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Labyrinthitis

Labyrinthitis is a balance disorder that usually follows an upper respiratory tract infection (URI). It is, as the name suggests, an inflammatory process affecting the labyrinths that house the vestibular system of the inner ear. more...

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Labrynthitis causes vertigo, disequilibrium, and sometimes nystagmus beating away from affected ear. Hearing loss is commonly present in the infected ear. Nausea, anxiety and a general ill feeling are common due to the distorted balance signals that the brain receives from the inner ear. There are also sometimes cochlear symptoms such as tinnitus and hearing loss. It appears labyrinthitis is caused by a virus (the herpes virus has been implicated) but can also arise from bacterial infection, head injury, an allergy or as a reaction to a particular medicine. Both bacterial and viral labyrinthitis can cause permanent hearing loss, although this is rare. Prochlorperazine is commonly prescribed for all types of the infection, which helps with the nausea and sickness. Recovery from acute labyrinthine inflammation generally takes from one to six weeks, however it is not uncommon for residual symptoms (disequilibrium and/or dizziness) to last for many months or even years (Bronstein, 2002).

Labyrinthitis and Anxiety

Chronic anxiety is a common side-effect of labyrinthitis which can produce tremors, heart palpitations, panic attacks and depression. Often a panic attack is one of the first symptoms to occur as labyrinthitis begins. While dizziness can occur from extreme anxiety, labyrinthitis itself can precipitate a panic disorder. Three models have been proposed to explain the relationship between vestibular dysfunction and panic disorder (Simon et al, 1998):

  • Psychosomatic model: vestibular dysfunction which occurs as a result of anxiety.
  • Somatopsychic model: panic disorder triggered by misinterpreted internal stimuli (eg. stimuli from vestibular dysfunction), that are interpreted as signifying imminent physical danger. Heightened sensitivity to vestibular sensations leads to increased anxiety and, through conditioning, drives the development of panic disorder.
  • Network alarm theory: panic which involves noradrenergic, serotonergic, and other connected neuronal systems. According to this theory, panic can be triggered by stimuli that set off a false alarm via afferents to the locus ceruleus, which then triggers the neuronal network. This network is thought to mediate anxiety and includes limbic, midbrain and prefrontal areas. Vestibular dysfunction in the setting of increased locus ceruleus sensitivity may be a potential trigger.

Treatment

Because anxiety interferes with the compensation process, it is important to treat an anxiety disorder and/or depression as soon as possible to allow the brain to compensate for any vestibular damage. Acute anxiety can be treated in the short term with benzodiazepines such as diazepam, however long term use is not recommended because of the addictive nature of benzodiazepines and the interference they may cause with vestibular compensation and adaptive plasticity (Solomon and Shepard, 2002). Evidence suggests that selective serotonin reuptake inhinbitors (SSRI) may be more effective in treating labyrinthitis. They act by relieving anxiety symptoms and may stimulate new neural growth within the inner ear allowing more rapid vestibular compensation to occur. Some evidence suggests that viral labyrinthitis should be treated in its early stages with corticosteroids such as prednisone, and possibly antiviral medication such as Valtrex and that this treatment should be undertaken as soon as possible to prevent permanent damage to the inner ear.

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Labyrinthitis
From Gale Encyclopedia of Medicine, 4/6/01 by Rebecca J. Frey

Definition

Labyrinthitis is an inflammation of the inner ear that is often a complication of otitis media. It is caused by the spread of bacterial or viral infections from the head or respiratory tract into the inner ear.

Description

Labyrinthitis is characterized by dizziness or feelings of motion sickness caused by disturbance of the sense of balance.

Causes & symptoms

Causes

The disease agents that cause labyrinthitis may reach the inner ear by one of three routes:

  • Bacteria may be carried from the middle ear or the membranes that cover the brain.
  • The viruses that cause mumps, measles, influenza, and colds may reach the inner ear following an upper respiratory infection.
  • The rubella virus can cause labyrinthitis in infants prior to birth.

Labyrinthitis can also be caused by toxic drugs.

Symptoms

The primary symptoms of labyrinthitis are vertigo (dizziness), accompanied by hearing loss and a sensation of ringing in the ears called tinnitus. Vertigo occurs because the inner ear controls the sense of balance as well as hearing. Some patients also experience nausea and vomiting and spontaneous eye movements in the direction of the unaffected ear. Bacterial labyrinthitis may produce a discharge from the infected ear.

Diagnosis

The diagnosis of labyrinthitis is based on a combination of the patient's symptoms and history--especially a history of a recent upper respiratory infection. The doctor will test the patient's hearing, and order a laboratory culture to identify the organism if the patient has a discharge.

If there is no history of a recent infection, the doctor will order extra tests in order to exclude injuries to the brain or Meniere's disease.

Treatment

Medication

Patients with labyrinthitis are given antibiotics, either by mouth or intravenously to clear up the infection. They may also be given meclizine (Antivert, Bonine) for vertigo and nausea.

Surgery

Some patients require surgery to drain the inner and middle ear.

Supportive care

Patients with labyrinthitis should rest in bed for three to five days until the acute dizziness subsides. Patients who are dehydrated by repeated vomiting may need intravenous fluid replacement. In addition, patients are advised to avoid driving or similar activities for four to six weeks after the acute symptoms subside, because they may have occasional dizzy spells during that period.

Prognosis

Most patients with labyrinthitis recover completely, although it often takes five to six weeks for the vertigo to disappear completely and the patient's hearing to return to normal. In a few cases the hearing loss is permanent.

Prevention

The most effective preventive strategy includes prompt treatment of middle ear infections, as well as monitoring of patients with mumps, measles, influenza, or colds for signs of dizziness or hearing problems.

Key Terms

Labyrinth
The bony cavity of the inner ear.
Meniere's syndrome
A disease of the inner ear marked by recurrent episodes of vertigo and roaring in the ears lasting several hours. Its cause is unknown.
Otitis media
Inflammation of the middle ear. It can lead to labyrinthitis.
Vertigo
A sensation of dizziness marked by the feeling that one's self or surroundings are spinning or whirling.

Further Reading

For Your Information

    Books

  • Baloh, Robert W. "Episodic Vertigo." In Conn's Current Therapy, edited by Robert E. Rakel. Philadelphia: W. B. Saunders Company, 1998.
  • Borer, William Z., and Duane W. Taebel. "Nausea, Vomiting, and Dyspepsia." In Current Diagnosis 9, edited by Rex B. Conn, et al. Philadelphia: W. B. Saunders Company, 1997.
  • Jackler, Robert K., and Michael J. Kaplan. "Ear, Nose, & Throat." In Current Medical Diagnosis & Treatment 1998, edited by Lawrence M. Tierney, Jr., et al. Stamford, CT: Appleton & Lange, 1997.
  • "Labyrinthitis." In Professional Guide to Diseases, edited by Stanley Loeb, et al. Springhouse, PA: Springhouse Corporation, 1991.
  • "Otolaryngology: Purulent Labyrinthitis." In The Merck Manual of Diagnosis and Therapy, vol. II, edited by Robert Berkow, et al. Rahway, NJ: Merck Research Laboratories, 1992.
  • Rowe, Lee D. "Otolaryngology-- Head & Neck Surgery." In Current Surgical Diagnosis & Treatment, edited by Lawrence W. Way. Stamford, CT: Appleton & Lange, 1994.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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