Labyrinthitis

About labyrinthitis

Your ear is made up of three parts: the outer ear, the middle ear and the inner ear. The inner ear consists of a system of fluid-filled tubes (the labyrinth). This is made up of the cochlea, which senses sound, and the vestibular system, which senses movement of your head and helps with balance.

When you turn your head, the change in position and direction is sensed by the vestibular system, which then sends messages to your brain. Your brain also uses messages sent from your eyes, joints and muscles to get information about the position of your body. However, if any one of these sources of information suddenly becomes disrupted, your brain can't co-ordinate the messages properly and your balance will be affected.

Labyrinthitis is a condition caused by inflammation in your inner ear and disrupts the messages sent from your ear to your brain. This causes you to feel dizzy because your brain thinks your head is moving when it’s still. When this happens, the information that is sent to your brain from other areas of your body (eyes, joints and muscles) can’t be co-ordinated and causes you to feel dizzy.

How labyrinthitis develops

          

Symptoms of labyrinthitis

If you have labyrinthitis, you may:

  • have vertigo – this is the sensation that you, or things around you, are spinning even when you're still
  • feel sick (nauseous) or be sick (vomit)
  • have reduced hearing or hearing loss
  • have tinnitus (a ringing sound in your ears)
  • feel giddy and unbalanced

Although not necessarily a result of labyrinthitis, see your GP if you have these symptoms.

Labyrinthitis can sometimes develop when you have the flu, so you may have flu-like symptoms such as a sore throat and fever.

Also, your eyes may shake very slightly (nystagmus), but it's usually only your GP who notices this.

The symptoms of labyrinthitis can come on suddenly, for example, when you wake up or during the course of the day. Your symptoms usually improve within a few days. You may also feel unsteady for several days and weeks afterwards, but this usually improves over time.

Complications of labyrinthitis

Labyrynthitis often settles without complications. Sometimes, however, labyrinthitis can cause permanent hearing loss and lasting damage to the balance system in your inner ear. Although your brain can try to compensate for the damage, you may continue to feel unsteady, even after the initial spinning and dizziness has gone away.

Causes of labyrinthitis

Doctors don't always know exactly how or why labyrinthitis develops. Some possible causes are listed below.

  • Viral infections. Most commonly upper respiratory tract viruses, such as a cold, but many other viruses including the herpes zoster virus (that causes shingles), mumps, measles and rubella viruses may cause the condition.
  • Bacterial infections. Middle ear infections (otitis media) or meningitis caused by bacteria can lead to labyrinthitis.
  • Autoimmune conditions. Normally, your body's immune system produces white blood cells and proteins called antibodies to fight infection. If you have an autoimmune condition, your immune system attacks some of your body's healthy tissues, causing inflammation and damage.

Some symptoms of labyrinthitis, such as vertigo, can sometimes be triggered by migraines, or a stroke or a transient ischaemic attack (‘mini stroke’).

If you have viral labyrinthitis, your hearing should return to normal. If you have bacterial labyrinthitis, then your hearing loss may be permanent.

Diagnosis of labyrinthitis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will look into your ear using an instrument called an otoscope. This is used to check for signs of inflammation and infection in your outer or middle ear. He or she may also look at your eyes and test your balance.

Your GP may refer you to an ear, nose and throat (ENT) specialist or an audiovestibular specialist (a doctor who specialises in identifying and treating conditions that affect hearing and balance) for further investigation. You may need to have:

  • hearing tests
  • balance tests
  • blood tests
  • an MRI (magnetic resonance imaging) scan or a CT (computerised tomography) scan

Treatment of labyrinthitis

Initially, you will need to rest and maintain your fluid levels by drinking enough water. Your GP is likely to prescribe you anti-sickness medication to help with nausea and vomiting. Some of these medicines can cause drowsiness so you may not be able to drive. Speak to your GP about how your medicine may affect you and always read the patient information leaflet that comes with your medicine.

Hospital treatment

If you have bacterial labyrinthitis, rarely, you may need to have intravenous antibiotics. Your doctor may take a swab from your ear and send it to a laboratory for testing. This will enable him or her to prescribe an appropriate antibiotic.

If your vomiting is severe, you may need to go to hospital and have a drip inserted into a vein in your hand or arm to give you fluids.

Vestibular rehabilitation therapy

If you continue to feel unsteady after a number of weeks, your doctor may advise you to try vestibular rehabilitation therapy. The exercises you do as part of the therapy can improve your brain's ability to sort out the 'good' information from the 'bad', which may help with your balance and walking skills. Initially you may feel more unsteady, but this will improve over time. Speak to your GP for further advice and information about vestibular rehabilitation. For more information see our FAQs.

Is feeling dizzy the same as having vertigo?

Answer

No. Vertigo is just one specific form of dizziness. You can feel dizzy without having vertigo.

Explanation

If you feel dizzy, it means that you may feel light-headed or unsteady. People often feel light-headed or dizzy before they faint. It can be a reaction to a strong emotion, to standing still for a long time or to standing up too quickly. Dizziness and fainting are very common and aren't often serious. However, you should still be checked by your GP if you faint for no obvious reason or feel dizzy.

Many other things can also make you feel dizzy, such as problems with your heart, blood (eg anaemia) and some conditions related to your brain. It can also be a side-effect of some types of medicine.

Vertigo is just one specific type of dizziness, which is caused by a problem with your inner ear. If you have vertigo, it means you have the feeling that you, or things around you, are moving even when you are still.

What do vestibular rehabilitation exercises involve?

Answer

Vestibular rehabilitation starts with very simple exercises, such as moving your eyes, and gradually progresses to more complicated exercises.

Explanation

One of the most common sets of rehabilitation exercises for labyrinthitis are called Cawthorne-Cooksey exercises. These include the following.

  • Move only your eyes from side to side and up and down when you're in bed or sitting down, then just move your head, first with your eyes open and then closed.
  • Shrug and circle your shoulders while sitting down, and bend forwards to pick up objects when you're sitting.
  • Stand up from a sitting position with your eyes open and then closed, and throw a small ball from hand to hand when you're standing.
  • Walk across a room with your eyes open and then closed, and walk up and down steps with your eyes open and then closed.

These exercises can help you return to your usual activities more quickly. You should only do these exercises if you have been shown how to do them by your specialist or a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility).

Is labyrinthitis contagious?

Answer

Labyrinthitis itself isn’t contagious. However, infections that may trigger the condition can be.

Explanation

You can't catch labyrinthitis directly from someone else who has the condition.

However, viral infections such as mumps and flu that are thought to trigger labyrinthitis are contagious and can be spread from one person to another. It's therefore possible that you can catch a virus (such as mumps and flu) from someone who has had labyrinthitis and go on to develop the condition yourself. For further information, see causes of labyrinthitis.