This condition is much less common than is generally thought. In many instances it is confused with Vestibular Neuritis (see Vestibular Neuritis page). It is called Labyrinthitis as ‘labyrinth’ is the term used to describe the whole inner ear encompassing both the hearing and balance parts.
Labyrinthitis is caused by infection of the inner ear. It affects not only the balance part of the inner ear but also the hearing part. Patients report a sudden onset of whirling dizziness. They also experience hearing loss on the affected side and may also report a ringing sound (tinnitus). The dizziness is incapacitating and usually means that the affected patient cannot move his/her head without severe dizziness accompanied by vomiting. It can be several hours or even a day before head movements can be accomplished without retching. Over the course of two to three days the affected patient gradually gets back on their feet but balance is severely disturbed and can take weeks to gradually return to normal. Unfortunately hearing is permanently affected and tinnitus may also be permanent. Most patients will gradually return to normal but a significant number will still experience dizziness when their balance system is overstressed. Pain is not usually a feature.
Initial treatment is with medicine to suppress the information sent from the infected balance organ to the brain. The compounds used are called ‘vestibular sedatives’ as they calm the balance or vestibular organ. It is important however not to take these medications for more than 2-4 days at most as the brain needs to receive unadulterated messages from both ears in order to make an accurate assessment of the altered information coming in from the damaged balance organ. This allows it to readjust quicker and restore normal balance responses to challenging situations.
History and examination
The history is usually typical of labyrinthitis as described above. If the patient is still relatively early in the recovery phase the eyes can be seen to be jerking. This is called nystagmus and if seen by a balance specialist will give useful information as to which ear is affected and the degree of recovery already achieved. An examination may be limited depending upon the phase of the patient’s recovery.
Following a full history and examination, a hearing test is essential. It is also likely that an MRI scan is required to rule out a form of stroke. Certain blood tests to exclude rare causes of these symptoms may be appropriate depending upon the pre-dizziness history given.
Following labyrinthitis, some patients develop an overdependence upon their eyes to give them balance. This can be diagnosed in the history and examination. It is usually treated by a series of exercises that are gradually increased in complexity to improve balance responses. Typical symptoms of this visual dependence include difficulties with balance in visually complex environments eg crowds, supermarkets etc.
Treatment is usually very effective if the rest of the balance system is functioning normally.