Labyrinthitis: Symptoms and a Story


A 28 year-old woman was seen in an ER because of severe vertigo (spinning sensation) and vomiting for several hours.

She had no significant past medical history and did not smoke or drink.

She had been well until 1 week earlier, when cough prouctive of yellow sputum developed. She was treated with a 1 week course of levofloxacin (an antibiotic). On the day she was brought to the ER, she had gone to work and experienced extreme nausea, vomiting and sudden onset of vertigo, which was incapacitating.

On examination, she appeared anxious, was throwing up and had nystagmus (rapid eye motion). She was diagnosed with labyrinthitis (also called vestibular neuronitis) secondary to an upper respiratory infection (URI).

Symptoms and Causes

Labyrinthitis is a disorder of balance and is presumed to be caused by inflammation of the vestibular nerve and labyrinths housing the vestibular system of the inner ear. The hearing part of the inner ear is the cochlea and the balance part is the vestibular (with 3 semicircular canals). Either, or both parts of the inner ear may become inflammed.

Labyrinthitis is often a complication of a URI and can be due to a virus (e.g., herpes simplex type 1), bacterial infection, head injury, stress or a reaction to a medicine. It typically begins acutely, lasts for several days and usually resolves spontaneously. Recurrent episodes may occur, as well as family outbreaks, which may be spread by infection.

Other symptoms include hearing loss and ringing in the ears (tinnitus).

Treatments

Recovery takes 1-6 weeks. Residual symptoms (dysequilibrium and/or dizziness) may last months or years. Treatment consists of antihistaminics (meclizine), or phenothiazines (prochlorperazine), which alleviates symptoms and diazepam, which treats anxiety. There is evidence that selective serotonin reuptake inhibitors (SSRIs) may be more effective at relieving anxiety and may stimulate new neural growth within the inner ear.

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