Prognosis
If the patient has no serious neurologic sequelae, the prognosis for acute labyrinthitis is generally good. Patients with other neurologic complications from bacterial meningitis such as hydrocephalus or stroke may require additional therapy such as a ventriculoperitoneal shunt or physical and occupational therapy. Patients with cerebral infarcts in critical areas are often left with significant disabilities.
Incomplete vestibular compensation
After injury to the inner ear, the brain undergoes a complex set of changes that allow it to adapt to the altered sensory input and abolish the perception of vertigo. This process is called vestibular compensation. Some patients may experience problems with incomplete vestibular compensation and so continue to experience vertigo. This can often be alleviated by a course of vestibular rehabilitation therapy, eliminating the vestibular suppressants, and increasing daily activities.[41]
Hearing loss
The hearing loss that occurs with suppurative labyrinthitis is typically irreversible.[4] Treatment with corticosteroids may decrease inflammation and potentially preserve some hearing. Corticosteroids also decrease the inflammatory response within the cochlea, thus decreasing fibrosis and ossification, which can make cochlear implantation more challenging in the setting of bilateral suppurative labyrinthitis. Patients with serous labyrinthitis often recover their hearing. Hearing loss can be permanent in up to 20% of children with meningitis.
Tinnitus
The type associated with sensorineural hearing loss typically gets less noticeable with time. However, patients with persistent tinnitus can develop a reactive depression. These patients may benefit from antidepressant therapy (selective serotonin-reuptake inhibitors), tinnitus retraining, biofeedback, tinnitus maskers, and amplification with a hearing aid.
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