ENT - Vertigo = Viral Labyrinthitis

Question 1

Viral Labyrinthitis (VL) - what is it?

Answer 1

Labyrinthitis is an inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs

Labyrinthitis can be viral, bacterial or associated with systemic diseases

Viral labyrinthitis is the most common form of labyrinthitis

The inflammation is usually attributed to a viral upper respiratory tract infection

Question 2

VL - how do you distinguish between VL and vestibular neuronitis?

Answer 2

Vestibular neuritis is used to define cases in which only the vestibular nerve is involved, - so NO hearing impairment

Labyrinthitis is used when both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment

Question 3

VL - what is the onset, and what are the clinical features?

Answer 3

Patients typically present with an acute onset of:

1. Vertigo: not triggered by movement but exacerbated by movement
2. N+V
3. Hearing loss: may be unilateral or bilateral (Meniere’s HL is typically unilateral, way to differentiate between the two)
4. Tinnitus
5. Preceding or concurrent symptoms of upper respiratory tract infection

Question 4

VL - what are the signs on examination?

Answer 4

spontaneous unidirectional horizontal nystagmus towards the unaffected side

sensorineural hearing loss: shown by Rinne’s test and Weber test

abnormal head impulse test: signifies an impaired vestibulo-ocular reflex

gait disturbance: the patient may fall towards the affected side

Question 5

VL - how do you diagnose?

Answer 5

Clinical diagnosis

The diagnosis is largely based on history and examination

Question 6

VL - management?

Answer 6

Episodes are usually self-limiting

Prochlorperazine or antihistamines may help reduce dizziness sensation

Same management as with vestibular neuronitis, with supportive care and short-term use (up to 3 days) of medication to suppress the symptoms