eMedicine Specialties > Neurology > Neuro-otology

Inner Ear, Labyrinthitis: Differential Diagnoses & Workup

Author: Mark E Boston, MD, Chairman, Department of Otolaryngology-Head and Neck Surgery, Wilford Hall Medical Center, Lackland Air Force Base
Coauthor(s): Barry Strasnick, MD, FACS, Chairman, Professor, Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School
Contributor Information and Disclosures

Updated: Sep 9, 2009

Differential Diagnoses

Benign Paroxysmal Positional Vertigo
Inner Ear, Perilymphatic Fistula
CNS Causes of Vertigo
Inner Ear, Sudden Hearing Loss
Complications of Otitis Media
Migraine-Associated Vertigo
Inner Ear, Autoimmune Disease
Skull Base, Tumors, Other CPA Tumors
Inner Ear, Meniere Disease, Medical Treatment
Inner Ear, Meniere Disease, Surgical Treatment
Inner Ear, Ototoxicity

Other Problems to Be Considered

Vertebrobasilar insufficiency
Presyncope dizziness
Cerebellar infarct
Dysequilibrium of aging
Drug-induced vertigo and/or hearing loss

Workup

Laboratory Studies

  • No specific laboratory studies are available for labyrinthitis. Routine serology testing often fails to reveal an infectious organism, and when results are positive, methods to determine if the same organism caused the damage to the membranous labyrinth are not available.  Obtain appropriate tests to help exclude other possible etiologies in the differential diagnosis.
  • Examine cerebrospinal fluid if meningitis is suggested. If a systemic infection is considered, a CBC count and blood cultures are indicated.
  • Perform culture and sensitivity testing of middle ear effusions if present, and select appropriate antibiotic therapy accordingly.

Imaging Studies

  • CT scan
    • Consider a CT scan prior to lumbar puncture in cases of possible meningitis.
    • A CT scan is also useful to help rule out mastoiditis as a potential cause.
    • A temporal bone CT scan may aid in the management of patients with cholesteatoma and labyrinthitis.
    • A noncontrast CT scan is best for visualizing fibrosis and calcification of the membranous labyrinth in persons with chronic labyrinthitis or labyrinthitis ossificans.
  • MRI
    • MRI can be used to help rule out acoustic neuroma, stroke, brain abscess, or epidural hematoma as potential causes of vertigo and hearing loss.
    • The cochlea, vestibule, and semicircular canals enhance on T1-weighted postcontrast images in persons with acute and subacute labyrinthitis.17 This finding is highly specific and correlates with objective and subjective patient assessment. Recent improvements in MRI techniques may make this the study of choice for suspected labyrinthitis.

Other Tests

  • Audiography
    • Obtain an audiogram in all patients who may have labyrinthitis. Evaluate critically ill and severely vertiginous patients when stable and able to tolerate the test. The audiogram may show different findings depending on the etiology of the labyrinthine inflammation.
    • Persons with viral labyrinthitis have mild-to-moderate high-frequency SNHL in the affected ear, although any frequency spectrum may be affected.
    • Suppurative (bacterial) labyrinthitis typically results in severe-to-profound unilateral hearing loss. In cases of meningitis, the loss is often bilateral.
    • Persons with serous (bacterial) labyrinthitis have unilateral high-frequency hearing loss in the affected ear. A conductive loss in the same ear may occur secondary to effusion.
  • Vestibular testing
    • Caloric testing and an electronystagmogram may help in diagnosing difficult cases and establishing a prognosis for recovery. Recent evidence suggests that careful evaluation of the vestibuloocular reflex may help establish the etiology of the labyrinthitis.18
    • Persons with viral labyrinthitis have nystagmus with unilateral caloric vestibular paresis/hypofunction.
    • Persons with suppurative (bacterial) labyrinthitis have nystagmus and an absent caloric response on the affected side.
    • Persons with serous (bacterial) labyrinthitis usually have normal electronystagmogram results, but they may have a decreased caloric response in the affected ear. However, the presence of a middle ear effusion can attenuate the caloric response and cause a false-positive finding.

More on Inner Ear, Labyrinthitis

Overview: Inner Ear, Labyrinthitis
Differential Diagnoses & Workup: Inner Ear, Labyrinthitis
Treatment & Medication: Inner Ear, Labyrinthitis
Follow-up: Inner Ear, Labyrinthitis
Multimedia: Inner Ear, Labyrinthitis
References
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References

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Further Reading

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Keywords

labyrinthitis of the inner ear, labyrinthitis, viral labyrinthitis, serous labyrinthitis, bacterial labyrinthitis, suppurative labyrinthitis, sudden sensorineural hearing loss, neurolabyrinthitis, vestibulocochleitis, vestibulocochlearis, sudden hearing loss, ear infection, inner ear infection, ear labyrinth infection, hearing disorder, hearing disturbance, balance disorder, balance disturbance, vertigo, dysequilibrium, hearing loss, vestibular neuritis, herpes zoster oticus, Ramsay-Hunt syndrome, varicella-zoster virus, varicella reactivation, zoster reactivation, rubella, cytomegalovirus, CMV, mumps, measles, SNHL, herpes oticus, labyrinthine inflammation, labyrinthine disease, labyrinthine disorder, labyrinthine infection

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Contributor Information and Disclosures

Author

Mark E Boston, MD, Chairman, Department of Otolaryngology-Head and Neck Surgery, Wilford Hall Medical Center, Lackland Air Force Base
Mark E Boston, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Barry Strasnick, MD, FACS, Chairman, Professor, Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School
Barry Strasnick, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American College of Surgeons, American Medical Association, American Tinnitus Association, Ear Foundation Alumni Society, Norfolk Academy of Medicine, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, Vestibular Disorders Association, and Virginia Society of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Michael E Hoffer, MD, Director, Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center of San Diego
Michael E Hoffer, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: American biloogical group Royalty Other

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gerard J Gianoli, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center
Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Robert A Egan, MD, Director of Neuro-Ophthalmology, St Helena Hospital
Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, and Oregon Medical Association
Disclosure: Nothing to disclose.

 
 
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