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:
- dizziness
- vertigo – the feeling that the world is moving or spinning around you
- loss of balance
- hearing loss
The symptoms are usually mild and get better after a few weeks. However, some cases are more severe and last much longer. 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's located at the point where the ear connects to the skull. The labyrinth 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, and can trigger the symptoms of labyrinthitis.
Inflammation of the labyrinth is usually caused by either:
- 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 one to three 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 30–60 years old. Women are twice as likely to be affected by viral labyrinthitis than men.
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 1 in 6 people who visited their GP 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 1 in 3 cases of acquired hearing loss are caused by bacterial labyrinthitis.
Read more about complications of labyrinthitis
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Causes
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. This important information 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 labyrinths 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 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.
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Diagnosis
Your GP 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 GP will carry out some tests to determine whether you have labyrinthitis. Theses tests may include:
- a physical examination – your GP may try to reproduce any feelings of dizziness or vertigo that you have by asking you to turn your head quickly or to change the position of your body
- hearing tests – you are more likely to have labyrinthitis if you have hearing loss
Your GP 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. These include:
- severe headache
- mental confusion
- slurred speech
- weakness or paralysis on one side of your body
These tests can include:
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Treatment
Labyrinthitis is usually treated using a combination of self-help techniques and medication.
Self-help techniques
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. Therefore, 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 that you have. 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 GP may prescribe a short course of a type of medication known as a benzodiazepine.
Benzodiazepines reduce activity inside your central nervous system. This means that your brain is less likely to be affected by the abnormal signals that are 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.
A prescription medication, known as an antiemetic, may be prescribed if you are experiencing the troublesome symptoms of nausea and vomiting.
Prochlorperazine is an antiemetic that can be used to effectively treat the symptoms of vertigo and dizziness. It may be considered as an alternative treatment if benzodiazepines are considered to be unsuitable for you.
Most people are able to tolerate prochlorperazine and side effects are uncommon. However, possible side effects could include tremors (shaking) or abnormal, or involuntary, body and facial movements.
Sleepiness is another possible side effect of prochlorperazine. 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 type of prochlorperazine that comes in tablet form and which dissolves and absorbs into your body. You place the tablet inside your mouth between your gums and cheek.
Corticosteroid medications, such as prednisolone, may be recommended if your symptoms are particularly severe. They are often effective at reducing inflammation levels.
Side effects of prednisolone include:
- an increase in appetite
- weight gain
- insomnia
- fluid retention
- mood changes, such as feeling irritable or anxious
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 much less effective than antibiotics and may have a limited effect in speeding up your recovery time. Therefore, your GP may feel that there is little benefit in prescribing antiviral medication.
When to seek further advice
Contact your GP if you develop additional symptoms that suggest your condition may be getting worse, in which case hospital admission may be required. 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 GP 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.
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Complications
Chronic labyrinthitis and VRT
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 they are 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) 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 that your brain starts to get used to, and then ignores, disruptive signals sent by your vestibular system
- 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.
You can ask your GP to refer you to a physiotherapist, or you have the option of paying for private treatment. If you decide to see a private physiotherapist, make sure that they are fully qualified and that they are a member of a recognised body, such as the Chartered Society of Physiotherapy (CSP).
Physiotherapists who are members of the CSP will follow high standards of professional practice and will have a good level of knowledge and skills. The Physio First website lists qualified members (private).
Not all physiotherapists have training in VRT, so you need to make it clear that you require this type of treatment before making an appointment.
Hearing loss
Permanent hearing loss can be a common complication of bacterial labyrinthitis, particularly in children who have developed bacterial labyrinthitis as a complication of the brain infection meningitis.
It's estimated that as many as 1 in 5 children will develop hearing loss after having meningitis. The hearing loss can either be partial or complete.
Due to 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 effects of 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.
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