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Labyrinthitis
OVERVIEW: Inflammation of the vestibular labyrinth (a system of intercommunicating cavities and canals in the inner ear). There are many possible causes (see Differential Diagnosis). The most constant and pervasive symptom is vertigo.
System(s) affected: Nervous
Genetics: No known genetic pattern
Incidence/Prevalence in USA: Unknown
Predominant age: All ages beyond infancy
Predominant sex: Male = Female
SIGNS AND SYMPTOMS: • Vertigo
• Dizziness
• Hearing loss, fluctuating
• Nausea and vomiting
• Tinnitus
• Perspiration
• Increased salivation
• Generalized malaise
• Hypercapnia
• Nystagmus
CAUSES: • Physiological - mismatch of vestibular, visual and somatosensory systems triggered by an external stimulus, such as a stop after whirling turns, heights, motion sickness
• Pathological - imbalance in the vestibular system caused by a lesion within vestibular pathways (inner ear to cerebral cortex)
• Infections (especially viral)
• Tumors
• Vasculitis
• Infarction
• Ototoxic drugs, especially aminoglycosides
• Head injury
• Neuronitis
RISK FACTORS: • Trauma
• Stress
• Drug ingestion
• Predisposing virus infection
• Cardiovascular disease
• Cerebrovascular disease
DIAGNOSIS DIFFERENTIAL DIAGNOSIS: • Acute viral labyrinthitis
• Benign positional vertigo
• Meniere's syndrome
• Post-concussive syndrome
• Chronic bacterial otomastoiditis
• Drug-induced damage to vestibular labyrinth
• Vascular insufficiency
• Cerebellopontine-angle tumors, such as acoustic neuroma
• Multiple sclerosis
• Para-infectious encephalomyelitis
• Para-infectious cranial polyneuritis
• Ramsay Hunt syndrome
• Cerebral or systemic vasculitis
• Temporal lobe epilepsy
• HIV infection
LABORATORY: Routine laboratory studies not helpful
Drugs that may alter lab results: All drugs with potential ototoxicity
Disorders that may alter lab results: N/A
PATHOLOGICAL FINDINGS: N/A
SPECIAL TESTS: • Electronystagmography
• Caloric test
• Doll's eye test
• Forced voluntary hyperventilation for 1 to 3 minutes to mimic symptoms if cause is physiologic or emotional
IMAGING: CT or MRI for suspected lesions involving the eighth cranial nerve
DIAGNOSTIC PROCEDURES: History and physical
TREATMENT APPROPRIATE HEALTH CARE: Outpatient
GENERAL MEASURES: • Treat underlying disorder when possible
• Symptomatic treatment to accompany specific treatment
SURGICAL MEASURES: N/A
ACTIVITY: Lie still with eyes closed in darkened room during acute attacks. Otherwise, activity as tolerated.
DIET: Reduced sodium
PATIENT EDUCATION: Griffith, H.W.: Instructions for Patients, Philadelphia, W.B. Saunders Co.
MEDICATIONS DRUG(S) OF CHOICE: • Meclizine (Antivert) 25 mg qid
• Diazepam (Valium) 5 mg qid
• Promethazine (Phenergan) 25 mg qid
• Prochlorperazine (Compazine) suppositories 25 mg, for vomiting
• Scopolamine transdermal where available
Contraindications: Refer to manufacturer's literature
Precautions: All the listed medications have significant adverse reactions. Use with caution. Avoid scopolamine in the elderly.
Significant possible interactions: Refer to manufacturer's literature
ALTERNATIVE DRUGS: • Diazepam 5 mg qid
• Prochlorperazine (Compazine) suppositories 25 mg
FOLLOW UP PATIENT MONITORING: As needed
PREVENTION/AVOIDANCE: No preventive measures
POSSIBLE COMPLICATIONS: Permanent hearing loss
EXPECTED COURSE AND PROGNOSIS: Depends on cause. Physiological labyrinthitis usually clears completely.
MISCELLANEOUS ASSOCIATED CONDITIONS: • Menie re's disease
• Head injury
AGE-RELATED FACTORS:
Pediatric: Unusual in this age group
Geriatric:
• Very common in this age group, especially benign positional vertigo
• Avoid scopolamine or use with extreme caution in this age group
Others: N/A
PREGNANCY: Avoid medications
SYNONYMS: • Acute peripheral vestibulopathy
• Vestibular neuronitis
ICD-9-CM: 386.30 Labyrinthitis, unspecified
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Intestinal obstruction
Cystic fibrosis
Henoch-Schonlein purpura
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