Labyrinthitis

Disease Description (Causes and Symptoms)

• Definition: Labyrinthitis is inflammation of the inner ear (labyrinth), which damages the vestibular organs (balance) and cochlea (hearing), causing acute peripheral vertigo and sensorineural hearing loss.
• Causes: Usually an infectious inflammation (viral or bacterial) occurring as an intratemporal bone complication of otitis media. It may be associated with systemic viral infections such as measles and mumps. Rarely, it occurs after trauma or surgery.
• Pathophysiology: Inflammation of the labyrinth affects the vestibular nerve and cochlea, causing vestibular dysfunction (acute spinning vertigo and balance impairment) and sensorineural hearing loss. If the inflammation is severe, it may spread to surrounding structures (the mastoid and cranial cavity).
• Main symptoms: Sudden severe spinning dizziness, nausea and vomiting, unilateral hearing loss or reduced hearing, ear pain, tinnitus, and ear discharge (when accompanied by otitis media), and unsteady gait.

Treatment Methods

• General principles: Early treatment of the underlying infection (such as otitis media) takes priority. When a bacterial cause is suspected, appropriate antibiotics are administered (intravenous administration is often necessary). For viral causes, symptomatic treatment is used, and steroids may be considered depending on the case.
• Medication:
  • Antibiotics: Administered according to the causative organism and severity when bacterial labyrinthitis or an otitis media complication is suspected (orally or intravenously). The choice of antibiotic depends on culture results and the clinical condition.
  • Steroids: Short-term administration may be considered to reduce acute inflammation and promote hearing recovery, but the indication and expected effect are determined according to the patient’s condition.
  • Vestibular suppressants and antiemetics: Meclizine, dimenhydrinate, or, if necessary, benzodiazepines may be used to relieve acute vertigo and nausea (short-term use is recommended).
• Procedures/Surgery:
  • If otitis media or mastoid complications are severe or persistent, drainage and removal of the infection may be performed through mastoidectomy or tympanostomy.
  • If there is no response to treatment and intracranial complications such as meningitis develop, labyrinth drainage or additional surgical treatment may be considered.
• Lifestyle management and precautions:
  • During the acute phase, avoid sudden changes in posture and rest with your eyes closed. Avoid excessive head movements, driving, and work at heights.
  • Do not consume alcohol or central nervous system depressants (such as sedatives and opioid analgesics).
  • Vestibular rehabilitation (balance training) may be needed in the long term.
• Complication management: Hearing recovery may be incomplete, so monitoring is needed for chronic dizziness, permanent hearing loss, and intracranial infections (meningitis), among other complications.

Checklist Before an Outpatient Visit (Items to Prepare and Example Questions)

Items to prepare/bring:

• A list of currently used medications (including prescription drugs, over-the-counter medications, and supplements)
• Medical history (especially otolaryngologic surgery and a history of otitis media)
• A recent history of infectious diseases such as fever, a cold, measles, or mumps
• The date symptoms began and their course (when they started, sudden/gradual onset, factors that worsen or improve them)
• The type of dizziness (spinning vs non-spinning), whether it is episodic or persistent, and accompanying symptoms (vomiting, tinnitus, ear discharge, and hearing changes)
• Bring any previous hearing test (audiogram) or imaging (CT/MRI) results, if available
• Whether you use a hearing aid Examples of questions to write down (you can present them directly to the doctor during the visit):
• The date the symptoms began and how they first appeared
• The degree of hearing loss (sound volume and ability to understand speech)
• Whether there has been ear discharge, ear pain, or fever

Examples of General Questions to Ask the Doctor

• What are the side effects of this medication (or prescribed treatment)? What precautions should I take while using it?
• How much can my hearing and balance function recover? What is the prognosis?
• Do I need hospitalization or surgery? If surgery is recommended, what are the expected benefits and risks?
• When can I return to daily activities or work (such as driving or operating heavy machinery)?
• What measures should I take to prevent recurrence?

Examples of Disease-Specific Questions

• What additional tests are needed to determine whether my hearing loss is sensorineural (such as a hearing test or electronystagmography)?
• If an otitis media complication is suspected, when would mastoidectomy or labyrinth drainage be necessary, and is hearing recovery possible through surgery? Please explain.

(Tests that may help with diagnosis, if necessary: hearing test (audiogram), electronystagmography, caloric test, hyperventilation provocation test, temporal bone CT, or brain imaging (CT/MRI) — for differentiating central vertigo and evaluating mastoid and intracranial complications)