Question: Could you please discuss labyrinthitis? I am an 81 year old female and have been suffering from it for several months. I have improved, but still have issues with balance and a feeling of fullness in my head. What causes labyrinthitis? Is there a treatment that can help?
A: Labyrinthitis occurs when inflammation or swelling in the inner ear causes difficulty with balance.
Although all three parts of the ear – outer, middle, and inner – play a role in hearing, only the inner ear is responsible for balance. It is located in a small compartment inside the temporal bones, which help form the sides and base of the skull. It is made up of the cochlea, which is the auditory part of the inner ear, and a complex of fluid-filled tubes and other structures, which deal with balance. Together, these tubes and structures are known as the vestibular or labyrinth system. They specialize in detecting various types of head movements, such as tilting up or down, tilting left or right, lateral rotation, and acceleration. Tiny hairs located throughout the vestibular system decode movement and turn it into nerve impulses. These are sent to the brain via the eighth cranial nerve, also known as the auditory nerve. The brain translates information and tells the body how to do it.
The most common cause of labyrinthitis is a viral infection, such as a cold or the flu. Viruses that cause shingles, measles, mumps, and rubella can also affect the inner ear. The disease can be caused by a bacterial infection that has spread from the middle ear, but it is more common in children than in adults. It can also occur as a result of an allergic reaction.
Inflammation and swelling affect the auditory nerve and also interfere with the proper functioning of fluid and fine hairs in the vestibular system. As a result, they receive truncated information regarding movement and balance and send this misinformation to the brain. Symptoms of labyrinthitis include dizziness, vertigo, disturbed balance, a feeling of spinning or falling, or nausea. If the inflammation affects the cochlea, tinnitus and hearing loss are also possible. Treatment depends on the person’s specific symptoms, age, and general health. These can include drugs such as corticosteroids to reduce inflammation, antiviral drugs to fight infection, and drugs to control nausea and relieve dizziness.
In most cases, labyrinthitis resolves over time and does not cause lasting problems. Although your case lasts longer than what is usually observed, your continuous improvement is encouraging. The feeling of fullness that you describe suggests that the middle ear may be involved. If you haven’t already, you should talk to your healthcare provider. If a bacterial infection is suspected, antibiotics may be prescribed.
Patients who have persistent symptoms of labyrinthitis may benefit from an exercise program called vestibular rehabilitation. It involves exercises that help the brain learn to cope with the altered signals it receives from the vestibular system. If your symptoms persist, we recommend that you ask your doctor for a referral to a vestibular rehabilitation specialist.
Dr. Eve Glazier, MBA, is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.