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Labyrinthitis and vestibular neuritis

Last reviewed: 13 Jul 2025
Last updated: 29 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • vertigo
  • dizziness
  • nausea and vomiting
  • hearing loss
  • nystagmus
  • tinnitus
  • otorrhea
Full details

Other diagnostic factors

  • vertigo-related quick head or body movements
  • influenza-like symptoms
  • otalgia
Full details

Risk factors

  • viral infections
  • chronic suppurative otitis media
  • acute otitis media
  • cholesteatoma
  • meningitis
  • inner ear malformations
  • autoimmune ear diseases
  • syphilis
Full details

Diagnostic tests

1st tests to order

  • audiogram
  • Weber test
  • Rinne test
Full details

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)
Full details

Treatment algorithm

ACUTE

labyrinthitis

vestibular neuritis

ONGOING

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

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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.
  • Labyrinthitis and vestibular neuritis images
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    • Meniere disease
    • Posterior fossa cerebrovascular accident
    • Temporal bone fracture
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  • Guidelines

    • Suspected neurological conditions: recognition and referral
    • Practice guidance: vestibular rehabilitation
    More Guidelines
  • Patient information

    Labyrinthitis

    More Patient information
  • Videos

    How to examine the ear

    More videos
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