labyrinthitis

Etiology

• viral (most common)
  • etiologic agent has not been isolated
• bacterial
  • symptoms may be severe
  • often in association with bacterial meningitis
• serous: associated with otitis media

Epidemiology

• frequently occurs 1-2 weeks after an upper respiratory tract infection
• most frequent in spring & early summer
• occasionally occurs in epidemics

Pathology

• inflammation of the inner labyrinth where cochlear &nvestibular structures are in continuity
• atrophy of one or more vestibular nerve trunks

Clinical manifestations

• vertigo develops acutely
• intense constant vertigo for a few days
• nausea/vomiting
• imbalance
• unilateral sensorineural hearing loss
• tinnitus may occur
• nystagmus directed toward the unaffected ear
• head-thrust test may be positive
• viral form generally not associated with auditory or neurologic symptoms
• resolution generally within 1-2 weeks

Differential diagnosis

• vestibular neuronitis (no hearing loss)
• Meniere's disease (duration of vertigo < 24 hours)
• benign positional vertigo
  • no hearing loss
  • episodic, not constant, duration of vertigo minutes to hours
  • negative Rhomberg test

Management

• prednisone
• former recommendations
  • meclizine (Antivert) 25-50 mg PO every 6 hours
  • dimenhydrinate (Dramamine) 50 mg PO every 6 hours
  • promethazine (Phenergan) 25-50 mg PO every 6 hours

More general terms

• vestibular disorder (vestibulopathy)

Additional terms

• vertigo