Labyrinthitis

Labyrinthitis is an inner ear infection. It causes a delicate structure deep inside your ear called the labyrinth to become inflamed, affecting your hearing and balance.

Contents

Introduction

Labyrinthitis is an inner ear infection. It causes a delicate structure deep inside your ear called the labyrinth to become inflamed, affecting your hearing and balance.

Symptoms of labyrinthitis include:

The symptoms may be quite severe in the first week but usually get better after a few weeks. However, some cases can have much longer-lasting symptoms. This can have a major impact on a person's quality of life and their ability to do everyday tasks.

The labyrinth

The labyrinth is the innermost part of the ear. It contains two important parts:

  • the cochlea – this relays sounds to the brain and is responsible for hearing
  • the vestibular system – a complex set of fluid-filled channels responsible for your sense of balance

Inflammation of the labyrinth can disrupt both your hearing and sense of balance, triggering the symptoms of labyrinthitis.

The labyrinth usually becomes inflamed either because of:

  • a viral infection, such as a cold or flu
  • a bacterial infection, which is much less common

Read more about the causes of labyrinthitis.

Treating labyrinthitis

In most cases, the symptoms of labyrinthitis pass within a few weeks. Treatment for labyrinthitis involves a combination of bed rest and medication to help you cope better with the symptoms. In some cases you may need additional medication to fight the underlying infection.

A small number of people have persistent symptoms that last for several months, or possibly years.

These people will require a more intensive type of treatment called vestibular rehabilitation therapy (VRT). This treatment attempts to "retrain" the brain to cope with the altered signals that come from the vestibular system.

Who gets labyrinthitis?

Most cases of viral labyrinthitis occur in adults aged 30 to 60 years old.

Viral labyrinthitis is thought to be a relatively common ear condition among adults. Other types of ear infections are usually more widespread in children.

One study found that around one in six people who visited their doctor with symptoms of vertigo had labyrinthitis.

Bacterial labyrinthitis is much less common. Younger children under two years old are more vulnerable to developing bacterial labyrinthitis.

Bacterial labyrinthitis carries a higher risk of causing permanent hearing loss. It's estimated that one in three cases of acquired hearing loss are caused by bacterial labyrinthitis. Read more about complications of labyrinthitis.

Symptoms

The three most common symptoms of labyrinthitis are dizziness, hearing loss and vertigo – the sensation that you, or the environment around you, is moving.

These symptoms can range from mild to severe. For example, some people may only feel mildly dizzy and out of balance. Other people have reported that their symptoms of vertigo and loss of balance were so intense that they could no longer remain upright and were worried that they might have been having a stroke.

Hearing loss can affect one or both ears and can range from mild to total loss of hearing.

Other symptoms of labyrinthitis include:

  • a feeling of pressure inside your ear(s)
  • ringing or humming in your ear(s) (tinnitus)
  • fluid or pus leaking out of your ear(s)
  • ear pain
  • feeling sick (nausea)
  • being sick
  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • changes in vision, such as blurred vision or double vision

Why am I so dizzy?

There are a number of things that sometimes make dizziness worse, including:

  • head movements
  • colds or illness
  • computers
  • the dark
  • small rooms
  • crowds
  • tiredness
  • menstruation
  • focusing on people
  • sitting for periods of time
  • walking
  • being in shops and supermarkets

Avoid driving, using tools and machinery or working at heights if you're feeling dizzy and unbalanced.

Read more information about how labyrinthitis is treated.

Causes

Labyrinthitis is caused by inflammation of part of the inner ear known as the labyrinth. This is caused by an infection.

How the labyrinth works

The fluid-filled channels of the labyrinth are known as the vestibular system. All the channels are connected and are at different angles.

When you move your head, the fluid inside the channels of the labyrinth also moves. This tells your brain how far, fast and in what direction your head is moving, which allows your body to balance properly.

The vestibular system works in a similar way to a stereo, with your right ear sending one signal to your brain and your left ear sending another signal. If one ear becomes infected, these signals become out of sync and the mismatch between the two signals can confuse your brain. This triggers many of the symptoms associated with labyrinthitis, such as dizziness and loss of balance.

The labyrinth also contains a small, spiral-shaped cavity called the cochlea. The cochlea sends sound waves to the language processing areas of the brain. Inflammation in and around your cochlea can disrupt this function, leading to hearing loss.

Viral labyrinthitis

Around half of all cases of viral labyrinthitis are thought to be caused when a viral infection of the chest, nose, mouth and airways – such as the common cold or flu – spreads to the inner ear.

Infections that affect the rest of the body, such as measles, mumps or glandular fever, are a less common cause of viral labyrinthitis.

Bacterial labyrinthitis

Labyrinthitis can sometimes be caused by a bacterial infection. This is rarer than a viral infection and is likely to be more serious.

Bacteria can enter the labyrinth if the thin layers of tissue that separate your middle ear from your inner ear are broken. This can happen if you have a middle ear infection or an infection of the brain lining (meningitis). Bacteria can also get into your inner ear if you have had a head injury.

Diagnosis

Your doctor will usually diagnose labyrinthitis based on your symptoms, your medical history and a physical examination.

Many medical conditions can cause dizziness and vertigo, so your doctor will carry out tests to determine whether you have labyrinthitis. These may include:

  • a physical examination – your doctor may try to reproduce any feelings of dizziness or vertigo by asking you to turn your head quickly or to change the position of your body
  • hearing tests – labyrinthitis is more likely to be the cause of your symptoms if you have hearing loss

Your doctor will also check your eyes. If they are flickering uncontrollably, it is usually a sign that your vestibular system (the body's balancing system) is not working properly.

Viral or bacterial labyrinthitis?

There is no reliable test to determine whether labyrinthitis is caused by a viral or bacterial infection. This is because it is currently impossible to directly test for infection without damaging the delicate structures that make up the labyrinth.

As viral labyrinthitis is much more common, doctors can usually safely assume that labyrinthitis is the result of a viral infection unless there is strong evidence to suggest otherwise, such as:

  • the labyrinthitis is in a very young child
  • labyrinthitis occurs in someone who is already known to have a bacterial infection
  • you have symptoms that are more commonly associated with bacterial labyrinthitis, such as nausea, vomiting and complete hearing loss

Further testing

Further testing is usually only required if you have additional symptoms that suggest you may have a more serious condition, such as meningitis or a stroke. Symptoms can include:

  • severe headache
  • mental confusion
  • slurred speech
  • weakness or paralysis on one side of your body

These tests can include:

Treatment

Labyrinthitis is usually treated using a combination of self-help techniques and medication. Chronic labyrinthitis may be treated with vestibular rehabilitation therapy (VRT).

Self-help

Drink plenty of liquid, particularly water, to avoid becoming dehydrated. You should drink little and often.

In its early stages, labyrinthitis can make you feel constantly dizzy and it can give you severe vertigo. You should rest in bed to avoid falling and injuring yourself. After a few days, the worst of these symptoms should have passed and you should no longer feel dizzy all the time.

You can do several things to minimise any remaining feelings of dizziness and vertigo. For example:

  • during an attack, lie still in a comfortable position (on your side is often best)
  • avoid chocolate, coffee and alcohol
  • stop smoking
  • avoid bright lights
  • try to cut out noise and anything that causes stress from your surroundings

Medication

If your symptoms of dizziness, vertigo and loss of balance are particularly severe, your doctor may prescribe a short course of medication such as benzodiazepine or antiemetics (vestibular sedatives).

Benzodiazepine

Benzodiazepines reduce activity inside your central nervous system. This means your brain is less likely to be affected by the abnormal signals coming from your vestibular system.

However, long-term use of benzodiazepines is not recommended because they can be highly addictive if used for long periods.

Antiemetics

A prescription medication known as an antiemetic may be prescribed if you are experiencing nausea and vomiting.

[Prochlorperazine 5mg tablets] are an antiemetic used to treat the symptoms of vertigo and dizziness. It may be considered as an alternative treatment to benzodiazepines.

Most people are able to tolerate prochlorperazine and side effects are uncommon, but can include tremors (shaking), abnormal or involuntary body and facial movements, and sleepiness.

Check the patient information leaflet that comes with your medicine for a full list of possible side effects.

If you are vomiting, there is a [prochlorperazine 3mg tablet] available which you place inside your mouth between your gums and cheek.

Corticosteroids

Corticosteroids such as prednisolone may be recommended if your symptoms are particularly severe. They are often effective at reducing inflammation.

Side effects of prednisolone include:

  • an increase in appetite
  • weight gain
  • insomnia
  • fluid retention
  • mood changes, such as feeling irritable or anxious

Antibiotics

If your labyrinthitis is thought to be caused by a bacterial infection, you will be prescribed antibiotics. Depending on how serious the infection is, this could either be antibiotic tablets or capsules (oral antibiotics) or antibiotic injections (intravenous antibiotics).

A number of antiviral medications are also available, but these are usually less effective than antibiotics and may have a limited effect in speeding up your recovery time. Your doctor may therefore feel there is little benefit in prescribing you this type of medication.

When to seek further advice

Contact your doctor if you develop additional symptoms that suggest your condition may be getting worse. If this happens, you may be admitted to hospital. These symptoms include:

  • mental confusion
  • double vision
  • weakness or numbness in one part of your body
  • a change in the way you usually walk

Also contact your doctor if you do not notice any improvement in your symptoms after three weeks. You may need to be referred to an ear, nose and throat (ENT) specialist.

Chronic labyrinthitis

A small number of people experience symptoms of dizziness and vertigo that last for many months and, in some cases, years. This is sometimes known as chronic labyrinthitis.

The symptoms of chronic labyrinthitis are not usually as severe as when you first get the condition, although even mild dizziness can have a considerable impact on your quality of life, employment and other daily activities.

Vestibular rehabilitation therapy (VRT)

Vestibular rehabilitation therapy (VRT) is an effective treatment for people with chronic labyrinthitis. VRT attempts to "retrain" your brain and nervous system to compensate for the abnormal signals that come from your vestibular system.

VRT is usually carried out under the supervision of a physiotherapist and involves a range of exercises designed to:

  • co-ordinate your hand and eye movements
  • stimulate sensations of dizziness so your brain starts to get used to disruptive signals sent by your vestibular system and then ignores them
  • improve your balance and walking ability
  • improve your strength and fitness

The Brain and Spine Foundation is a UK charity that has more information about vestibular rehabilitation on its website.

Not all physiotherapists have training in VRT, so you need to make it clear you require this type of treatment before making an appointment.

Complications

Permanent hearing loss can be a common complication of labyrinthitis, particularly in children who have developed bacterial labyrinthitis as a complication of the brain infection meningitis.

It's estimated that as many as one in five children will develop hearing loss after having meningitis. The hearing loss can either be partial or complete.

Because of the high risk of hearing loss occurring after bacterial labyrinthitis, it is recommended that a person is given a hearing test once they have recovered from the infection.

If your or your child's hearing is severely affected, small devices called cochlear implants may be required. Cochlear implants are inserted into your ears to help improve your hearing.

Read more information about hearing loss.

Content supplied by NHS Choices