Labyrinthitis Differential Diagnoses

Updated: Sep 02, 2020
  • Author: Mark E Boston, MD; Chief Editor: Robert A Egan, MD  more...
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DDx

Diagnostic Considerations

Vestibular neuritis

Viral labyrinthitis is often confused with vestibular neuritis, and the terms are occasionally used interchangeably in the literature. However, most authors agree that vestibular neuritis is a disorder of the vestibular nerve and is not associated with hearing loss. [10] Because the cochlea is affected in pan-labyrinthine inflammation, hearing loss is always present in persons with viral labyrinthitis.

Vestibular neuritis typically manifests as sudden, acute vertigo without hearing loss in an otherwise healthy patient. The condition is more common in the fourth and fifth decades of life and affects men and women equally. An upper respiratory tract infection often precedes the condition, and the disorder is more common in the spring and early summer.

Histopathologic nerve studies of patients with vestibular neuritis demonstrate axonal loss, endoneurial fibrosis, and atrophy. [10] These findings are consistent with a viral inflammatory etiology. The treatment of vestibular neuritis and viral labyrinthitis is similar.

Other conditions

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. [18]

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.

Conditions to consider in the differential diagnosis of labyrinthitis also include the following:

  • Vertebrobasilar insufficiency

  • Presyncopal dizziness

  • Cerebellar infarct

  • Dysequilibrium of aging

  • Drug-induced vertigo and/or hearing loss

Differential Diagnoses