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LABYRINTHITIS
Labyrinthitis
Inflammation of the labyrinth of the inner ear.

2
Etiology
•
•
•
•
•
•

Viral or bacterial infections
Cholesteatoma
Drug toxicity
Head injury
Tumour
Vasculitis
Clinical manifestations
• Vestibular manifestations (vertigo)
• Cochlear manifestations (hearing loss)
• Nausea and vomiti...
Pathology
• Infection usually occurs by one of three
routes:
– From the meninges
– From the middle ear space
– Hematogenou...
Pathology
• Meningogenic: through the IAC, cochlear
aqueduct, both (bilateral)
• Tympanogenic: extension of infection from...
Bacterial Infections
Two types of labyrinthitis associated with
bacterial infections:
Toxic Labyrinthitis
Suppurative Laby...
Toxic Labyrinthitis
• Toxic Labyrinthitis: results from a sterile
inflammation of the inner ear following an
acute or chro...
Bacterial Infection
Toxic Labyrinthitis produces mild high frequency
hearing loss or mild vestibular dysfunction
Treatment...
Suppurative Labyrinthitis
• Suppurative Labyrinthitis: direct invasion of
the inner ear by bacteria.
• From otitis or meni...
Suppurative Labyrinthitis: 4 stages
1. Serous or irritative: production of Ig rich
exudates in the perilymph
2. Acute or p...
Diagnosis
• History:
– severe vertigo from any movement of the head.
– Nausea and vomiting
– U/L or B/L hearing loss
– Rec...
Diagnosis
• Physical findings:
– Spontaneous nystagmus
– Jerking movements of eyes toward unaffected ear
– Purulent discha...
Management
•
•
•
•
•

Meclizine to relieve vertigo
Antiemetics
Antibiotics
Oral fluids
IV fluids for severe dehydration
Surgery
• Surgical excision of cholesteatoma
• Incision and drainage
• Labyrinthectomy
Complications
• Meningitis
• Permanent balance disability
• Permanent hearing loss
Thank you
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Labyrinthitis

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Labyrinthitis

Labyrinthitis

  1. 1. LABYRINTHITIS
  2. 2. Labyrinthitis Inflammation of the labyrinth of the inner ear. 2
  3. 3. Etiology • • • • • • Viral or bacterial infections Cholesteatoma Drug toxicity Head injury Tumour Vasculitis
  4. 4. Clinical manifestations • Vestibular manifestations (vertigo) • Cochlear manifestations (hearing loss) • Nausea and vomiting 4
  5. 5. Pathology • Infection usually occurs by one of three routes: – From the meninges – From the middle ear space – Hematogenous spread 5
  6. 6. Pathology • Meningogenic: through the IAC, cochlear aqueduct, both (bilateral) • Tympanogenic: extension of infection from the middle ear, mastoid cells or petrous apex-most common through the round or oval window (unilateral) • Hematogenous: through blood, least common 6
  7. 7. Bacterial Infections Two types of labyrinthitis associated with bacterial infections: Toxic Labyrinthitis Suppurative Labyrinthitis 7
  8. 8. Toxic Labyrinthitis • Toxic Labyrinthitis: results from a sterile inflammation of the inner ear following an acute or chronic otitis media or early bacteria meningitis. • Toxins penetrate the round window, IAC, or cochlear aqueduct and cause an inflammatory reaction in the perilymph space. 8
  9. 9. Bacterial Infection Toxic Labyrinthitis produces mild high frequency hearing loss or mild vestibular dysfunction Treatment: Antibiotics for precipitating otitis, possible myringotomy. 9
  10. 10. Suppurative Labyrinthitis • Suppurative Labyrinthitis: direct invasion of the inner ear by bacteria. • From otitis or meningitis 10
  11. 11. Suppurative Labyrinthitis: 4 stages 1. Serous or irritative: production of Ig rich exudates in the perilymph 2. Acute or purulent: bacterial and leukocyte invasion of the perilymphatic scala-end organ necrosis 3. Fibrous or latent: proliferation of fibroblasts and granulation tissue in the perilymph 4. Osseous or sclerotic: new bone deposition throughout the involved labyrinth 11
  12. 12. Diagnosis • History: – severe vertigo from any movement of the head. – Nausea and vomiting – U/L or B/L hearing loss – Recent URTI – Loss of balance and falling in the direction of the affected ear. 12
  13. 13. Diagnosis • Physical findings: – Spontaneous nystagmus – Jerking movements of eyes toward unaffected ear – Purulent discharge • Lab: – Culture and sensitivity test • Audiometry • A flat tympanogram • Electronystagmography
  14. 14. Management • • • • • Meclizine to relieve vertigo Antiemetics Antibiotics Oral fluids IV fluids for severe dehydration
  15. 15. Surgery • Surgical excision of cholesteatoma • Incision and drainage • Labyrinthectomy
  16. 16. Complications • Meningitis • Permanent balance disability • Permanent hearing loss
  17. 17. Thank you

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