Labyrinthitis and its management
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Labyrinthitis and its management
- 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
Editor's Notes
- Cholesteatoma- a destructive and expanding keratiniging sq epithellium in middle ear.
- In medicine, the 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.