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...

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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