What Is Labyrinthitis?

Labyrinthitis is inflammation of a portion of the inner ear known as the labyrinth—a system of fluid-filled channels involved in your ability to balance and hear. The condition causes severe vertigo that lasts for more than 20 minutes and sometimes for several days. Labyrinthitis can be temporary if caused by an infection (e.g., otitis media) or recurrent if caused by allergies or medication.

Labyrinthitis Symptoms

Labyrinthitis can cause a variety of symptoms. The severity of your symptoms can vary from mild to quite intense, and in rare cases, labyrinthitis may be disabling.

The most common features of labyrinthitis are:

• Sudden onset of vertigo (a sense of spinning)
• Nausea
• Vomiting

Other concerns commonly reported with labyrinthitis include the following. Symptoms that affect your ear generally affect one ear, rather than both.

• Dizziness
• Lightheadedness
• Instability or imbalance when walking
• Worsened symptoms when your eyes are open
• Difficulty concentrating
• Tinnitus (ringing in the ears)
• Diminished hearing or hearing loss

In general, symptoms come on rapidly, worsening over a few hours or days. The effects of labyrinthitis are usually at their worst around 24 hours after they begin, and then they gradually improve.

Causes 

The cause of labyrinthitis is not well understood, but symptoms often begin after an infection or after an inflammatory condition.

Circumstances that commonly precede labyrinthitis include:

• Viral or bacterial infections including upper respiratory infections or ear infections
• Allergies
• Cholesteatoma (a type of benign growth in the middle ear)
• Use of medications that are irritating or toxic to the ear

Risk Factors 

There are several conditions that can predispose you to labyrinthitis. These may interfere with your ability to fight infections in your middle ear.

• Smoking
• Excessive alcohol consumption
• A history of allergies
• Stress

Diagnosis

Diagnosis of labyrinthitis relies on your clinical history and physical examination, several diagnostic tests, and ruling out other conditions that could be the cause of your symptoms.

Physical Examination

Your healthcare provider will ask questions about recent illnesses as well as your general health, including whether any of the risk factors apply to you.

You will likely have your ears examined with an otoscope, a non-invasive instrument that healthcare providers use to look inside the ear.

You may have a sign called nystagmus, which is a "jumpiness" of your eye movements that can occur with labyrinthitis, so your healthcare provider will observe your eye movements as well.

Your healthcare provider will also check your balance and coordination by asking you to walk and to do simple tasks, such as touching your finger to your nose.

If your healthcare provider wants you to have your eyes or ears examined by a specialist, you might be referred to an ophthalmologist, who will do a detailed eye exam and specialized diagnostic tests of the eyes; or an ear, nose, and throat specialist (ENT), who will do a detailed ear exam and specialized diagnostic tests of the ears.

Diagnostic Tests

Several diagnostic tests can be helpful in assessing symptoms of labyrinthitis. You are not likely to need all of these tests, but you may have some depending on whether your healthcare provider is concerned about possible causes of your symptoms.

• Head impulse testing (HIT): This non-invasive test involves evaluating how your eyes move after moving your head. This examination can help assess the function of the semicircular canals in the inner ear, which would suggest extensive inflammation.
• Tympanometry: A test that uses a device similar to an otoscope, tympanometry measures fluid in the ear and assesses the function of the middle ear and eardrum.
• Audiogram: If you have developed decreased hearing, you may need this or another hearing test.
• Electronystagmography (ENG) may be used to assess vestibular function.
• Imaging: If there is a concern that you could have a more serious medical condition, such as a stroke or a brain tumor, you may need such as a brain magnetic resonance imaging test (MRI) or computerized tomography (CT) scan.

Treatment

The symptoms related to labyrinthitis can be bothersome or even debilitating. Fortunately, the condition is usually self-limited, meaning that it improves on its own.

Symptoms of labyrinthitis may begin to subside one to four weeks after they begin. Labyrinthitis usually goes away completely in two the three months. Sometimes, intermittent dizziness persists and hearing loss may be permanent. This is more likely if you already had some hearing loss or experienced dizziness prior to your bout of labyrinthitis.

Rest

It is a good idea to try to relax as you are recovering. Stress can increase your symptoms.

Your healthcare provider may recommend bed rest to avoid falls or exacerbation of your symptoms. Gradually, you can increase your activity level as your symptoms decrease.

Medication

Most people do not need medication to treat labyrinthitis, but prescription medications are an option when symptoms are persistent or difficult to tolerate.

Treatments for labyrinthitis are targeted at managing symptoms and reducing the inflammation. Antiviral or antibacterial medications aren't used to manage labyrinthitis, but they may be used to treat an infection.

Medications used for management of labyrinthitis include:

• Corticosteroids: Prednisone, a commonly used steroid, decreases inflammation and may hasten the recovery time of labyrinthitis. Steroids can cause adverse reactions when stopped abruptly, so your healthcare provider may give you a schedule to taper the medication when it's time to do so.
• Antihistamines: These medications can be used to help suppress symptoms of dizziness. The most common antihistamines used for managing symptoms of labyrinthitis are usually Antivert (meclizine), Dramamine (dimenhydrinate), and Benadryl (diphenhydramine).
• Antiemetics: If you experience severe nausea or vomiting, your healthcare provider may prescribe an antiemetic (anti-nausea medication) to help reduce these symptoms. Possibilities include Reglan (metoclopramide), Phenergan (promethazine), Zofran (ondansetron), and Compro (prochlorperazine).

Scopolamine is an anticholinergic drug that may also be used to treat nausea. It is administered through a patch that is usually placed behind the ear.

Benzodiazepines, including clonazepam and diazepam, are also potent medications for treating vertigo.

Vestibular Rehabilitation

Vestibular rehabilitation may be useful if your symptoms persist for a long time or become chronic. Vestibular rehabilitation is a form of physical therapy that works to retrain your mind and body to compensate for your vestibular imbalance.

This type of rehabilitation includes balance exercises (like yoga) and strategies for helping you get around safely if your balance is limited.

Hospitalization

In severe cases, nausea and vomiting may result in dehydration. In fact, you might need hospitalization, intravenous (IV) fluid replacement, and monitoring of your vital signs (pulse and respiration). Once your labyrinthitis resolves, nausea and vomiting should resolve as well.

A Word From Verywell

If you experience vertigo, dizziness, unsteadiness, or other symptoms of labyrinthitis, be sure to get prompt medical attention. While its cause may be minor, it could also be serious and in need of urgent medical attention. Labyrinthitis is a clinical diagnosis that relies on combining clues from your history, physical exam, and diagnostic tests—but there is no definitive test that confirms the condition.

Fortunately, there are ways to manage your symptoms. As you recover, be sure to talk to your healthcare provider if you have any lingering effects so that you can get rehabilitation and treatment for any persistent issues.