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Labyrinthitis

Labyrinthitis is inflammation of the inner ear labyrinth that can be caused by viral or bacterial infections, drugs, head injuries, or other conditions. It produces vestibular symptoms like vertigo and nausea as well as hearing loss. The infection can spread from the meninges, middle ear, or bloodstream. Bacterial labyrinthitis has toxic or suppurative forms, with the latter invading the inner ear directly. Diagnosis involves a history of ear problems and dizziness as well as physical exams and tests. Treatment focuses on relieving vertigo and nausea with drugs while antibiotics target bacterial causes. Surgery may be needed in severe cases. Complications can include meningitis, permanent balance issues

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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 vomiting 4
Pathology • Infection usually occurs by one of three routes: – From the meninges – From the middle ear space – Hematogenous spread 5
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
Bacterial Infections Two types of labyrinthitis associated with bacterial infections: Toxic Labyrinthitis Suppurative Labyrinthitis 7
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
Bacterial Infection Toxic Labyrinthitis produces mild high frequency hearing loss or mild vestibular dysfunction Treatment: Antibiotics for precipitating otitis, possible myringotomy. 9
Suppurative Labyrinthitis • Suppurative Labyrinthitis: direct invasion of the inner ear by bacteria. • From otitis or meningitis 10
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
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
Diagnosis • Physical findings: – Spontaneous nystagmus – Jerking movements of eyes toward unaffected ear – Purulent discharge • Lab: – Culture and sensitivity test • Audiometry • A flat tympanogram • Electronystagmography
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
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