Labyrinthitis Differential Diagnoses

  • Author: Mark E Boston, MD; Chief Editor: Robert A Egan, MD   more...
 
Updated: Feb 22, 2012
 
 

Diagnostic Considerations

Vestibular neuritis

Viral labyrinthitis is often confused with vestibular neuritis, and the terms are occasionally used interchangeably in the literature. However, most authors agree that vestibular neuritis is a disorder of the vestibular nerve and is not associated with hearing loss.[9] Because the cochlea is affected in pan-labyrinthine inflammation, hearing loss is always present in persons with viral labyrinthitis.

Vestibular neuritis typically manifests as sudden, acute vertigo without hearing loss in an otherwise healthy patient. The condition is more common in the fourth and fifth decades of life and affects men and women equally. An upper respiratory tract infection often precedes the condition, and the disorder is more common in the spring and early summer.

Histopathologic nerve studies of patients with vestibular neuritis demonstrate axonal loss, endoneurial fibrosis, and atrophy.[9] These findings are consistent with a viral inflammatory etiology. The treatment of vestibular neuritis and viral labyrinthitis is similar.

Other conditions

A 2009 case report suggests that an early anterior inferior cerebellar artery infarction should be considered in patients presenting with acute hearing loss and vertigo.[17]

Noninfectious labyrinthitis is very rare in children; therefore, seek an alternative diagnosis in patients this age. Labyrinthitis resulting from otitis media or meningitis is not uncommon in children.

Conditions to consider in the differential diagnosis of labyrinthitis also include the following:

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

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Mark E Boston, MD  Physician, Otolaryngology-Head and Neck Surgery, San Antonio Military Health System; Chief Surgical Services Consultant, Air Force Medical Operations Agency

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.

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.

Additional Contributors

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: Vesticon, Inc. None Board membership

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

Amalia Renee Steinberg, MD Resident Physician, Department of Otolaryngology, Eastern Virginia Medical School

Amalia Renee Steinberg, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References

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