Labyrinthitis (Inner Ear Inflammation)

Picture of the Outer, Middle, and Inner Ear Structures

Labyrinthitis is a type of inner ear condition that causes dizziness, a spinning sensation (vertigo), and problems with balance. The dizziness also can cause acute nausea and vomiting. Inflammation of the nerves in the inner ear causes labyrinthitis. The inflammation leading to labyrinthitis can be caused by an inner ear infection, and it has many of the same symptoms as an ear infection.

The anatomy of the ear is divided into three parts:

1. Outer ear
2. Middle ear
3. Inner ear

The outer ear consists of the parts you can see outside the body, the auricle (also known as pinna), earlobe, and ear canal up to the eardrum. The middle ear consists of the eardrum (tympanic membrane) and the auditory bones (ossicles)—the incus, malleus, and stapes. The inner ear consists of the fluid-filled semicircular canals, cochlea, vestibular nerve, and auditory nerve.

The exact cause of labyrinthitis is unknown. It may be caused by swelling or problems with the nerve inside the brain responsible for balance and hearing. Labyrinthitis also may occur during or after a viral infection. Viruses associated with labyrinthitis include influenza, herpes viruses, measles, mumps, rubella, hepatitis, Epstein-Barr virus, and polio.

Rarely, other ear problems like barotrauma (injury due to abnormal pressure inside the ear) or otosclerosis (abnormal growth of bone impeding the middle ear) can cause labyrinthitis.

Labyrinthitis itself is not contagious; however, viral infections that lead to labyrinthitis are.

Labyrinthitis is an inner ear condition that causes dizziness, a spinning sensation (vertigo), and problems with balance.

Signs and symptoms of labyrinthitis (inner ear infection) may include (one or more):

• Dizziness
• Spinning sensation (vertigo)
• Nausea
• Vomiting
• Problems with balance
• Difficulty walking
• Hearing loss (or decrease in sound volume) in one ear
• Earache or ear pain
• The feeling of fullness in the ear
• Ringing in the ear (tinnitus) or hearing abnormal sounds
• Discharge from the ear

The symptoms of labyrinthitis are very similar to another inner ear disorder called vestibular neuritis. The two conditions have similar symptoms, but vestibular neuritis does not include hearing loss.

Labyrinthitis (inner ear infections) symptoms usually last only a few weeks.

• See your doctor if your symptoms don’t resolve after about 3 weeks.
• If your symptoms are severe (unable to walk, excessive vomiting, headache, or weakness) seek medical care immediately.

The only way to know if you have labyrinthitis or another ear problem is to see a doctor. Labyrinthitis symptoms such as dizziness and loss of balance can resemble other medical problems, so a doctor will rule out conditions that may cause the symptoms such as head injury, heart disease, stroke, side effects of medications, anxiety, and neurological disorders.

Make an appointment with your doctor, ENT (ear, nose, and throat specialist), or other healthcare professional if you experience symptoms of an ear infection such as:

• Ear pain
• Fullness in the ear
• Ringing in the ear or other abnormal sounds
• Discharge from the ear
• Dizziness
• Spinning sensation
• Nausea
• Vomiting
• Problems with balance or walking
• Hearing loss

The doctor will use an otoscope to examine the inside of the ear canal and eardrum to check for redness or swelling, earwax build-up, or any abnormalities in the ear. The doctor may gently puff air against the eardrum to see if it moves, which is normal. If the eardrum does not move, there may be fluid buildup in the middle ear.

A tuning fork exam may help diagnose neurologic hearing loss. Sound waves from the vibration of the tuning fork can be heard through the air and the bones around the ear.

Once other conditions have been ruled out, the treatment for labyrinthitis depends on the cause, your symptoms, and how long the problem has been present.

Your doctor or other healthcare professional may prescribe medications to treat any infection, reduce swelling and inflammation, treat nausea and vomiting, and help eliminate dizziness and vertigo.

If you are having balance problems, your doctor may refer you to a physical therapist who can prescribe exercises to help with balance.

Labyrinthitis symptoms and any associated infection may be treated with over-the-counter (OTC) medications or prescription medications.

• Your doctor may recommend OTC diphenhydramine (Benadryl), or prescription meclizine (Antivert), promethazine hydrochloride (Phenergan), lorazepam (Ativan), or diazepam (Valium) to help control nausea and vomiting and to relieve dizziness and vertigo.
• Prescription medications, for example, steroids (prednisone), antibiotics, and antivirals may help with inflammation and treat any infection associated with labyrinthitis.
• If you become dehydrated from severe vomiting, you may receive intravenous fluids in an Emergency Department.

Home remedies cannot treat or cure labyrinthitis, but they may help relieve symptoms.

• Using a warm compress over the ear may ease the pain.
• Stand or keep your head upright. Sitting can help drain the ear.
• A saltwater gargle may help clear Eustachian tubes, and soothe a sore throat that may accompany labyrinthitis.
• Do not smoke and limit alcohol intake.
• Use stress management techniques to control emotional and psychological stress, as stress can worsen symptoms.
• Over-the-counter (OTC) medications, for example, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may relieve pain. Do not give children and teenagers aspirin as this has been linked with a serious condition called Reye's syndrome.
• If your doctor approves, OTC eardrops may be used to relieve pain. Eardrops should not be used in children with tympanostomy tubes (ear tubes) unless specifically prescribed by your child’s pediatrician.
• AVOID cold and cough medicines in young children, as these can have dangerous side effects.

Some natural remedies and alternative treatments are touted as treatments or cures for labyrinthitis, including garlic oil or tea tree oil ear drops, apple cider vinegar, basil, olive oil, and hydrogen peroxide. Scientific studies do not show any of these to be effective.

Some chiropractors also claim to be able to treat labyrinthitis with manipulation; however, there currently are no studies that show chiropractic treatment to be effective for labyrinthitis.

Talk to your doctor before using any home remedies.

When treated promptly, most bouts of labyrinthitis will resolve in days to about 2 weeks duration, with no permanent damage to the ear.

Complications of labyrinthitis include:

• Labyrinthitis can lead to an increased risk of hearing loss, especially in children who develop the condition as a complication of meningitis.
• Labyrinthitis can lead to a condition called BPPV (benign paroxysmal positional vertigo), which causes brief episodes of dizziness and vertigo. The dizziness can be mild to severe.
• Labyrinthitis may also lead to Ménière disease (also called idiopathic endolymphatic hydrops) to develop years after the initial infection. Ménière's disease can cause variable hearing loss, vertigo, ringing in the ears, and a feeling of fullness or pressure in the ear.

You cannot get labyrinthitis from another person who has the condition. However, labyrinthitis often results from ear infections. An ear infection itself is not contagious, but the viruses and bacteria that cause them are. To prevent ear infections, practice good hygiene.

• Wash your hands frequently.
• Avoid sharing food and drinks, especially with someone you know to have an ear infection.
• Do not smoke and avoid secondhand smoke.

Children should be vaccinated, specifically with a pneumococcal conjugate vaccine to protect against several types of pneumococcal bacteria, which are the most common cause of ear infections.