Labyrinthitis

Last updated
Labyrinthitis and vestibular neuritis
Other namesOtitis interna, vestibular neuronitis, vestibular neuritis
Gray920.png
Diagram of the inner ear
Specialty Otorhinolaryngology
Frequency35 million per year [1] [ dubious – discuss ]

Labyrinthitis is inflammation of the labyrinth, a maze of fluid-filled channels in the inner ear. Vestibular neuritis is inflammation of the vestibular nerve (the nerve in the inner ear that sends messages related to motion and position to the brain). [2] [3] [4] Both conditions involve inflammation of the inner ear. [5] Labyrinths that house the vestibular system sense changes in the head's position or the head's motion. [6] Inflammation of these inner ear parts results in a sensation of the world spinning and also possible hearing loss or ringing in the ears. [6] It can occur as a single attack, a series of attacks, or a persistent condition that diminishes over three to six weeks. It may be associated with nausea, vomiting, and eye nystagmus.

Contents

The cause is often not clear. It may be due to a virus, but it can also arise from bacterial infection, head injury, extreme stress, an allergy, or as a reaction to medication. 30% of affected people had a common cold prior to developing the disease. [1] Either bacterial or viral labyrinthitis can cause a permanent hearing loss in rare cases. [7] This appears to result from an imbalance of neuronal input between the left and right inner ears. [8]

Signs and symptoms

The main symptoms are severe vertigo and nystagmus. The most common symptom for vestibular neuritis is the onset of vertigo that has formed from an ongoing infection or trauma. [9] The dizziness sensation that is associated with vertigo is thought to be from the inner ear labyrinth. [10] Rapid and undesired eye motion (nystagmus) often results from the improper indication of rotational motion. Nausea, anxiety, and a general ill feeling are common due to the distorted balance signals that the brain receives from the inner ear system. [11] Other common symptoms include tinnitus, ear ache, and a feeling of fullness in the ear. [12] [13]

Causes

Some people will report having an upper respiratory infection (common cold) or flu prior to the onset of the symptoms of vestibular neuritis; others will have no viral symptoms prior to the vertigo attack.

Some cases of vestibular neuritis are thought to be caused by an infection of the vestibular ganglion by the herpes simplex type 1 virus. [8] However, the cause of this condition is not fully understood, and in fact, many different viruses may be capable of infecting the vestibular nerve.

Acute localized ischemia of these structures also may be an important cause. Especially in children, vestibular neuritis may be preceded by symptoms of a common cold. However, the causative mechanism remains uncertain. [14]

This can also be brought on by pressure changes such as those experienced while flying or scuba diving. [15] [16] [17]

Mechanism

In the vestibular system, there are three canals that are semicircular in shape that input sensory clues. [18] These canals allow the brain to sense rotational motion and linear motion changes. [19] The brain then uses the sensory input clues and the visual input clues from the vestibular system to retain balance. The vestibulo–ocular reflex retains continuous visual focus during motion which is also the vestibular systems job during activity. [19]

Treatment

The treatment for vestibular neuritis depends on the cause. However, symptoms of vertigo can be treated in the same way as other vestibular dysfunctions with vestibular rehabilitation. [20]

Physical therapy

Typical treatments include combinations of head and eye movements, postural changes, and walking exercises. Specifically, exercises that may be prescribed include keeping eyes fixated on a specific target while moving the head, moving the head right to left at two targets at a significant distance apart, walking while keeping eyes fixated on a specific target, and walking while keeping eyes fixated on a specific target while also turning the head in different directions. [21] The main function behind repeating a combination of head and eye movements, postural changes and walking is that through this repetition, compensatory changes for the dysfunctions arising from peripheral vestibular structures may be promoted in the central vestibular system (brainstem and cerebellum). [21]

Vestibular rehabilitation therapy is a highly effective way to substantially reduce or eliminate residual dizziness from labyrinthitis. [22] VRT works by causing the brain to use already existing neural mechanisms for adaptation, neuroplasticity, and compensation. [20] Vestibular neuritis rehabilitation is an effective and safe management to improve symptoms. [23] The vestibular neuritis rehabilitation can improve symptoms or resolve the symptoms which is dependent on each individual. [23]

Rehabilitation strategies most commonly used are: [20]

These exercises function by challenging the vestibular system. Progression occurs by increasing the amplitude of the head or focal point movements, increasing the speed of movement, and combining movements such as walking and head turning. [24]

One study found that patients who believed their illness was out of their control showed the slowest progression to full recovery, long after the initial vestibular injury had healed. [25] The study revealed that the patient who compensated well was one who, at the psychological level, was not afraid of the symptoms and had some positive control over them. Notably, a reduction in negative beliefs over time was greater in those patients treated with rehabilitation than in those untreated. "Of utmost importance, baseline beliefs were the only significant predictor of change in a handicap at 6 months follow-up."

Medication

Vestibular neuritis is generally a self-limiting disease. Treatment with drugs is neither necessary nor possible. The effect of glucocorticoids has been studied, but they have not been found to significantly affect long-term outcome. [26]

Symptomatic treatment with antihistaminics such as cinnarizine, however, can be used to suppress the symptoms of vestibular neuritis while it spontaneously regresses. [27] Prochlorperazine is another commonly prescribed medication to help alleviate the symptoms of vertigo and nausea.

Mental disorders

Because mood disorders can hamper recovery from labyrinthitis, treatment may also include any co-occurring anxiety disorder or depression. Severe anxiety episodes are usually addressed by short-term benzodiazepine therapy. [28]

Prognosis

Recovery from acute labyrinthine inflammation generally takes from one to six weeks, but it is not uncommon for residual symptoms such as dysequilibrium and dizziness to last for a couple of months. [25]

Recovery from a temporarily damaged inner ear typically follows two phases:

  1. An acute period, which may include severe vertigo and vomiting
  2. approximately two weeks of sub-acute symptoms and rapid recovery

Epidemiology

Labyrinthitis affects approximately 35 million people per year[ dubious – discuss ] (approximately 3.5 cases per 100,000 people). [29] It typically occurs in those between 30 and 60 years of age, [29] and there are no significant differences between male and female incidence rates. [29] In 95% of cases, sufferers experience a single attack and fully recover. [30] Vestibular rehabilitation showed a statistically significant increase in controlling symptoms over no intervention in people who have vestibular neuritis. [31]

Related Research Articles

<span class="mw-page-title-main">Ménière's disease</span> Disorder of the inner ear

Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Typically, only one ear is affected initially, but over time, both ears may become involved. Episodes generally last from 20 minutes to a few hours. The time between episodes varies. The hearing loss and ringing in the ears can become constant over time.

<span class="mw-page-title-main">Motion sickness</span> Nausea caused by motion or perceived motion

Motion sickness occurs due to a difference between actual and expected motion. Symptoms commonly include nausea, vomiting, cold sweat, headache, dizziness, tiredness, loss of appetite, and increased salivation. Complications may rarely include dehydration, electrolyte problems, or a lower esophageal tear.

A balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness, or wooziness, or having a sensation of movement, spinning, or floating. Balance is the result of several body systems working together: the visual system (eyes), vestibular system (ears) and proprioception. Degeneration or loss of function in any of these systems can lead to balance deficits.

<span class="mw-page-title-main">Otitis media</span> Inflammation of the middle ear

Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. The other main type is otitis media with effusion (OME), typically not associated with symptoms, although occasionally a feeling of fullness is described; it is defined as the presence of non-infectious fluid in the middle ear which may persist for weeks or months often after an episode of acute otitis media. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks. It may be a complication of acute otitis media. Pain is rarely present. All three types of otitis media may be associated with hearing loss. If children with hearing loss due to OME do not learn sign language, it may affect their ability to learn.

<span class="mw-page-title-main">Vestibular system</span> Sensory system that facilitates body balance

The vestibular system, in vertebrates, is a sensory system that creates the sense of balance and spatial orientation for the purpose of coordinating movement with balance. Together with the cochlea, a part of the auditory system, it constitutes the labyrinth of the inner ear in most mammals.

<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, is a general term describing damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerves are affected. Neuropathy affecting motor, sensory, or autonomic nerves result in different symptoms. More than one type of nerve may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

<span class="mw-page-title-main">Dizziness</span> Neurological condition causing impairment in spatial perception and stability

Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness.

<span class="mw-page-title-main">Benign paroxysmal positional vertigo</span> Medical condition

Benign paroxysmal positional vertigo (BPPV) is a disorder arising from a problem in the inner ear. Symptoms are repeated, brief periods of vertigo with movement, characterized by a spinning sensation upon changes in the position of the head. This can occur with turning in bed or changing position. Each episode of vertigo typically lasts less than one minute. Nausea is commonly associated. BPPV is one of the most common causes of vertigo.

<span class="mw-page-title-main">Otitis</span> Medical condition

Otitis is a general term for inflammation in ear or ear infection, inner ear infection, middle ear infection of the ear, in both humans and other animals. When infection is present, it may be viral or bacterial. When inflammation is present due to fluid build up in the middle ear and infection is not present it is considered Otitis media with effusion. It is subdivided into the following:

<span class="mw-page-title-main">Vertigo</span> Type of dizziness where a person has the sensation of moving or surrounding objects moving

Vertigo is a condition in which a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties walking. It is typically worse when the head is moved. Vertigo is the most common type of dizziness.

<span class="mw-page-title-main">Neuritis</span> Inflammation of a nerve or generally any part of the nervous system

Neuritis is inflammation of a nerve or the general inflammation of the peripheral nervous system. Inflammation, and frequently concomitant demyelination, cause impaired transmission of neural signals and leads to aberrant nerve function. Neuritis is often conflated with neuropathy, a broad term describing any disease process which affects the peripheral nervous system. However, neuropathies may be due to either inflammatory or non-inflammatory causes, and the term encompasses any form of damage, degeneration, or dysfunction, while neuritis refers specifically to the inflammatory process.

<span class="mw-page-title-main">Vestibular nerve</span> Branch of the vestibulocochlear nerve

The vestibular nerve is one of the two branches of the vestibulocochlear nerve. In humans the vestibular nerve transmits sensory information transmitted by vestibular hair cells located in the two otolith organs and the three semicircular canals via the vestibular ganglion of Scarpa. Information from the otolith organs reflects gravity and linear accelerations of the head. Information from the semicircular canals reflects rotational movement of the head. Both are necessary for the sensation of body position and gaze stability in relation to a moving environment.

The semicircular canal dehiscence (SCD) is a category of rare neurotological diseases/disorders affecting the inner ears, which gathers the superior SCD, lateral SCD and posterior SCD. These SCDs induce SCD syndromes (SCDSs), which define specific sets of hearing and balance symptoms. This entry mainly deals with the superior SCDS.

The Epley maneuver or repositioning maneuver is a maneuver used by medical professionals to treat one common cause of vertigo, benign paroxysmal positional vertigo (BPPV) of the posterior or anterior canals of the ear. The maneuver works by allowing free-floating particles, displaced otoconia, from the affected semicircular canal to be relocated by using gravity, back into the utricle, where they can no longer stimulate the cupula, therefore relieving the patient of bothersome vertigo. The maneuver was developed by the physician, John M. Epley, and was first described in 1980.

<span class="mw-page-title-main">Nausea</span> Medical symptom or condition

Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat.

The spins is an adverse reaction of intoxication that causes a state of vertigo and nausea, causing one to feel as if "spinning out of control", especially when lying down. It is most commonly associated with drunkenness or mixing alcohol with other psychoactive drugs such as cannabis. This state is likely to cause vomiting, but having "the spins" is not life-threatening unless pulmonary aspiration occurs.

Vestibular migraine (VM) is vertigo with migraine, either as a symptom of migraine or as a related neurological disorder.

The righting reflex, also known as the labyrinthine righting reflex, is a reflex that corrects the orientation of the body when it is taken out of its normal upright position. It is initiated by the vestibular system, which detects that the body is not erect and causes the head to move back into position as the rest of the body follows. The perception of head movement involves the body sensing linear acceleration or the force of gravity through the otoliths, and angular acceleration through the semicircular canals. The reflex uses a combination of visual system inputs, vestibular inputs, and somatosensory inputs to make postural adjustments when the body becomes displaced from its normal vertical position. These inputs are used to create what is called an efference copy. This means that the brain makes comparisons in the cerebellum between expected posture and perceived posture, and corrects for the difference. The reflex takes 6 or 7 weeks to perfect, but can be affected by various types of balance disorders.

<span class="mw-page-title-main">Vestibular rehabilitation</span> Form of physical therapy for vestibular disorders

Vestibular rehabilitation (VR), also known as vestibular rehabilitation therapy (VRT), is a specialized form of physical therapy used to treat vestibular disorders or symptoms, characterized by dizziness, vertigo, and trouble with balance, posture, and vision. These primary symptoms can result in secondary symptoms such as nausea, fatigue, and lack of concentration. All symptoms of vestibular dysfunction can significantly decrease quality of life, introducing mental-emotional issues such as anxiety and depression, and greatly impair an individual, causing them to become more sedentary. Decreased mobility results in weaker muscles, less flexible joints, and worsened stamina, as well as decreased social and occupational activity. Vestibular rehabilitation therapy can be used in conjunction with cognitive behavioral therapy in order to reduce anxiety and depression resulting from an individual's change in lifestyle.

Inner ear decompression sickness, (IEDCS) or audiovestibular decompression sickness is a medical condition of the inner ear caused by the formation of gas bubbles in the tissues or blood vessels of the inner ear. Generally referred to as a form of decompression sickness, it can also occur at constant pressure due to inert gas counterdiffusion effects.

References

  1. 1 2 Greco, A; Macri, GF; Gallo, A; Fusconi, M; De Virgilio, A; Pagliuca, G; Marinelli, C; de Vincentiis, M (2014). "Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo?". Journal of Immunology Research. 2014: 459048. doi: 10.1155/2014/459048 . PMC   3987789 . PMID   24741601.
  2. ↑ "Labyrinthitis and vestibular neuritis". 23 October 2017.
  3. ↑ Ferri's Clinical Advisor 2016: 5 Books in 1. Elsevier Health Sciences. 2015. p. 735. ISBN   9780323378222.
  4. ↑ Hogue, JD (June 2015). "Office Evaluation of Dizziness". Primary Care. 42 (2): 249–258. doi:10.1016/j.pop.2015.01.004. PMID   25979586.
  5. ↑ "Labyrinthitis". National Library of Medicine . Retrieved 16 March 2018.
  6. 1 2 "Clinical Methods: The History, Physical, and Laboratory Examinations". Annals of Internal Medicine. 113 (7): 563. 1990-10-01. doi:10.7326/0003-4819-113-7-563_2. ISSN   0003-4819.
  7. ↑ "NLM".
  8. 1 2 Marill, Keith (2011-01-13). "Vestibular Neuronitis: Pathology". eMedicine, Medscape Reference. Retrieved 2011-08-07.
  9. ↑ Dewyer, Nicholas A.; Kiringoda, Ruwan; McKenna, Michael J. (2018), "Inner Ear Infections (Labyrinthitis)", Infections of the Ears, Nose, Throat, and Sinuses, Springer International Publishing, pp. 79–88, doi:10.1007/978-3-319-74835-1_7, ISBN   978-3-319-74834-4
  10. ↑ Murdin, Louisa; Hussain, Kiran; Schilder, Anne GM (2013-08-11), "Betahistine for symptoms of vertigo", in The Cochrane Collaboration (ed.), Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, pp. CD010696, doi: 10.1002/14651858.cd010696
  11. ↑ "Table 1: The Single Nucleotide Polymorphisms in cathepsin B protein mined from literature (PMID: 16492714)". PeerJ BIOINFORMATICS AND GENOMICS. doi: 10.7717/peerj.7425/table-1 .
  12. ↑ "Infections of the Inner Ear". Vestibular Disorders Association.
  13. ↑ "Inner Ear Infection (Labyrinthitis) Symptoms, Causes, Contagious, Treatment Cure". MedicineNet. Retrieved 2021-02-28.
  14. ↑ Keith A Marill. "Vestibular Neuronitis" . Retrieved 2008-06-28.
  15. ↑ Martin-Saint-Laurent A, Lavernhe J, Casano G, Simkoff A (March 1990). "Clinical aspects of inflight incapacitations in commercial aviation". Aviation, Space, and Environmental Medicine. 61 (3): 256–60. PMID   2317181.
  16. ↑ Farmer, Jr JC, ed. (1973). Labyrinthine Dysfunction During Diving. 1st Undersea and Hyperbaric Medical Society Workshop. Vol. UHMS Publication Number WS6-15-74. Undersea and Hyperbaric Medical Society. p. 11. Archived from the original on October 7, 2008. Retrieved 2009-03-11.{{cite conference}}: CS1 maint: unfit URL (link)
  17. ↑ Kennedy RS (March 1974). "General history of vestibular disorders in diving". Undersea Biomedical Research. 1 (1): 73–81. PMID   4619861. Archived from the original on July 3, 2009. Retrieved 2009-03-11.{{cite journal}}: CS1 maint: unfit URL (link)
  18. ↑ "Labyrinthitis". www.audiologicaldiagnostics.com. Archived from the original on 2019-11-23. Retrieved 2019-12-02.
  19. 1 2 "Germany". International Journal of Health Care Quality Assurance. 19 (4). 2017. doi:10.1108/ijhcqa.2006.06219dab.003. ISSN   0952-6862.
  20. 1 2 3 Burton M. J.; Monsell E. M.; Rosenfeld R. M. (2008). "Extracts from the cochrane library: Vestibular rehabilitation for unilateral peripheral vestibular dysfunction (review)". Otolaryngology–Head and Neck Surgery. 138 (4): 415–417. doi:10.1016/j.otohns.2008.02.004. PMID   18359346. S2CID   9907751.
  21. 1 2 Walker, MF (January 2009). "Treatment of vestibular neuritis". Current Treatment Options in Neurology. 11 (1): 41–5. doi:10.1007/s11940-009-0006-8. PMID   19094835. S2CID   37693582.
  22. ↑ "Vestibular Rehabilitation Therapy (VRT)". Vestibular Disorders Association. 2011-12-27. Retrieved 2018-05-19.
  23. 1 2 Fishman, Jonathan M; Burgess, Chris; Waddell, Angus (2010-07-07), "Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)", in The Cochrane Collaboration (ed.), Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, pp. CD008607, doi:10.1002/14651858.cd008607
  24. ↑ "Physical Therapy Rehabilitation" . Retrieved 2019-10-29.
  25. 1 2 Bronstein, Adolfo (February 2002). "Visual and psychological aspects of vestibular disease". Current Opinion in Neurology. 15 (1): 1–3. doi:10.1097/00019052-200202000-00001. PMID   11796943.
  26. ↑ Fishman, JM; Burgess C; Waddell A (May 2011). "Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)". Cochrane Database Syst Rev (5): CD008607. doi:10.1002/14651858.CD008607.pub2. PMID   21563170.
  27. ↑ Scholtz, AW; Steindl R; Burchardi N; Bognar-Steinberg I; Baumann W (June 2012). "Comparison of the therapeutic efficacy of a fixed low-dose combination of cinnarizine and dimenhydrinate with betahistine in vestibular neuritis: a randomized, double-blind, non-inferiority study". Clin Drug Investig. 32 (6): 387–399. doi:10.2165/11632410-000000000-00000. PMID   22506537. S2CID   207301804.
  28. ↑ Solomon, D; Shepard, NT (July 2002). "Chronic Dizziness". Current Treatment Options in Neurology. 4 (4): 281–288. doi:10.1007/s11940-002-0028-y. PMID   12036501. S2CID   38952122.
  29. 1 2 3 Greco, A.; Macri, G. F.; Gallo, A.; Fusconi, M.; De Virgilio, A.; Pagliuca, G.; Marinelli, C.; de Vincentiis, M. (2014). "Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo?". Journal of Immunology Research. 2014: 459048. doi: 10.1155/2014/459048 . ISSN   2314-7156. PMC   3987789 . PMID   24741601.
  30. ↑ "Vestibular Neuritis". Cleveland Clinic. Retrieved 2019-11-15.
  31. ↑ McDonnell, Michelle N; Hillier, Susan L (2015-01-13). Cochrane ENT Group (ed.). "Vestibular rehabilitation for unilateral peripheral vestibular dysfunction". Cochrane Database of Systematic Reviews. 1: CD005397. doi: 10.1002/14651858.CD005397.pub4 . PMID   25581507.
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