Labyrinthitis

Question 1

What are the clinical features of labyrinthitis?

Answer 1

• *Sudden onset vertigo lasting ≥ 1day (most pronounced symptom)
• SNHL (vertigo w/o SNHL = vestibular neuronitis)
• +/- otalgia, otorrhoea, fever
• W/o neuro impairment

Question 2

What are the signs of labyrinthitits?

Answer 2

• Nystagmus (similar to vestibular neuronitis)
• Ear exam: NAD (no appreciable disease) or may have mastoidits, middle ear disease, vesicles
• Neuro exam: NAD or may have evidence of infection (e.g. meningitis)

Question 3

What are the investigations done for labyrinthitis?

Answer 3

PTA: unilat SNHL

MRI brain TRO r/o CVA (stroke), acoustic neuroma, brain abscess

+/- CT temporal bone 🡪 otomastoiditis, cholesteatoma, adjacent brain/meningeal involvement

+/- Videonystagmography (VNG) 🡪 reduction in caloric response

Question 4

How can labyrinthitis be managed?

Answer 4

General: Supportive care - vestibular suppressants/ vestibular sedatives (e.g. prochlorperazine) and vestibular rehabilitation (e.g. Cooksey-Cawthorne exercises)

If bacterial labyrinthitis, w/ mastoiditis:

• IV antibiotics
• +/- myringotomy and grommet tube
• +/- mastoidectomy to drain abscess or cholesteatoma (if present)

Early Tx w steroids (w/in 1/12), poor response if steroids started later than 1/12 from 1st episode.

If brain involvement 🡪 Refer to neurosurgery