In labyrinthitis, an infection occurs in the inner ear. In this process, the labyrinth of the ear becomes inflamed.
What is labyrinthitis?
Labyrinthitis is one of the inner ear diseases. In medicine, it also bears the name otitis interna. Affected by the infection are the organ of balance as well as the cochlea. It occurs either directly in the inner ear or is caused by an inflammation outside the ear. Doctors distinguish between two forms of labyrinthitis. There is circumscribed labyrinthitis and diffuse labyrinthitis. In the circumscribed form of progression, there is an erosion of the lateral arcade, which can happen in a cholesteatoma, which is a chronic purulent inflammation of the middle ear. Diffuse labyrinthitis is seen in serous inflammation such as acute otitis media acuta. Labyrinthitis can affect people of all ages. In most cases, the infection occurs in babies and young children. In contrast, adults suffer from the disease less frequently.
Causes
The causes of labyrinthitis are manifold and depend on the particular form:
- Tympanogenic labyrinthitis
- Lueslabyrinthitis
- Meningogenic labyrinthitis
- Viral labyrinthitis
Tympanogenic labyrinthitis is also called serous labyrinthitis. It is caused by inflammation of the middle ear, which spreads to the neighboring structures. During this process, toxins spread to the inner ear via the oval or round window of the middle ear. In this way, inflammation occurs in the structures of the inner ear. Lues labyrinthitis is the term used when labyrinthitis occurs in the second or third stage of a lues disease. The inflammation is often accompanied by luetic pleurisy or meningitis. Meningogenic labyrinthitis is caused by bacteria such as meningococcus or pneumococcus. These cause meningitis, which in turn results in labyrinthitis. Via the aqueductus chochlae, the pathogens can penetrate towards the inner ear. Meningogenic labyrinthitis is characterized by a loss of labyrinth. Like bacteria, viruses are also capable of causing labyrinthitis. In this case, the inflammation is preceded by diseases such as measles, mumps or zoster oticus. In rare cases, autoimmune diseases such as Wegener’s disease are also responsible for labyrinthitis. There are also some risk factors that promote the development of labyrinthitis in adults. These include a pronounced consumption of alcohol and cigarettes, the use of certain medications such as aspirin, extreme stress or chronic fatigue. Another risk factor is a history of allergies.
Symptoms, complaints, and signs
Typical symptoms of labyrinthitis include vomiting and rotary vertigo. If only the labyrinth of the ear is affected, spontaneous nystagmus occurs on the affected side of the body. If the labyrinth fails, this results in nystagmus on the opposite side. In addition, the patient’s hearing suffers from the disease. A possible complication is purulent labyrinthitis. Complaints such as vomiting and dizziness become more intense. Furthermore, deafness may occur. In the worst case, the labyrinthitis spreads further through the internal auditory canal. Another conceivable complication is labyrinthostitis, which carries the risk of meningitis. Other symptoms of labyrinthitis may include tinnitus, loss of balance, and problems focusing the eyes.
Diagnosis and course of the disease
Diagnosis of labyrinthitis involves a physical examination, most often combined with an ear examination. When an audiogram is obtained, sensorineural hearing loss is often apparent. If it is purulent labyrinthitis, it is considered important to identify bony involvement. For this purpose, a computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed. If the physician performs an otoscopy, an effusion can usually be detected. If meningitis is suspected, a cerebrospinal fluid (CSF) puncture is performed, during which the physician takes nerve fluid.In most patients, the symptoms of labyrinthitis resolve on their own after one to three weeks. It can sometimes take several months until complete recovery. During the recovery phase, it is possible to gradually resume everyday activities. Only rarely does labyrinthitis progress to a chronic form. Usually, it manifests only once in a lifetime.
Complications
Labyrinthitis primarily causes severe and, above all, unpleasant discomfort in the patient’s ears. In most cases, this results in hearing loss. The overall hearing ability is reduced as a result, which can lead to severe psychological discomfort or depression, especially in children and in young people. Likewise, the development of children is significantly limited by labyrinthitis. In the worst case, the affected person suffers from complete deafness. Furthermore, the disease leads to fever and vomiting, thus extremely reducing the quality of life. Patients may also suffer from tinnitus or other noises in the ear. It is not uncommon for patients to experience sleep problems or disturbances in concentration and coordination. In most cases, the symptoms of labyrinthitis are only temporary and disappear after a few weeks or a few months. Special complications do not usually occur. Treatment of labyrinthitis is carried out with the help of medication and usually leads to success. The patient’s life expectancy is also not reduced or limited by labyrinthitis.
When should you see a doctor?
Individuals suffering from labyrinthitis should see their primary care physician early. Parents who notice signs of the condition in their child are best to consult the pediatrician immediately. If symptoms such as hearing difficulties, pain or balance problems develop, medical advice is always sought. The doctor can rule out or diagnose inner ear disease and then initiate therapeutic measures immediately. People who have suffered inflammation of the inner ear or pleurisy are at risk. They should quickly consult their family doctor or a competent ENT specialist if they experience any of the above-mentioned symptoms. Other contacts are the internist or ear specialist. If complications arise, the patient must be taken to the doctor’s office immediately. Hearing loss, for example, must be clarified, as must persistent sleep complaints or accompanying psychological symptoms. The same applies to fever and vomiting if health problems arise as a result of the symptoms. If there are signs of a circulatory collapse, the emergency doctor must be called or the affected person must be taken quickly to a specialist clinic.
Treatment and therapy
The therapy of labyrinthitis depends on the triggering cause. For example, if bacteria are responsible for the infection, treatment is with antibiotics. If, on the other hand, viruses cause the disease, they can be combated with antivirals such as aciclovir. Corticosteroids such as prednisone and rheologics to promote blood flow are also considered helpful. If the patient suffers from labyrinthitis for which an autoimmune disease is responsible, he or she is given immunosuppressants. Medications are also prescribed to counteract nausea and dizziness. These include Antivert, among others. If the spinning vertigo persists for a long period of time, physical or occupational therapy exercises are considered useful to improve the sense of balance. If the labyrinthitis is accompanied by bone fusion, surgical intervention such as mastoidectomy takes place. If advanced necrosis is present, a labyrinthectomy may also be performed.
Outlook and prognosis
In most patients, the prognosis of labyrinthitis is favorable. There is a prospect of spontaneous recovery in this health disorder. If the causes of the disease are clarified and there is a rapid reduction in the triggering elements, improvement can often be documented within 2-3 weeks. Close cooperation with a physician is important for this, as a diagnosis is made as quickly as possible by means of various medical tests, thus revealing the cause. Nevertheless, even with an optimal course of the disease, several months are required until freedom from symptoms finally occurs.In addition, the triggering stimuli for the disturbance of the functional activity of the ear must be completely avoided in the long term. If stress triggers or emotional stress states are responsible for the disease, a change in lifestyle and cognitive processing are particularly important for a good prognosis. Otherwise, there is a risk of recurrence of the symptoms in the course of life. In the case of an autoimmune disease, the affected person requires long-term drug therapy. Without cooperation with a medical doctor, no relief of the symptoms can be achieved here. On the contrary, there is a risk of secondary diseases. Due to dizziness and balance disorders, the general risk of accidents is increased. This complicates the management of everyday life and the fulfillment of professional obligations to a considerable extent.
Prevention
As a preventive measure against labyrinthitis, it is recommended for flu-like infections and inflammation of the middle ear to ensure that the ear is decongested and ventilated. If a child suffers from middle ear inflammation more frequently, it is essential to visit an ENT specialist to make sure that there are no congenital disorders of ventilation. Protective vaccinations for young children are also important.
Follow-up care
In most cases, few measures and options for direct aftercare are available to those affected by labyrinthitis. First and foremost, this condition requires proper treatment of the infection in the ear to prevent further complications and other ailments. The earlier a doctor is contacted, the better the further course of the disease often is. Therefore, affected individuals should ideally see a doctor at the first symptoms and signs of the disease to prevent further worsening of the symptoms. In most cases, it is necessary to take various medications to alleviate the infection. In this case, it is always necessary to pay attention to the correct dosage and also to take the medication regularly. In case of any ambiguity or side effects, always contact a doctor first. In most cases, labyrinthitis can be alleviated relatively well, so that no other complications arise from this disease. The ear should be especially well protected during treatment.
This is what you can do yourself
Labyrinthitis definitely requires medical treatment. What measures the affected person can take himself to relieve the discomfort depends on the particular symptoms and medical therapy. Nausea, vomiting and rotary vertigo can be treated with rest and bed rest. If hearing is severely impaired, a hearing aid can be worn for a short time. In most cases, however, this is not possible due to the inflammation and the affected person should instead take a sick leave for a few days. Accompanying medical treatment, the patient may also be able to use homeopathic remedies. This should be done in consultation with the medical doctor in charge. The physician can then refer the patient to a suitable specialist. If symptoms of meningitis appear, this requires immediate medical clarification. It is then best to refrain from self-help measures. To prevent the infection from spreading, regular check-ups by the doctor are indicated. It can sometimes take several weeks or months until complete recovery. Everyday activities should only be resumed after the acute phase of the disease. Sports activities can support the healing process, but should be done with earmuffs or similar aids.
