Viral Labyrinthitis

Question 1

What is labyrinthitis?

Answer 1

An inflammatory disorder of the membranous labyrinth affecting both the vestibular and cochlear end organs - can be viral, bacterial or associated with systemic disease (viral most common)

Question 2

How is it different from vestibular neuritis?

Answer 2

Vestibular neuritis - only the vestibular nerve involved, so no hearing impairment
Labyrinthitis - vestibular nerve and labyrinth involved, usually resulting in both vertigo and hearing impairment

Question 3

What is the average age of presentation?

Answer 3

40-70 years

Question 4

Patients typically present with an acute onset of…

Answer 4

Vertigo - not triggered by movement but exacerbated by it
Nausea and vomiting
Hearing loss - unilateral or bilateral, with varying severity
Tinnitus
Preceding or concurrent symptoms of URTI

Question 5

What signs suggest labyrinthitis?

Answer 5

Spontaneous unidirectional horizontal nystagmus towards unaffected side
Sensorineural hearing loss
Gait disturbance - may fall towards the affected side
Abnormality on inspection of the external ear canal and the tympanic membrane e.g vesicles in herpes simplex infection

Question 6

How is it diagnosed?

Answer 6

Based on history and examination
Investigations can be done if diagnosis is uncertain or suspecting more sinister cause:
- pure tone audiometry to assess hearing loss
- FBC and blood culture if systemic infection suspected
- culture and sensitivity if any middle ear effusion
- temporal bone CT if suspecting mastoiditis or cholesteatoma
- MRI to rule out causes such as suppurative labyrinthitis or central causes of vertigo