Labyrinthitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 1 Apr 2025

Last updated: 24 Sep 2021

Labyrinthitis is an inflammatory condition affecting the contents of the otic capsule. This includes the cochlea, three orthogonal semicircular 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 exam, and audiometry.

Treatment is typically symptomatic and primarily involves the use of vestibular suppressants and antiemetics, with ongoing management for persistent symptoms using vestibular rehabilitation.

Definition

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.[1][2][3] 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

vertigo
dizziness
nausea and vomiting
hearing loss
otorrhea

Full details

Other diagnostic factors

nystagmus
tinnitus
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
electronystagmography
rotary chair test
vestibular-evoked myogenic potentials
syphilis serology
cerebrospinal fluid Gram stain and culture
serum HIV rapid test
basic metabolic profile (including BUN and creatinine)

Full details

Treatment algorithm

ACUTE

viral: non-HIV

bacterial: secondary to otitis media

bacterial: secondary to meningitis

bacterial: syphilitic

HIV-associated

autoimmune

ONGOING

with persistent vestibular symptoms post-treatment

Contributors

Authors

Brandon Isaacson, MD, FACS

Professor

Department of Otolaryngology-Head & Neck Surgery

University of Texas Southwestern Medical Center

Dallas

Disclosures

BI is an author of a reference cited in this topic.

Peer reviewers

Marc Bennett, MD

Associate Professor

The Otology Group of Vanderbilt

Nashville

Disclosures

MB declares that he has no competing interests.

Joni K. Doherty, MD, PhD

Assistant Professor

Neurotology Otolaryngology-Head & Neck Surgery

USC Keck School of Medicine

San Diego

Disclosures

JKD declares that she has no competing interests.

Iain Swan, MD, FRCS

Senior Lecturer in Otolaryngology

Honorary Consultant Otolaryngologist

Glasgow Royal Infirmary

Glasgow

Disclosures

IS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Lindeman RC. Acute labyrinthine disorders. Otolaryngol Clin North Am. 1979 May;12(2):375-87. Abstract

Goldstein NA, Casselbrant ML, Bluestone CD, et al. Intratemporal complications of acute otitis media in infants and children. Otolaryngol Head Neck Surg. 1998 Nov;119(5):444-54. Abstract

Davis LE, Johnsson LG. Viral infections of the inner ear: clinical, virologic, and pathologic studies in humans and animals. Am J Otolaryngol. 1983 Sep-Oct;4(5):347-62. Abstract

Voetsch B, Sehgal S. Acute dizziness, vertigo, and unsteadiness. Neurol Clin. 2021 May;39(2):373-89. Abstract

Rubin AM, Zafar SS. The assessment and management of the dizzy patient. Otolaryngol Clin North Am. 2002 Apr;35(2):255-73. 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
- Vestibular neuritis
- Benign paroxysmal positional vertigo
- Meniere disease
More Differentials
Guidelines
- Suspected neurological conditions: recognition and referral
- Practice guidance: vestibular rehabilitation
More Guidelines
Patient information
Middle ear infection
Outer ear infection
More Patient information
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Labyrinthitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

viral: non-HIV

bacterial: secondary to otitis media

bacterial: secondary to meningitis

bacterial: syphilitic

HIV-associated

autoimmune

with persistent vestibular symptoms post-treatment

Contributors

Authors

Brandon Isaacson, MD, FACS

Disclosures

Peer reviewers

Marc Bennett, MD

Disclosures

Joni K. Doherty, MD, PhD

Disclosures

Iain Swan, MD, FRCS

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice