Labyrinthitis

Question 1

Labyrinthitis vs Vestibular Neuritis

Answer 1

• Sometimes used interchangeably
• Labyrinthitis for when vestibular nerve and labyrinth affected, hearing loss, dizziness
• Vestibular neuritis when vestibular nerve only is affected, therefore dizziness without hearing loss

Question 2

Vestibular Neuritis Aetiology

Answer 2

• Reactivation of HSV1

- Prior URTI

Question 3

Labyrinthitis Aetiology

Answer 3

• Viral

- Bacterial can occur

Question 4

Vestibular Neuritis and Labyrinthitis Epidemiology

Answer 4

• More common in adults

- Bacterial cause rare

Question 5

Vestibular Neuritis and Labyrinthitis Presentation

Answer 5

• Sudden, spontaneous, severe and incapacitating vertigo
• Not triggered by movement but exacerbated by movement
• Nausea and vomiting frequent
• Tinnitus and hearing loss in labyrinthitis
• Previous URTI

Question 6

Vestibular Neuritis and Labyrinthitis Symptoms That Suggest Alternative Diagnosis

Answer 6

• Otorrhoea
• Otalgia
• Neck pain/stiffness
• Facial weakness
• CV RFs
• Medications
• FHx of migraine or Ménière’s

Question 7

Vestibular Neuritis and Labyrinthitis Examination

Answer 7

• Ear
• Cranial nerves
• Gait
• HINTS for ruling out stroke
• An abnormal head impulse test, unidirectional nystagmus and no vertical skew are sensitive markers of vestibular neuritis and of labyrinthitis

Question 8

Vestibular Neuritis and Labyrinthitis Investigations

Answer 8

• Bloods not helpful
• C+S if effusion
• Most do not require imaging unless alternative pathology suspected
• Audiometry if indicated

Question 9

Vestibular Neuritis and Labyrinthitis Differentials

Answer 9

• Serous labyrinthitis (inflammation in absence of direct bacterial contamination, toxins and cytokines leak through from acute/chronic OM)
• BPPV
• Vestibular migraine
• Ramsay-Hunt

Question 10

Vestibular Neuritis and Labyrinthitis Management

Answer 10

• Admission if sudden-onset unilateral hearing loss
• Otherwise reassurance
• Symptomatic treatment with prochlorperazine or antiemetics
• Self limiting condition, usually resolves within a few weeks
• Physiotherapy if treatment does not work
• Surgical management if indicated