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Labyrinthitis Medication

  • Author: Mark E Boston, MD; Chief Editor: Robert A Egan, MD  more...
 
Updated: Aug 24, 2015
 

Medication Summary

Medications may be indicated in persons with viral labyrinthitis to treat the symptoms of vertigo and nausea/vomiting. These medications include benzodiazepines and antiemetics and are typically used for a few days, until symptoms are relieved. (Avoid scopolamine, or use with extreme caution, in elderly patients.)

Corticosteroids should, in theory, reduce labyrinthine inflammation and prevent the sequelae of labyrinthitis due to infectious or inflammatory causes. Definitive evidence is lacking, however, for the efficacy of corticosteroids in the treatment of labyrinthitis and sudden SNHL.[28] Intratympanic steroids, either alone or in combination with systemic steroids, may be more effective than systemic steroids in the treatment of sudden hearing loss.[29, 30]

Antiviral agents may play a role in the treatment of labyrinthitis due to presumed viral infections. However, studies have not shown improvement in treatment outcomes when antivirals are combined with systemic steroids in the treatment of labyrinthitis.[31]

Antibiotic therapy for bacterial causes of labyrinthitis must be directed at the most likely causative organisms. A complete discussion of all the antibiotics available for the treatment of suppurative or toxic bacterial labyrinthitis is beyond the scope of this article.

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Benzodiazepines

Class Summary

These agents are used for the symptomatic treatment of vertigo.

Diazepam (Valium, Diastat)

 

Diazepam depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing the activity of gamma-aminobutyric acid (GABA). Individualize the dosage and increase it cautiously to avoid adverse effects.

Lorazepam (Ativan)

 

By increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, lorazepam may depress all levels of the CNS, including the limbic and reticular formation.

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Antiemetics

Class Summary

These agents are used for the relief of nausea and vomiting.

Prochlorperazine (Compro)

 

Prochlorperazine may relieve nausea and vomiting by blocking postsynaptic mesolimbic dopamine receptors through anticholinergic effects and depressing the reticular activating system. In addition to having antiemetic effects, prochlorperazine has the advantage of augmenting the hypoxic ventilatory response, acting as a respiratory stimulant at high altitudes.

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Antivirals, Other

Class Summary

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit herpes simplex virus polymerase with 30-50 times the potency of human alpha–deoxyribonucleic acid (DNA) polymerase.

Famciclovir (Famvir)

 

Famciclovir is a prodrug that, when biotransformed into an active metabolite (penciclovir), may inhibit viral DNA synthesis/replication.

Valacyclovir (Valtrex)

 

Valacyclovir is a prodrug that is rapidly converted to the active drug acyclovir. It is more expensive than acyclovir, but its dosing regimen is more convenient.

Acyclovir (Zovirax)

 

Acyclovir has an affinity for viral thymidine kinase and, once phosphorylated, causes DNA chain termination when acted upon by DNA polymerase. The drug, which requires 5 daily doses, can be associated with compliance problems.

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. These drugs modify the body's immune response to diverse stimuli. These are standard agents administered in cases of sudden hearing loss; they may play a role in the treatment of viral labyrinthitis. Their role in the treatment of bacterial labyrinthitis and meningogenic hearing loss is controversial.

Prednisone

 

Prednisone is an immunosuppressant used in the treatment of autoimmune disorders. It may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear cell activity. Prednisone stabilizes lysosomal membranes and suppresses lymphocytes and antibody production and activity.

Methylprednisolone (A-Methapred, Solu-Medrol, Depo-Medrol)

 

Methylprednisolone is available in intravenous (IV)/intramuscular (IM) or oral (PO) form. Methylprednisolone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity.

Prednisolone (Pediapred, Prelone, Orapred)

 

Prednisolone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity. It is a commonly used oral agent.

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Contributor Information and Disclosures
Author

Mark E Boston, MD Physician, Otolaryngology-Head and Neck Surgery, San Antonio Military Health System

Mark E Boston, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Academy of Otolaryngology-Head and Neck Surgery

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, Virginia Society of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Robert A Egan, MD Director of Neuro-Ophthalmology and Stroke Service, 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, Oregon Medical Association

Disclosure: Received honoraria from Biogen Idec for speaking and teaching; Received honoraria from Teva for speaking and teaching.

Acknowledgements

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

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Anatomy of the labyrinth.
 
 
 
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