Labyrinthitis: Difference between revisions
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*Infection of cochlear and vestibular apparatus (from middle ear via round/oval windows) | *Infection of cochlear and vestibular apparatus (from middle ear via round/oval windows) | ||
*Acute suppurative labyrinthitis is only cause of peripheral vertigo requiring urgent treatment | *Acute suppurative labyrinthitis is only cause of peripheral vertigo requiring urgent treatment | ||
*Some sources consider [[ | *Some sources consider [[vestibular Neuritis]] and labyrinthitis to be the same thing | ||
**Some differentiate based on auditory symptoms | **Some differentiate based on auditory symptoms | ||
==Clinical Features== | ==Clinical Features== | ||
*Peripheral vertigo + hearing loss + middle ear findings | *Peripheral [[vertigo]] + [[hearing loss]] + middle ear findings | ||
**Severity depends on type of labyrinthitis: | **Severity depends on type of labyrinthitis: | ||
***Acute suppurative labyrinthitis | ***Acute suppurative labyrinthitis | ||
****Caused by extension of infection from otitis media, meningitis, mastoiditis | ****Caused by extension of infection from [[otitis media]], [[meningitis]], [[mastoiditis]] | ||
****Signs of toxicity | ****Signs of toxicity | ||
***Serous labyrinthitis | ***Serous labyrinthitis | ||
****Caused by inflammatory | ****Caused by inflammatory response to nearby infections (including viral) | ||
****Clinical course similar to [[Vestibular Neuritis (Neuronitis)]] | ****Clinical course similar to [[Vestibular Neuritis (Neuronitis)]] | ||
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==Management== | ==Management== | ||
*Suppurative form requires antibiotics | *Suppurative form requires [[antibiotics]] | ||
*Prochlorperazine 10mg PO q6 PRN for nausea/vomiting | *[[Prochlorperazine]] 10mg PO q6 PRN for [[nausea/vomiting]] | ||
*Lorazepam '''OR''' diazepam as vestibular depressant | *[[Lorazepam]] '''OR''' diazepam as vestibular depressant | ||
*Bed rest and hydration | *Bed rest and hydration | ||
*Corticosteroids controversial especially in concomitant suppurative form | *[[Corticosteroids]] controversial especially in concomitant suppurative form | ||
==Disposition== | ==Disposition== | ||
Revision as of 21:01, 30 September 2019
Some sources consider vestibular neuritis and labyrinthitis to be the same thing (some differentiate based on auditory symptoms)
Background
- Infection of cochlear and vestibular apparatus (from middle ear via round/oval windows)
- Acute suppurative labyrinthitis is only cause of peripheral vertigo requiring urgent treatment
- Some sources consider vestibular Neuritis and labyrinthitis to be the same thing
- Some differentiate based on auditory symptoms
Clinical Features
- Peripheral vertigo + hearing loss + middle ear findings
- Severity depends on type of labyrinthitis:
- Acute suppurative labyrinthitis
- Caused by extension of infection from otitis media, meningitis, mastoiditis
- Signs of toxicity
- Serous labyrinthitis
- Caused by inflammatory response to nearby infections (including viral)
- Clinical course similar to Vestibular Neuritis (Neuronitis)
- Acute suppurative labyrinthitis
- Severity depends on type of labyrinthitis:
Differential Diagnosis
Vertigo
- Vestibular/otologic
- Benign paroxysmal positional vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- Ménière's disease
- Ear foreign body
- Otic barotrauma
- Otosclerosis
- Neurologic
- Cerebellar stroke
- Vertebrobasilar insufficiency
- Lateral Wallenberg syndrome
- Anterior inferior cerebellar artery syndrome
- Neoplastic: cerebellopontine angle tumors
- Basal ganglion diseases
- Vertebral Artery Dissection
- Multiple sclerosis
- Infections: neurosyphilis, tuberculosis
- Epilepsy
- Migraine (basilar)
- Other
- Hematologic: anemia, polycythemia, hyperviscosity syndrome
- Toxic
- Chronic renal failure
- Metabolic
Evaluation
See Vertigo
Management
- Suppurative form requires antibiotics
- Prochlorperazine 10mg PO q6 PRN for nausea/vomiting
- Lorazepam OR diazepam as vestibular depressant
- Bed rest and hydration
- Corticosteroids controversial especially in concomitant suppurative form
Disposition
- Suppurative form require admission for definitive ENT treatment