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.[26] Intratympanic steroids, either alone or in combination with systemic steroids, may be more effective than systemic steroids in the treatment of sudden hearing loss.[27, 28]
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.[29]
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.
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.
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.
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.
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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