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Labyrinthitis: Inner Ear Infection Effects on Balance & Hearing

What Is Labyrinthitis?

Inflammation of the membranous labyrinth (cochlea + vestibular apparatus) usually from viral infection (often post-URI) or bacterial spread (otitis media, meningitis).

Core Symptoms

  • Severe Vertigo: Spinning sensation, nausea, vomiting – worst first 24–72h.
  • Hearing Loss: Usually unilateral, sensorineural; may be permanent if cochlea damaged.
  • Tinnitus: Ringing, roaring, hissing.
  • Nystagmus: Involuntary eye movements (fast phase away from affected side in acute vestibular syndrome).
  • Imbalance: Gait unsteadiness, falls risk.
  • Headache, Fever, Fatigue (if infectious).

Complications

  • Permanent Vestibular Deficit: Chronic imbalance, oscillopsia.
  • Permanent Hearing Loss.
  • Bacterial Meningitis: Rare but life-threatening if bacterial labyrinthitis spreads.

Diagnosis

  • Clinical (acute vestibular syndrome + hearing loss).
  • Hearing test (audiometry).
  • MRI brain/IAC if atypical (rule out stroke, schwannoma).
  • Labs if bacterial suspected.

Treatment

  • Viral (most common): Supportive – vestibular suppressants (meclizine, benzodiazepines) short-term only; antiemetics; corticosteroids (prednisone) may improve hearing recovery if started early.
  • Bacterial: IV antibiotics (covering likely pathogens) + possible mastoidectomy.
  • Vestibular Rehabilitation Therapy (VRT): Critical for central compensation – gaze stability, habituation, balance exercises. Start early.

Prognosis

Vertigo resolves in days-weeks. Hearing recovery variable. VRT significantly improves long-term balance. Recurrence rare unless underlying autoimmune/Meniere's.

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