eMedicine Specialties > Neurology > Neuro-otology

Inner Ear, Labyrinthitis: Follow-up

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

Follow-up

Further Inpatient Care

  • Most patients with labyrinthitis can be evaluated and treated in the emergency department and then discharged.
  • Some patients with intractable vertigo and vomiting may require admission.
  • For those with a possible severe underlying condition (eg, vertebrobasilar ischemia, brainstem tumor), admission to the hospital may be appropriate under the direction of a neurologist, a neurosurgeon, or both.

Further Outpatient Care

Patients with persistent vestibular symptoms may be candidates for vestibular rehabilitation. For many patients with chronic vertigo due to a peripheral vestibular etiology, a simple home program of vestibular habituation head movement exercises reduces symptoms of imbalance during stance and gait.26

A follow-up audiogram should be performed in all patients with hearing loss and in patients who were not tested at presentation. An auditory brainstem response test is indicated for younger children.

Prognosis

The acute symptoms of vertigo and nausea and vomiting resolve after several days to weeks in all forms of labyrinthitis; however, hearing loss is more variable.

  • Suppurative labyrinthitis nearly always results in permanent and profound hearing loss, whereas hearing loss associated with viral labyrinthitis may recover. Dysequilibrium and/or positional vertigo also may be present long-term following resolution of the acute infection.
  • Permanent hearing loss occurs in 10-20% of children with meningitis.14,13
  • Permanent SNHL occurs in approximately 6% of patients with herpes zoster oticus who present with hearing loss.5

Patient Education

For excellent patient education resources, visit eMedicine's Ear, Nose, and Throat Center. Also, see eMedicine's patient education articles Labyrinthitis and Vertigo.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose a potentially life-threatening condition, such as meningitis, cerebrovascular ischemia, or a brainstem tumor. 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.27
  • Failure to counsel patients regarding the potential for injury to themselves or others if they operate heavy machinery or drive a vehicle while vertiginous or while taking certain medications to control symptoms

Special Concerns

  • 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.
  • Avoid scopolamine (or use with extreme caution) in elderly patients.
 


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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  2. Kuhweide R, Van de Steene V, Vlaminck S, Casselman JW. Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms. J Laryngol Otol. Oct 2002;116(10):844-8. [Medline].

  3. Hato N, Kisaki H, Honda N, Gyo K, Murakami S, Yanagihara N. Ramsay Hunt syndrome in children. Ann Neurol. Aug 2000;48(2):254-6. [Medline].

  4. Schraff SA, Schleiss MR, Brown DK, Meinzen-Derr J, Choi KY, Greinwald JH, et al. Macrophage inflammatory proteins in cytomegalovirus-related inner ear injury. Otolaryngol Head Neck Surg. Oct 2007;137(4):612-8. [Medline].

  5. Gulya AJ. Infections of the labyrinth. In: Bailey BJ, Johnson JT, Pillsbury HC, Tardy ME, Kohut RI, eds. Head and Neck Surgery-Otolaryngology. Vol 2. Philadelphia, Pa: JB Lippincott; 1993:1769-81.

  6. Berlow SJ, Caldarelli DD, Matz GJ, Meyer DH, Harsch GG. Bacterial meningitis and sensorineural hearing loss: a prospective investigation. Laryngoscope. Sep 1980;90(9):1445-52. [Medline].

  7. Jang CH, Park SY, Wang PC. A case of tympanogenic labyrinthitis complicated by acute otitis media. Yonsei Med J. Feb 28 2005;46(1):161-5. [Medline].

  8. Harris JP, Ryan AF. Fundamental immune mechanisms of the brain and inner ear. Otolaryngol Head Neck Surg. Jun 1995;112(6):639-53. [Medline].

  9. Broughton SS, Meyerhoff WE, Cohen SB. Immune-mediated inner ear disease: 10-year experience. Semin Arthritis Rheum. Oct 2004;34(2):544-8. [Medline].

  10. Bovo R, Ciorba A, Martini A. The diagnosis of autoimmune inner ear disease: evidence and critical pitfalls. Eur Arch Otorhinolaryngol. Jan 2009;266(1):37-40. [Medline].

  11. Byl FM. Seventy-six cases of presumed sudden hearing loss occurring in 1973: prognosis and incidence. Laryngoscope. May 1977;87(5 Pt 1):817-25. [Medline].

  12. Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology. Mar 1987;37(3):371-8. [Medline].

  13. Nadol JB Jr. Hearing loss as a sequela of meningitis. Laryngoscope. May 1978;88(5):739-55. [Medline].

  14. Woolley AL, Kirk KA, Neumann AM Jr, McWilliams SM, Murray J, Freind D. Risk factors for hearing loss from meningitis in children: the Children's Hospital experience. Arch Otolaryngol Head Neck Surg. May 1999;125(5):509-14. [Medline].

  15. Bohr V, Paulson OB, Rasmussen N. Pneumococcal meningitis. Late neurologic sequelae and features of prognostic impact. Arch Neurol. Oct 1984;41(10):1045-9. [Medline].

  16. Kutz JW, Simon LM, Chennupati SK, Giannoni CM, Manolidis S. Clinical predictors for hearing loss in children with bacterial meningitis. Arch Otolaryngol Head Neck Surg. Sep 2006;132(9):941-5. [Medline].

  17. Mark AS, Seltzer S, Nelson-Drake J, Chapman JC, Fitzgerald DC, Gulya AJ. Labyrinthine enhancement on gadolinium-enhanced magnetic resonance imaging in sudden deafness and vertigo: correlation with audiologic and electronystagmographic studies. Ann Otol Rhinol Laryngol. Jun 1992;101(6):459-64. [Medline].

  18. Maire R, van Melle G. Diagnostic value of vestibulo-ocular reflex parameters in the detection and characterization of labyrinthine lesions. Otol Neurotol. Jun 2006;27(4):535-41. [Medline].

  19. Strupp M, Zingler VC, Arbusow V, Niklas D, Maag KP, Dieterich M, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med. Jul 22 2004;351(4):354-61. [Medline].

  20. Barkdull GC, Vu C, Keithley EM, Harris JP. Cochlear microperfusion: experimental evaluation of a potential new therapy for severe hearing loss caused by inflammation. Otol Neurotol. Jan 2005;26(1):19-26. [Medline].

  21. Klein M, Koedel U, Pfister HW, Kastenbauer S. Meningitis-associated hearing loss: protection by adjunctive antioxidant therapy. Ann Neurol. Oct 2003;54(4):451-8. [Medline].

  22. Wei BP, Mubiru S, O'Leary S. Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database Syst Rev. Jan 25 2006;CD003998. [Medline].

  23. Battaglia A, Burchette R, Cueva R. Combination therapy (intratympanic dexamethasone + high-dose prednisone taper) for the treatment of idiopathic sudden sensorineural hearing loss. Otol Neurotol. Jun 2008;29(4):453-60. [Medline].

  24. Plontke SK, Löwenheim H, Mertens J, Engel C, Meisner C, Weidner A, et al. Randomized, double blind, placebo controlled trial on the safety and efficacy of continuous intratympanic dexamethasone delivered via a round window catheter for severe to profound sudden idiopathic sensorineural hearing loss after failure of systemic therapy. Laryngoscope. Feb 2009;119(2):359-69. [Medline].

  25. Westerlaken BO, Stokroos RJ, Dhooge IJ, Wit HP, Albers FW. Treatment of idiopathic sudden sensorineural hearing loss with antiviral therapy: a prospective, randomized, double-blind clinical trial. Ann Otol Rhinol Laryngol. Nov 2003;112(11):993-1000. [Medline].

  26. Cohen HS, Kimball KT. Decreased ataxia and improved balance after vestibular rehabilitation. Otolaryngol Head Neck Surg. Apr 2004;130(4):418-25. [Medline].

  27. Lee H, Kim HJ, Koo JW, Kim JS. Progression of acute cochleovestibulopathy into anterior inferior cerebellar artery infarction. J Neurol Sci. Mar 15 2009;278(1-2):119-22. [Medline].

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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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