Vestibular neuritis and Labyrinthitis

Question 1

What are the peripheral and central causes of vertigo?

Answer 1

Question 2

What are the differences between Labirythitis and vestibular neuritis in terms of:
* vertigo
* hearing loss
* tinnitus

Answer 2

Question 3

Define labyrinthitis.

Answer 3

Inflammatory disorder of membranous labyrinth affecting both vestibular and cochlear end organs.

Question 4

What are the causes of labyrinthitis?

Answer 4

Viral - most common
Bacterial
Systemic disease-associated

Question 5

How common is labyrinthitis? When does it usually occur?

Answer 5

Common
Average age of presentation is 40-70yrs

Question 6

What are the clinical features of labyrithitis?

Answer 6

• Vertigo - exacerbated by movement
• N&V
• Hearing loss - unilateral or bilateral
• Tinnitus
• Preceding or concurrent symptoms of URTI

O/E

• spontaneous unidirectional horizontal nystagmus towards unaffected side
• sensorineural hearing loss (Rinnes/Webers)
• abnormal head impulse test - signifies vestibulo-ocular reflex
• gait disturbance - patient falls towards affected side

Question 7

How do you diagnose labyrinthitis?

Answer 7

Usually clinical diagnosis

Question 8

What is the management of labyrinthitis?

Answer 8

Self limiting
Atihistamines or prochlorperazine - reduce the sensation of dizziness

Question 9

What are the complications of labyrithitis?

Answer 9

• Delayed endolymphatic hydrops - vertigo months to years after the episode -> room spinning vertigo and fluctuating tinnitus/hearing fullness

Other:

• Mastoiditis - usually only after suppurative labyrinthitis after meningitis/otitis media
• Cochlear ossification
• Hearing loss
• Bilateral vestiular hypo-function - usually post meningitis labyrinthitis

Question 10

What is the prognosis with labyrinthitis?

Answer 10

Generally good
May continue to experience vertigo due to incomplete vestibular compensation
Tinnitus gets less noticeable with time
Hearing loss from suppurative labyrinthitis is typically irreversible

Question 11

How do you distinguish VN from VL?

Answer 11

VN - only the vestibular nerve is involved so no hearing impairment

VN - both vestibular nerve and labyrinth are involved so vertigo and hearing impairment

Question 12

Define vestibular neuronitis.

Answer 12

Acute inflammation of the vestibular nerve

Question 13

What are the causes of vestibular neuronitis?

Answer 13

Unknown
May be precipitated by sinusitis, influenza, URTI or vascular disease (in elderly)

Question 14

What ages are commonly affected by vestibular neuronitis?

Answer 14

Previously well young and middle aged adults (20-40yrs)

Question 15

What are the clinical features of vestibular neuronitis?

Answer 15

• acute onset - hours to days
• recurrent vertigo attacks lasting hours or days
• nausea and vomiting may be present
• horizontal nystagmus is usually present

NO hearing loss or tinnitus

Question 16

What are some differentials for vestibular neuronitis?

Answer 16

Viral labyrinthitis
Posterioir circulation stroke: HiNTs exam will distinguish vestibular neuronitis from posterior circulation stroke

Question 17

How do you diagnose vestibular neuronitis?

Answer 17

Clinical
HiNTs exam to exclude posterior circulation stroke

Question 18

What is the prognosis with vestibular neuronitis?

Answer 18

After 2-5 days of the acute attack, a steady resolution usually occurs over a period of 6 to 12 weeks.

Question 19

What is the management of vestibular neuronitis?

Answer 19

Symptomatic - prochlorperazine (5mg TDS, buccal/IM) or antihistamine (cinnarizine, cyclizine, or promethazine)

Vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms

Antiviral therapy with or without corticosteroids has not been shown to be of any benefit.