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1. Labyrinthitis
Sunil Kumar Daha

2. INTRODUCION
• Labyrinthitis- Inflammation of inner ear
• Epidemiology-
40 % of vertigo and disequiliberium ,
1 in 10,000 people
• Etiology
Usually caused by a virus, but it can also arise
from bacterial infection, head injury, extreme stress,
an allergy or as a reaction to medication

3. Labyrinthitis
• Three types:
1. Circumscribed
• Thinning or erosion of bony capsule of labyrinth—usually horizontal
semicircular canal
2. Diffuse serous
• Diffuse intralabyrinthine inflammation without pus formation
• Reversible if treated early
3. Diffuse suppurative
• Diffuse pyogenic infection of the labyrinth
• Permanent loss of vestibular and cochlear functions

4. Circumscribed Labyrinthitis
• Clinical features: Sensitive to pressure change
• Transient vertigo induced by
• Pressure in the tragus
• Cleaning the ear
• Performing Valsalva manoeuvre
• Diagnosis
• Fistula test
• Pressure on tragus
• Sudden inward pressure on tragus, ↑air pressure in ear canal ; stimulation of
labyrinth causes vertigo and nystagmus
• Siegel’s speculum
• Positive pressure in ear canal  vertigo and nystagmus

5. Diffuse Serous Labyrinthitis
• Clinical features
• Vertigo
• Nausea, vomiting
• Sensorineural hearing loss
• If untreated, total loss of vestibular and cochlear function
• Serous Suppurative labyrinthitis

6. Treatment of Diffuse serous type
• Medical:
• Patient in bed with head immobilized, affected air above
• Antibiotics
• Pus culture
• Labyrinthine sedatives—prochlorperazine or dimenhydrinate
• Myringotomy
• Surgical
• Cortical mastoidectomy (Acute mastoiditis)
• Modified radical mastoidectomy (chronic middle ear infection or
cholesteatoma)

7. Diffuse Suppurative Labyrinthitis
• Clinical features
• Severe vertigo with nausea and vomiting(acute vestibular failure)
• Toxic looking
• Total loss of hearing
• Treatment
• Same as serous labyrinthitis
• Rarely, drainage of labyrinth if labyrinthine suppuration is acting
as a source of intracranial complications

8. Acute disease-specific treatment
• Treatment with corticosteroids
• Treatment with methylprednisolone (22-day tapering dose
schedule) significantly improved vestibular function at 12-month
follow-up compared with placebo.
• Treatment with prednisone(1 mg/kg per day for five days then a
15 day taper)

9. Investigation
-based on symptoms, medical history and physical examination.
- Vestibular Testing
- Audiography
- CT and MRI
•caloric reflex test
•(sometimes termed 'vestibular caloric stimulation')
is a test of the vestibulo-ocular reflex that involves
irrigating cold or warm water or air into the external
auditory canal.

10. References
• Diseases of Ear, Nose and Throat and head and neck surgery,
PL Dhingra, S Dhingra. 6th edition
• Medscape
• Uptodate version 21.2

11. THANK YOU