Labyrinthitis and vestibular neuritis

Labyrinthitis and vestibular neuritis are distinct conditions of the ear with similar presentations. While labyrinthitis involves inflammation of the inner ear, vestibular neuritis involves inflammation of the vestibular nerve. The cause of this inflammation can be infectious, inflammatory, or otherwise idiopathic.

Viral infections are the most common cause, but labyrinthitis can also be caused by advanced bacterial infections of the middle ear (complicated acute otitis media).

Patients with either condition have vertigo, nausea and vomiting of variable duration, and/or disequilibrium. Vestibular neuritis is not associated with hearing loss, whereas labyrinthitis may lead to hearing loss and/or tinnitus due to inflammation of the cochlea and cochlear nerve.

Diagnosis is supported by history, physical exam, audiometry, and vestibular tests. Imaging can help rule out important alternative differential diagnoses.

Treatment is typically symptomatic and primarily involves the use of systemic corticosteroids, vestibular suppressants, antiemetics, and long-term vestibular rehabilitation. In patients with labyrinthitis, antivirals or antibiotics may be needed to address the underlying viral or bacterial infections. Corticosteroids may be administered systemically or locally with intratympanic injection, based on the timing of presentation and patient’s medical status, in a paradigm that mirrors the management of idiopathic sudden sensorineural hearing loss.

Labyrinthitis involves inflammation of the inner ear, including the membranous labyrinth. Typical symptoms include vertigo, nausea and vomiting of variable duration, disequilibrium (problems with balance), dizziness, spontaneous nystagmus lasting for more than a day, and sensorineural hearing loss (that is typically irreversible) or tinnitus. Course of the disease is typically acute in onset, with a prolonged initial episode of vertigo lasting hours to days followed by weeks to months of imbalance. The pattern of hearing loss in labyrinthitis is sensorineural and typically profound in severity.[1]Strupp M, Bisdorff A, Furman J, et al. Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. J Vestib Res. 2022 Jun 11;32(5):389-406. https://journals.sagepub.com/doi/full/10.3233/VES-220201 http://www.ncbi.nlm.nih.gov/pubmed/35723133?tool=bestpractice.com

Vestibular neuritis, also known as vestibular neuronitis or acute unilateral vestibulopathy, involves inflammation of the vestibular nerve - the nerve that connects the inner ear balance system to the brain. An acute unilateral loss of peripheral vestibular function is seen, which may either be partial or complete. Subsequent recovery of function is variable.[1]Strupp M, Bisdorff A, Furman J, et al. Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. J Vestib Res. 2022 Jun 11;32(5):389-406. https://journals.sagepub.com/doi/full/10.3233/VES-220201 http://www.ncbi.nlm.nih.gov/pubmed/35723133?tool=bestpractice.com Typical symptoms include vertigo, nausea and vomiting of variable duration, disequilibrium (problems with balance), dizziness, and spontaneous nystagmus lasting for more than a day. Hearing is intact as the cochlea is not affected. Course of the disease can be acute, or rarely, subacute.[1]Strupp M, Bisdorff A, Furman J, et al. Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. J Vestib Res. 2022 Jun 11;32(5):389-406. https://journals.sagepub.com/doi/full/10.3233/VES-220201 http://www.ncbi.nlm.nih.gov/pubmed/35723133?tool=bestpractice.com