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Introduction

Labyrinthitis is self-limiting inner ear disorder, often secondary to viral infection. The infection of vestibular neuron and labyrinth primary affects balance and hearing. The condition is commonly called as vestibular neuritis/ vestibular neuronitis.

Pathophysiology

The major cause for labyrinthitis is known to be viral infection or post-viral inflammatory disorder that mainly affects the vestibular portion of eighth cranial nerve. The exact cause of labyrinthitis or vestibular neuronitis is still not clear. MRI with contrast had shown enhancement of the vestibular nerve fibers within the internal auditory canal, suggesting inflammatory process.

Differential Diagnosis

Labyrinthitis must be differentiated from other diseases that cause vertigo along with gait impairment such as:

• Cerebellar hemorrhage/Infarction
• Brainstem Infarction

Natural History and Prognosis

Labyrinthitis is self limiting disorder, often becomes acutely symptomatic for 1 to 2 days. The symptoms gradually improve over 2 weeks. Recurrence is rare. If left untreated, 15% of patients with labyrinthitis may progress to develop Benign Paroxysmal Positional Vertigo (BPPV) and around 10% may progress to develop panic disorder over 2 years.

Diagnosis

The diagnosis of labyrinthitis is based on clinical evaluation, rather than any test. The viral of preceding viral illness and acute onset symptoms like dizziness,nausea and vomiting with gait impairment suggestive of labyrinthitis. No any specific diagnostic test are available.

Diagnostic Study of Choice

Neuroimaging, generally MRI is done to rule out other acute causes for symptoms that includes cerebellar hemorrhage and brainstem infraction. If MRI not available, CT scan can be done to look for alternative diagnosis.

History and Symptoms

• Preceding Viral infection
• Severe dizziness
• Nausea
• Vomiting
• Gait impairment

MRI with contrast

Abnormal enhancement in membranous labyrinth can be observed in labyrinthitis.

Treatment

Specific treatment

• Glucocorticoids
• Antivirals

Symptomatic treatment

• Anti-emetics
• Anti-histamines
• Anti-cholinergics
• Benzodiazepines

Vestibular rehabilitation

• Vestibular exercises/ physical therapy