Labyrinthitis

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.

The most common symptoms are dizziness, hearing loss (from mild to total loss of hearing) and vertigo – the sensation that you, or the environment around you, is moving.

These symptoms can range from mild to severe, with some people feeling that they are unable to remain upright. Other symptoms include:

• a feeling of pressure inside your ear(s)
• ringing or humming in your ear(s) (tinnitus)
• fluid or pus leaking out of your ear(s)
• ear pain
• feeling sick (nausea) or being sick
• a high temperature (fever) of 38C (100.4F) or above
• changes in vision, such as blurred vision or double vision
• mild headaches 

Certain things can make the dizziness worse, including:

• colds or illness 
• the dark
• being in crowded areas or small rooms
• tiredness
• a women’s period
• walking

See your GP if you have these symptoms.

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

Treating labyrinthitis

In most cases, the symptoms pass within a few weeks. Treatment involves a combination of bed rest and medication to help you cope better with the symptoms. You may need additional medication to fight the underlying infection, although antibiotics are not often required as the cause is most commonly due to a virus.

Contact your GP if you do not notice any improvement after three weeks. You may need to be referred to an ear, nose and throat (ENT) specialist.

A small number of people have persistent symptoms that last for several months, or possibly years. This requires a more intensive type of treatment called vestibular rehabilitation therapy (VRT).

Read more about treating labyrinthitis

The labyrinth

The labyrinth is the innermost part of the ear. It 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 that contributes to your sense of balance

Inflammation of the labyrinth can disrupt your hearing and sense of balance, triggering the symptoms of labyrinthitis. The labyrinth usually becomes inflamed either because of:

• a viral infection, such as a cold or flu
• a bacterial infection, which is much less common

Read more about the causes of labyrinthitis

Who gets labyrinthitis?

Most cases of viral labyrinthitis occur in adults aged 30 to 60 years old. Viral labyrinthitis is relatively common in adults. Other types of ear infections are usually more widespread in children. Bacterial labyrinthitis is much less common. Younger children under two years old are more vulnerable to developing bacterial labyrinthitis.

Complications of labyrinthitis

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

Because of this high risk, a hearing test is recommended following bacterial labyrinthitis.

Severe hearing loss following bacterial labyrinthitis can sometimes be treated with a cochlear implant. This is not a conventional hearing aid, but a small electronic device fitted under the skin behind the ear during surgery.

Read more information about hearing loss

Vestibular neuronitis

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

This is actually known as vestibular neuronitis rather than labyrinthitis.

However, both terms are often used to describe the same diagnosis.

Labyrinthitis is caused by inflammation of part of the inner ear known as the labyrinth. This is caused by an infection.

How the labyrinth works

The fluid-filled channels of the labyrinth are known as the vestibular system and they are connected at different angles. This fluid moves when you move your head, telling your brain how far, fast and in what direction your head is moving. This allows your body to balance properly. The vestibular system works in a similar way to a stereo, with your left and right ears sending separate signals to your brain. If one ear becomes infected, these signals become out of sync, which confuses your brain and triggers symptoms such as dizziness and loss of balance.

The labyrinth also contains a small, spiral-shaped cavity called the cochlea. It sends sound waves to the language processing areas of the brain. Inflammation can disrupt this function, leading to hearing loss.

Viral labyrinthitis

Around half of all cases of viral labyrinthitis 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 is 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.

Immune system problems

Labyrinthitis often develops in people who have an underlying autoimmune condition (where the immune system mistakenly attacks healthy tissue rather than fighting off infections).

Many conditions can cause dizziness and vertigo. Your GP will usually diagnose labyrinthitis based on your symptoms, your medical history and a physical examination.

Your GP may carry out the following tests:

• a physical examination – you may be asked to move your head or body and your ears will be checked for signs of inflammation and infection
• hearing tests – labyrinthitis is more likely 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 because testing for infection would damage the labyrinth.

Doctors can usually safely assume that labyrinthitis is the result of a viral infection (more common) 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 common bacterial labyrinthitis symptoms, 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. Symptoms can include:

• severe headache
• mental confusion
• slurred speech
• weakness or paralysis on one side of your body

These tests can include:

• a lumbar puncture – a fluid sample is taken from the base of your spine and checked for infection
• computerised tomography (CT) scan – to give a three-dimensional picture of your brain
• magnetic resonance imaging (MRI) scan – to give a detailed image of your brain
• blood tests

Labyrinthitis is usually treated using a combination of self-help techniques and medication. Chronic labyrinthitis may be treated with vestibular rehabilitation therapy (VRT).

Self-help

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

In its early stages, you may feel constantly dizzy and it can give you severe vertigo. 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. For example:

• during an attack, lie still in a comfortable position (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 dizziness, vertigo and loss of balance are particularly severe, your GP may prescribe a short course of medication such as benzodiazepine or antiemetics (vestibular sedatives).

Benzodiazepine

Benzodiazepines reduce activity inside your central nervous system. This means your brain is less likely to be affected by the abnormal signals 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.

Antiemetics

A prescription medication known as an antiemetic may be prescribed if you're experiencing nausea and vomiting.

Prochlorperazine 5mg tablets are an antiemetic used to treat the symptoms of vertigo and dizziness. It may be considered as an alternative treatment to benzodiazepines.

Most people are able to tolerate prochlorperazine and side effects are uncommon, but can include:

• tremors (shaking)
• abnormal or involuntary body and facial movements
• sleepiness

If you are vomiting, there is a prochlorperazine 3mg tablet available which you place inside your mouth between your gums and cheek.

Corticosteroids

Corticosteroids such as prednisolone may be recommended if your symptoms are particularly severe. They are often effective at reducing inflammation.

Antibiotics

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).

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

When to seek further advice

Contact your GP if you develop additional symptoms that suggest your condition may be getting worse. If this happens, you may be admitted to hospital. These symptoms include:

• mental confusion
• slurred speech
• 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 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 are not usually as severe as 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)

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 coming 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 your brain starts to get used to disruptive signals sent by your vestibular system and then ignores them
• 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 can pay for private treatment. If you decide to see a private physiotherapist, make sure they are fully qualified and a member of a recognised body, such as the Chartered Society of Physiotherapy (CSP).

Not all physiotherapists have training in VRT, so you need to make it clear you require this type of treatment before making an appointment.

Permanent hearing loss can be a common complication of labyrinthitis, particularly in children who have developed bacterial labyrinthitis as a complication of the brain infection meningitis.

It's estimated that as many as one in five children will develop hearing loss after having meningitis. The hearing loss can either be partial or complete.

Because of 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 infection.

Permanent, severe hearing loss following bacterial labyrinthitis can sometimes be treated with a cochlear implant. This is not a conventional hearing aid, but a small electronic device fitted under the skin behind the ear during surgery.

Read more information about hearing loss.