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Highlights & Basics
- Labyrinthitis is an inflammatory condition affecting the contents of the otic capsule. This includes the cochlea, three orthogonal semicircular canals, and the otolith organs (utricle, saccule).
- Viral infections are the most common cause of labyrinthitis. Bacterial labyrinthitis is a complication of otitis media or meningitis.
- Typical presentation includes vertigo, imbalance, and hearing loss.
- Diagnosis is supported by history, physical exam, and audiometry.
- Treatment is typically symptomatic and primarily involves the use of vestibular suppressants and antiemetics, with ongoing management for persistent symptoms using vestibular rehabilitation.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Lindeman RC. Acute labyrinthine disorders. Otolaryngol Clin North Am. 1979 May;12(2):375-87.[Abstract]
Goldstein NA, Casselbrant ML, Bluestone CD, et al. Intratemporal complications of acute otitis media in infants and children. Otolaryngol Head Neck Surg. 1998 Nov;119(5):444-54.[Abstract]
Davis LE, Johnsson LG. Viral infections of the inner ear: clinical, virologic, and pathologic studies in humans and animals. Am J Otolaryngol. 1983 Sep-Oct;4(5):347-62.[Abstract]
Voetsch B, Sehgal S. Acute dizziness, vertigo, and unsteadiness. Neurol Clin. 2021 May;39(2):373-89.[Abstract]
Rubin AM, Zafar SS. The assessment and management of the dizzy patient. Otolaryngol Clin North Am. 2002 Apr;35(2):255-73.[Abstract]
1. Lindeman RC. Acute labyrinthine disorders. Otolaryngol Clin North Am. 1979 May;12(2):375-87.[Abstract]
2. Kangsanarak J, Fooanant S, Ruckphaopunt K, et al. Extracranial and intracranial complications of suppurative otitis media: report of 102 cases. J Laryngol Otol. 1993 Nov;107(11):999-1004. [Abstract]
3. Goldstein NA, Casselbrant ML, Bluestone CD, et al. Intratemporal complications of acute otitis media in infants and children. Otolaryngol Head Neck Surg. 1998 Nov;119(5):444-54.[Abstract]
4. Kitsko DJ, Dohar JE. Inner ear and facial nerve complications of acute otitis media, including vertigo. Curr Allergy Asthma Rep. 2007 Nov;7(6):444-50.[Abstract]
5. Girasoli L, Cazzador D, Padoan R, et al. Update on vertigo in autoimmune disorders, from diagnosis to treatment. J Immunol Res. 2018 Sep 26;2018:5072582.[Abstract][Full Text]
6. Chan YM, Adams DA, Kerr AG. Syphilitic labyrinthitis: an update. J Laryngol Otol. 1995 Aug;109(8):719-25.[Abstract]
7. Davis LE, Johnsson LG. Viral infections of the inner ear: clinical, virologic, and pathologic studies in humans and animals. Am J Otolaryngol. 1983 Sep-Oct;4(5):347-62.[Abstract]
8. Merchant SN, Gopen Q. A human temporal bone study of acute bacterial meningogenic labyrinthitis. Am J Otol. 1996 May;17(3):375-85.[Abstract]
9. Isaacson B, Roland PS, Wright CG. Anatomy of the middle-turn cochleostomy. Laryngoscope. 2008 Dec;118(12):2200-4.[Abstract]
10. Nadol JB Jr, Hsu WC. Histopathologic correlation of spiral ganglion cell count and new bone formation in the cochlea following meningogenic labyrinthitis and deafness. Ann Otol Rhinol Laryngol. 1991 Sep;100(9 Pt 1):712-6.[Abstract]
11. Green JD Jr, Marion MS, Hinojosa R. Labyrinthitis ossificans: histopathologic consideration for cochlear implantation. Otolaryngol Head Neck Surg. 1991 Mar;104(3):320-6.[Abstract]
12. Kenna M. Incidence and prevalence of complications of otitis media. Ann Otol Rhinol Laryngol Suppl. 1990;149:38-9.
13. Nadol JB Jr. Hearing loss as a sequela of meningitis. Laryngoscope. 1978 May;88(5):739-55.[Abstract]
14. Maranhão A, Andrade J, Godofredo V, et al. Epidemiology of intratemporal complications of otitis media. Int Arch Otorhinolaryngol. 2014 Apr;18(2):178-83.[Abstract][Full Text]
15. Voetsch B, Sehgal S. Acute dizziness, vertigo, and unsteadiness. Neurol Clin. 2021 May;39(2):373-89.[Abstract]
16. Petri M, Chirilă M, Bolboacă SD, et al. Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders. Braz J Otorhinolaryngol. 2017 Nov-Dec;83(6):611-8.[Abstract][Full Text]
17. Newman-Toker DE, Edlow JA. TiTrATE: A novel, evidence-based approach to diagnosing acute dizziness and vertigo. Neurol Clin. 2015 Aug;33(3):577-99, viii.[Abstract][Full Text]
18. Rubin AM, Zafar SS. The assessment and management of the dizzy patient. Otolaryngol Clin North Am. 2002 Apr;35(2):255-73.[Abstract]
19. Bayoumy AB, de Ru JA. Sudden deafness and tuning fork tests: towards optimal utilisation. Pract Neurol. 2020 Feb;20(1):66-8.[Abstract][Full Text]
20. Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009 Nov;40(11):3504-10.[Abstract][Full Text]
21. Edlow JA. Diagnosing patients with acute-onset persistent dizziness. Ann Emerg Med. 2018 May;71(5):625-31.[Abstract][Full Text]
22. Grasland A, Pouchot J, Hachulla E, et al. Typical and atypical Cogan's syndrome: 32 cases and review of the literature. Rheumatology (Oxford). 2004 Aug;43(8):1007-15.[Abstract][Full Text]
23. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-e418.[Abstract][Full Text]
24. Shetty VS, Reis MN, Aulino JM, et al. ACR Appropriateness Criteria head trauma. J Am Coll Radiol. 2016 Jun;13(6):668-79.[Abstract]
25. Weinreich HM, Carey JP. Perilymphatic fistulas and superior semi-circular canal dehiscence syndrome. Adv Otorhinolaryngol. 2019;82:93-100.[Abstract]
26. American College of Radiology. Hearing loss and/or vertigo. 2018 [internet publication].[Full Text]
27. Kopelovich JC, Germiller JA, Laury AM, et al. Early prediction of postmeningitic hearing loss in children using magnetic resonance imaging. Arch Otolaryngol Head Neck Surg. 2011 May;137(5):441-7. [Abstract][Full Text]
28. Miles RD, Zapala DA. Vestibular function measurement devices. Semin Hear. 2015 Feb;36(1):49-74.[Abstract][Full Text]
29. Fife TD, Colebatch JG, Kerber KA, et al. Practice guideline: cervical and ocular vestibular evoked myogenic potential testing: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology (reaffirmed 2024). Neurology. 2017 Nov 28;89(22):2288-96.[Abstract][Full Text]
30. van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62.[Abstract][Full Text]
31. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010 Jul;23(3):467-92.[Abstract][Full Text]
32. Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice guideline: sudden hearing loss (update). Otolaryngol Head Neck Surg. 2019 Aug;161(suppl 1):S1-45.[Abstract][Full Text]
33. Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014 Oct;151(2 suppl):S1-S40.[Abstract][Full Text]
34. Soto E, Vega R. Neuropharmacology of vestibular system disorders. Curr Neuropharmacol. 2010 Mar;8(1):26-40.[Abstract][Full Text]
35. European Medicines Agency. European Medicines Agency recommends changes to the use of metoclopramide. July 2013 [internet publication].[Full Text]
36. Hannley MT, Denneny JC 3rd, Holzer SS. Use of ototopical antibiotics in treating 3 common ear diseases. Otolaryngol Head Neck Surg. 2000 Jun;122(6):934-40.[Abstract]
37. Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015 Sep 12;(9):CD004405.[Abstract][Full Text]
38. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov 1;39(9):1267-84.[Abstract][Full Text]
39. Ryan AF, Harris JP, Keithley EM. Immune-mediated hearing loss: basic mechanisms and options for therapy. Acta Otolaryngol Suppl. 2002;(548):38-43.[Abstract]
40. Cohen HS, Kimball KT. Decreased ataxia and improved balance after vestibular rehabilitation. Otolaryngol Head Neck Surg. 2004 Apr;130(4):418-25.[Abstract]
41. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015 Jan 13;(1):CD005397.[Abstract][Full Text]
42. Tokle G, Mørkved S, Bråthen G, et al. Efficacy of vestibular rehabilitation following acute vestibular neuritis: a randomized controlled trial. Otol Neurotol. 2020 Jan;41(1):78-85.[Abstract]
43. Meldrum D, Herdman S, Vance R, et al. Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch Phys Med Rehabil. 2015 Jul;96(7):1319-28;e1.[Abstract]
44. Aminpour S, Tinling SP, Brodie HA. Role of tumor necrosis factor-alpha in sensorineural hearing loss after bacterial meningitis. Otol Neurotol. 2005 Jul;26(4):602-9. [Abstract]
45. Ge NN, Brodie HA, Tinling SP. Long-term hearing loss in gerbils with bacterial meningitis treated with superoxide dismutase. Otol Neurotol. 2008 Dec;29(8):1061-7. [Abstract]
46. Battaglia A, Burchette R, Cueva R. Combination therapy (intratympanic dexamethasone + high-dose prednisone taper) for the treatment of idiopathic sudden sensorineural hearing loss. Otol Neurotol. 2008 Jun;29(4):453-60.[Abstract]
47. National Institute for Health and Care Excellence. Suspected neurological conditions: recognition and referral. NG127. May 2019 [internet publication].[Full Text]
48. British Society of Audiology. Practice guidance: vestibular rehabilitation. April 2019 [internet publication].[Full Text]
49. Aschendorff A, Klenzner T, Laszig R. Deafness after bacterial meningitis: an emergency for early imaging and cochlear implant surgery. Otolaryngol Head Neck Surg. 2005 Dec;133(6):995-6.[Abstract]
50. El-Kashlan HK, Ashbaugh C, Zwolan T, et al. Cochlear implantation in prelingually deaf children with ossified cochleae. Otol Neurotol. 2003 Jul;24(4):596-600.[Abstract]
51. Kutz JW, Simon LM, Chennupati SK, et al. Clinical predictors for hearing loss in children with bacterial meningitis. Arch Otolaryngol Head Neck Surg. 2006 Sep;132(9):941-5.[Abstract][Full Text]
52. House JW, Kutz JW Jr. Bone-anchored hearing aids: incidence and management of postoperative complications. Otol Neurotol. 2007 Feb;28(2):213-7.[Abstract]
