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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]

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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.

MRI

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]

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Audiography

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.

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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.

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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

References
  1. 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. 2007 Oct. 137(4):612-8. [Medline].

  2. Kuhweide R, Van de Steene V, Vlaminck S, Casselman JW. Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms. J Laryngol Otol. 2002 Oct. 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. 2000 Aug. 48(2):254-6. [Medline].

  4. Wu JF, Jin Z, Yang JM, Liu YH, Duan ML. Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis. Acta Otolaryngol. 2012 Mar. 132 (3):261-5. [Medline].

  5. Wu JF, Jin Z, Yang JM, Liu YH, Duan ML. Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis. Acta Otolaryngol. 2012 Jan 8. [Medline].

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

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

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

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

  10. Schuknecht HF, Kitamura K. Second Louis H. Clerf Lecture. Vestibular neuritis. Ann Otol Rhinol Laryngol Suppl. 1981 Jan-Feb. 90(1 Pt 2):1-19. [Medline].

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

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

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

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

  15. 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. 1999 May. 125(5):509-14. [Medline].

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

  17. 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. 2006 Sep. 132(9):941-5. [Medline].

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

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

  20. 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. 1992 Jun. 101(6):459-64. [Medline].

  21. Kopelovich JC, Germiller JA, Laury AM, Shah SS, Pollock AN. Early prediction of postmeningitic hearing loss in children using magnetic resonance imaging. Arch Otolaryngol Head Neck Surg. 2011 May. 137(5):441-7. [Medline].

  22. Peng R, Chow D, De Seta D, Lalwani AK. Intensity of gadolinium enhancement on MRI is useful in differentiation of intracochlear inflammation from tumor. Otol Neurotol. 2014 Jun. 35 (5):905-10. [Medline].

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

  24. 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. 2004 Jul 22. 351(4):354-61. [Medline].

  25. 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. 2005 Jan. 26(1):19-26. [Medline].

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

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

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

  29. 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. 2008 Jun. 29(4):453-60. [Medline].

  30. 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. 2009 Feb. 119(2):359-69. [Medline].

  31. 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. 2003 Nov. 112(11):993-1000. [Medline].

 
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Anatomy of the labyrinth.
 
 
 
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