History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include viral infections, acute or chronic otitis media, meningitis, cholesteatoma, and inner ear malformations.
vertigo
Patients typically describe 'room-spinning' (acute rotational) vertigo.
Acute vertigo may last up to 72 hours.
dizziness
Can mean a variety of things, including floating, imbalance, disequilibrium, and impaired cognition.
nausea and vomiting
Vertigo is often associated with nausea and vomiting.
hearing loss
Typical presentation.
May be unilateral or bilateral.
otorrhoea
Ear discharge alerts to presence of acute or chronic otitis media with tympanic membrane perforation.
Other diagnostic factors
common
nystagmus
Rapid side-to-side movement of the eyes is typically seen in patients with acute-onset labyrinthitis.
tinnitus
Possible presentation (constant noise in the ear).
vertigo-related quick head or body movements
Follow acute vertigo; indicate incomplete vestibular compensation.
influenza-like symptoms
Viral labyrinthitis may occur during an influenza-like illness or during illnesses such as measles or mumps.[7] Therefore, fever, sore throat, and influenza-like symptoms may be present.
uncommon
otalgia
Pain in the ear may be present in patients with acute or chronic otitis media.
Risk factors
strong
viral infections
Labyrinthitis often follows an upper respiratory tract infection.
Other aetiological infectious agents include varicella zoster virus, cytomegalovirus, mumps, measles, rubella, and HIV.[7]
chronic suppurative otitis media
Chronic middle ear infections such as chronic suppurative otitis media (CSOM, a persistent inflammation of the middle ear or mastoid cavity), if not treated in a timely manner, may lead to diffusion of bacterial toxins into the inner ear.[14]
Direct bacterial invasion into the otic capsule has been demonstrated in CSOM with or without accompanying cholesteatoma.
acute otitis media
Acute infections of the middle ear most typically result in serous labyrinthitis secondary to diffusion of bacterial toxins into the membranous labyrinth.[4][14] Bacterial invasion into the inner ear does not occur in this setting, rather, toxins from the bacteria in the middle ear diffuse into the inner ear causing a serous labyrinthitis picture.
cholesteatoma
Direct erosion into the labyrinth or internal auditory canal by cholesteatoma (a collection of epidermal and connective tissues within the middle ear) increases the risk of developing labyrinthitis.[14][Figure caption and citation for the preceding image starts]: Cholesteatoma in middle earFrom the collection of Professor Brandon Isaacson; used with permission [Citation ends].
meningitis
Serous labyrinthitis results from bacterial toxins diffusing through the round window or internal auditory canal. Bacterial meningitis may result in labyrinthitis via spread of infection and inflammatory mediators into the inner ear via the cochlear aqueduct. The cochlear aqueduct connects the subarachnoid space to the scala tympani of the proximal basal turn of the cochlea. Meningitis secondary to Streptococcus pneumoniae poses the greatest risk for labyrinthitis and resultant hearing loss.
inner ear malformations
Commonly associated with abnormal communications between the inner and middle ear.
weak
autoimmune ear diseases
Labyrinthitis has been associated with autoimmune inner ear disease (e.g., Cogan's syndrome or Behcet's disease). These rare diseases cause immune-mediated inner ear damage with resultant hearing loss and vestibular dysfunction.
syphilis
History of sexually transmitted disease increases risk of having contracted syphilis.[6] If left untreated, syphilis may eventually affect the central nervous system and the inner ear (tertiary neurosyphilis).
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