner ear, usually as a result of an infection. They can make you feel sick and dizzy, and cause problems with your balance. Labyrinthitis also affects your hearing.

Causes of labyrinthitis and vestibular neuritis

Various things can cause labyrinthitis or vestibular neuritis.

• Viral infections are thought to be the most common cause – especially upper respiratory tract infections, such as colds or flu. Other viruses, including the varicella zoster virus (which causes shingles), and mumps and rubella viruses, have also been linked to labyrinthitis.
• Bacterial infections, usually middle ear infection (otitis media) or meningitis, that spread to your inner ear.
• Autoimmune conditions affecting your inner ear. If you have an autoimmune condition, your immune system mistakenly attacks some of your body's healthy tissues, causing inflammation and damage.
• Damage to your inner ear, due to an underlying disease, such as meningitis, circulatory problems or Ménière’s disease.

Symptoms of labyrinthitis and vestibular neuritis

The symptoms of labyrinthitis and vestibular neuritis may come on suddenly. Symptoms of the two conditions can be very similar. You may:

• have vertigo – this is the feeling that you, or things around you, are spinning even when you're still
• feel sick or be sick (vomit)
• feel dizzy and unbalanced, even when you’re resting

There are also specific labyrinthitis symptoms. These include:

• hearing loss – this can range from mild hearing loss to losing your hearing altogether. It can affect one or both ears
• tinnitus (a ringing sound in your ears)

Your eyes may also move around quickly, which you can’t control (called nystagmus). You may not notice it unless you’re being examined.

Labyrinthitis and vestibular neuritis are often associated with colds, flu, and other viral illnesses. So, you may also get a sore throat, runny nose and raised temperature (fever).

These symptoms may not be labyrinthitis or vestibular neuritis –other things can cause them too. If your symptoms don’t get better after a few days or are particularly severe, make an appointment with your GP.

Diagnosis of labyrinthitis and vestibular neuritis

Your GP will usually be able to diagnose labyrinthitis and vestibular neuritis by examining you and asking about your symptoms. They’ll ask when you noticed your symptoms, how long they last and what makes them worse. Your GP may also ask you about other medical problems you’ve had recently, or in the past. You should tell your GP about any medicines you’re taking, as some can cause vertigo.

Your GP will look into your ear using a device called an otoscope, to check for signs of inflammation or infection. Your GP may look at your eyes, sometimes while turning your head to check your reflexes. They may test your balance by asking you to walk around, and test your hearing with a tuning fork.

Most of the time, you won’t need any further tests for labyrinthitis and vestibular neuritis. If your symptoms are severe, or your GP is unsure of the cause, they may refer you to an ear, nose and throat (ENT) specialist for more tests. They may carry out further tests to check your hearing and to see how well your balance (vestibular) system is working. They might also suggest an MRI or CT scan to help rule out other causes of your symptoms.

Treatment of labyrinthitis and vestibular neuritis

Most people with labyrinthitis and vestibular neuritis can be treated at home with the self-help measures above, and if necessary, prescribed medicines to ease their symptoms. Very occasionally, you may need to be admitted to hospital if you’re being sick (vomiting) a lot. You may also need to be referred to an ear, nose and throat (ENT) specialist if you have sudden hearing loss. You may need immediate treatment to stop your hearing loss getting any worse.

Medicines for labyrinthitis and vestibular neuritis

Your doctor can prescribe anti-sickness medicines to help with 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 make you drowsy. 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 it.

If you have an underlying bacterial middle ear infection, you may be prescribed antibiotics.

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 exercises to improve your balance and reduce dizziness. You may do exercises in which you move your head or eyes, and others to improve your balance while standing or walking. You might also have help from a physiotherapist.

Complications of labyrinthitis and vestibular neuritis

Labyrinthitis and vestibular neuritis usually clear up on their own 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. This is because your nervous system has to adapt to the changes in your ear to get rid of the feeling of vertigo. Vestibular rehabilitation can help with this.

If labyrinthitis is caused by bacteria (also known as suppurative labyrinthitis), it can cause permanent hearing loss. It can also cause lasting damage to the balance system in your inner ear. You can ask your doctor about any long-term problems, but this may not be easy to predict.