Labyrinthitis is an inflammatory condition affecting the contents of the otic capsule. This includes the cochlea, three orthogonal semi-circular 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 examination, and audiometry.
Treatment is typically symptomatic and primarily involves the use of vestibular suppressants and anti-emetics, with ongoing management for persistent symptoms using vestibular rehabilitation.
Labyrinthitis is an inflammatory condition of the otic capsule. It is caused by bacteria or viruses that affect the inner ear, which consists of the cochlea and vestibular system. Typically, it presents with sensorineural hearing loss (that is typically irreversible), vertigo, and disequilibrium (problems with balance) and may affect one or both ears. It may be further classified as suppurative or serous. Suppurative (bacterial) labyrinthitis follows direct microbial invasion of the inner ear and usually presents with severe to profound hearing loss (that is typically irreversible) and vertigo. Serous (viral) labyrinthitis results from inflammation of the labyrinth only and usually presents with less severe hearing loss and vertigo than suppurative labyrinthitis, and the hearing loss often recovers.
History and exam
Key diagnostic factors
- presence of risk factors
- nausea and vomiting
- hearing loss
Other diagnostic factors
- vertigo-related quick head or body movements
- influenza-like symptoms
- viral infections
- chronic suppurative otitis media
- acute otitis media
- inner ear malformations
- autoimmune ear diseases
1st investigations to order
- Weber's test
- Rinne's test
Investigations to consider
- CT or MRI brain
- rotary chair test
- vestibular-evoked myogenic potentials
- syphilis serology
- cerebrospinal fluid Gram stain and culture
- serum HIV rapid test
- basic metabolic profile (including urea and creatinine)
bacterial: secondary to otitis media
bacterial: secondary to meningitis
with persistent vestibular symptoms post-treatment
- Vestibular neuritis
- Benign paroxysmal positional vertigo
- Meniere's disease
- Suspected neurological conditions: recognition and referral
- Practice guidance: vestibular rehabilitation
Middle ear infection
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