Introduction

Labyrinthitis
Labyrinthitis

Labyrinthitis is an inner ear infection.

It causes a delicate structure deep inside your ear called a labyrinth to become inflamed, which affects your hearing and balance.

Symptoms of labyrinthitis

The most common symptoms of labyrinthitis are:

  • feeling that you or your surroundings are moving or spinning (vertigo)
  • feeling or being sick
  • some hearing loss

These symptoms can vary in severity, with some people feeling that they can't stand upright.

Other symptoms of labyrinthitis may include:

  • mild headaches
  • ringing or humming in your ear(s) (tinnitus)
  • fluid or pus leaking out of your ear(s)
  • ear pain
  • changes in vision, such as blurred vision or double vision

The symptoms of labyrinthitis can be quite severe during the first week, but usually get better after a few weeks.

In some cases the symptoms can last longer and have a significant impact on your quality of life and ability to carry out everyday tasks.

When to get medical help

If you have dizziness, vertigo, some hearing loss or any of the above symptoms and they don't get better after a few days, or your symptoms are getting worse, see your GP or call NHS Direct Wales on 0845 46 47 (or 111 Wales if available in your area).

Symptoms of vertigo, nausea and sickness often improve gradually over a few days, although they can sometimes last for several weeks.

You may feel unsteady for a number of weeks or months. This usually improves over time and with treatment. Your hearing should return, although this may depend on the type of infection that caused the problem.

See your GP or call NHS Direct Wales immediately if you have sudden hearing loss in one ear, with or without vertigo. It's important the cause is investigated.

Diagnosing labyrinthitis

Labyrinthitis is diagnosed based on your symptoms, medical history and a physical examination.

Your GP may ask you to move your head or body, and your ears will be checked for signs of inflammation and infection.

You may also have some hearing tests, as labyrinthitis is more likely if you have hearing loss.

Your GP will also check your eyes. If they're flickering uncontrollably, it's usually a sign that your vestibular system, the body's balancing system, isn't working properly.

Treating labyrinthitis

The symptoms of labyrinthitis usually pass within a few weeks.

Treatment involves drinking plenty of fluid to avoid becoming dehydrated, bed rest, and medication to help you cope better with the symptoms.

Most cases of labyrinthitis are caused by a viral infection, in which case antibiotics won't help. But you'll be offered antibiotics if your doctor thinks your infection is bacterial.

Contact your GP if your symptoms don't improve after three weeks. You may need to be referred to an ear, nose and throat (ENT) specialist.

A small number of people have symptoms that persist for several months or, in some cases, years. This requires a more intensive type of treatment called vestibular rehabilitation therapy (VRT). VRT is a specialised form of physiotherapy.

Read more about treating labyrinthitis.

What causes labyrinthitis?

Labyrinthitis is caused by an infection in the labyrinth. The labyrinth is the innermost part of the ear.

It contains the:

  • cochlea – a small spiral-shaped cavity that relays sounds to the brain and is responsible for hearing
  • vestibular system – a set of fluid-filled channels that contributes to your sense of balance

Labyrinthitis usually follows a viral infection, such as a cold or the flu. The infection can spread from the chest, nose, mouth and airways to the inner ear.

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

In rare cases, labyrinthitis can be caused by a bacterial infection. Bacterial labyrinthitis is more likely to affect young children and can be serious.

Bacteria can enter the labyrinth if the thin membranes separating 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).

Labyrinthitis can also develop in people who have an underlying autoimmune condition, where the immune system mistakenly attacks healthy tissue rather than fighting off infections.

Complications of labyrinthitis

Bacterial labyrinthitis carries a higher risk of causing permanent hearing loss, particularly in children who've developed it as a complication of meningitis.

As a result of this increased risk, a hearing test is recommended after having bacterial labyrinthitis.

Severe hearing loss after bacterial labyrinthitis can sometimes be treated with a cochlear implant. This is a small hearing device fitted under the skin behind your ear during surgery.

Vestibular neuronitis

Many people diagnosed with labyrinthitis only experience the balance symptoms without hearing loss.

This is known as vestibular neuronitis rather than labyrinthitis. However, both terms are often used to describe the same diagnosis

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Treatment

Labyrinthitis is usually treated using a combination of self-help techniques and medication.

Vestibular rehabilitation therapy (VRT) may be recommended to treat long-term (chronic) labyrinthitis.

Self-help

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

In the early stages of labyrinthitis you may feel constantly dizzy and have severe vertigo.

You should rest in bed to avoid falling and injuring yourself. Your symptoms should improve after a few days and you shouldn't feel dizzy all the time.

To minimise any remaining feelings of dizziness and vertigo:

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

You should also avoid driving, using tools and machinery, or working at heights if you're feeling dizzy and unbalanced.

Medication

If your symptoms are severe, your GP may prescribe medication.

This could include:

  • a benzodiazepine – reduces activity inside your central nervous system, making your brain less likely to be affected by the abnormal signals coming from your vestibular system, the part of the labyrinth that affects balance
  • an antiemetic (vestibular sedative) – can help relieve the symptoms of nausea and vomiting
  • corticosteroids – to reduce inflammation
  • antibiotics – may be prescribed if labyrinthitis is thought to be caused by a bacterial infection

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

When to get further medical advice

Contact your GP if you develop additional symptoms that suggest your condition may be getting worse, such as:

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

You may need to be admitted to hospital for further assessment and treatment.

Also contact your GP if your symptoms don't improve 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 dizziness and vertigo for months or even years. This is sometimes known as chronic labyrinthitis.

The symptoms aren't usually as severe as when you first get the condition, but even mild dizziness can have an impact on your quality of life and daily activities.

Vestibular rehabilitation therapy (VRT)

Vestibular rehabilitation therapy (VRT) can help people with chronic labyrinthitis.

VRT uses exercises to help retrain your brain and nervous system to compensate for the abnormal signals coming from the vestibular system.

It's usually carried out under the supervision of a specially trained physiotherapist, who will use a range of exercises to:

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

The Brain and Spine Foundation has more information about vestibular rehabilitation on its website.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 19/06/2018 13:24:59