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Labyrinthitis Workup

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

Approach Considerations

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 complete blood count (CBC) and blood cultures are indicated. Perform culture and sensitivity testing of middle ear effusions, if present, and select appropriate antibiotic therapy accordingly.

Currently, no accurate or reliable autoimmune test is commercially available for autoimmune labyrinthitis. The diagnosis of the condition rests on a positive clinical response to steroid therapy.[19]


Imaging Studies

CT scanning

Consider a computed tomography (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.


Magnetic resonance imaging (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.[20] This finding is highly specific and correlates with objective and subjective patient assessment. Improvements that have been made in MRI techniques may make this the study of choice for suspected labyrinthitis.[21]  The intensity of gadolinium enhancement on MRI can be useful in distinguishing intracochlear tumors from other inner ear pathology, including labyrinthitis.[22]



Obtain an audiogram in all patients who may have labyrinthitis. Evaluate critically ill and severely vertiginous patients when they are stable and able to tolerate the test. The audiogram may show different findings in relation to the etiology of the labyrinthine inflammation.  For example, a patient with otitis media-induced labyrinthitis would most likely have a mixed hearing loss, whereas viral labyrinthitis would present with a sensorineural hearing loss.  Otoacoustic emission (OAE) testing or auditory brainstem response (ABR) testing may be helpful in patients who are unable to cooperate for standard audiometry.

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. Evidence suggests that careful evaluation of the vestibulo-ocular reflex may help to establish the etiology of the labyrinthitis.[23]

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.

Contributor Information and Disclosures

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.


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.


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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