Summary
Definition
History and exam
Key diagnostic factors
- vertigo
- dizziness
- nausea and vomiting
- hearing loss
- nystagmus
- tinnitus
- otorrhea
Other diagnostic factors
- vertigo-related quick head or body movements
- influenza-like symptoms
- otalgia
Risk factors
- viral infections
- chronic suppurative otitis media
- acute otitis media
- cholesteatoma
- meningitis
- inner ear malformations
- autoimmune ear diseases
- syphilis
Diagnostic tests
1st tests to order
- audiogram
- Weber test
- Rinne test
Tests to consider
- CT or MRI brain
- videonystagmography (VNG)
- head impulse testing (HIT) and video head impulse testing (vHIT)
- rotary chair test
- vestibular-evoked myogenic potentials (VEMPs)
- syphilis serology
- cerebrospinal fluid Gram stain and culture
- serum HIV rapid test
- basic metabolic profile (including BUN and creatinine)
Treatment algorithm
labyrinthitis
vestibular neuritis
with persistent vestibular symptoms posttreatment
Contributors
Authors
Tiffany Peng Hwa, MD
Assistant Professor
Medical Director, Center for Adult Onset-Hearing Loss
Director, Temporal Bone Surgical Dissection Laboratory
Division of Otology & Neurotology
Department of Otolaryngology-Head and Neck Surgery
University of Pennsylvania Health System
Philadelphia
PA
Disclosures
TPH has received honoraria from Amgen/Horizon Therapeutics for participation on the advisory board for ototoxicity and the agent, teprotumumab. TPH has given numerous educational lectures to trainees for nonpay, not specifically focused on labyrinthitis or vestibular neuritis. MedEl has reimbursed TPH for attendance at a cochlear implant training workshop regarding their new anatomy-based fitting technology. TPH has a pending NIH grant application regarding central auditory processing and speech perception assessment that has no relationship to labyrinthitis or vestibular neuritis. TPH has an investigator-initiated research grant from Cochlear Corporation, also unrelated to labyrinthitis or vestibular neuritis.
Acknowledgements
Dr Tiffany Peng Hwa would like to gratefully acknowledge Dr Brandon Isaacson, the previous contributor to this topic.
Disclosures
BI is an author of a reference cited in this topic.
Peer reviewers
Desi Schoo, MD
Assistant Professor of Otology, Neurotology, and Cranial Base Surgery
Department of Otolaryngology-Head and Neck Surgery
The Ohio State University Wexner Medical Center
Columbus
OH
Disclosures
DS declares that he has no competing interests.
Iain Swan, MD, FRCS
Senior Lecturer in Otolaryngology
Honorary Consultant Otolaryngologist
Glasgow Royal Infirmary
Glasgow
UK
Disclosures
IS declares that he has no competing interests.
References
Key articles
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.Full text Abstract
Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice guideline: sudden hearing loss (update). Otolaryngol Head Neck Surg. 2019 Aug;161(suppl 1):S1-45.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Meniere disease
- Posterior fossa cerebrovascular accident
- Temporal bone fracture
More DifferentialsGuidelines
- Suspected neurological conditions: recognition and referral
- Practice guidance: vestibular rehabilitation
More GuidelinesPatient information
Labyrinthitis
More Patient informationVideos
How to examine the ear
More videosLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer