Labyrinthitis - Revision history

Danbot: Strip excess bold

2026-03-22T09:35:01Z

Strip excess bold

← Older revision		Revision as of 09:35, 22 March 2026
Line 3:		Line 3:
	==Background==		==Background==
	*Inflammation of the inner ear (cochlear and vestibular apparatus)		*Inflammation of the inner ear (cochlear and vestibular apparatus)
	*~~'''~~Key distinction from [[Vestibular Neuritis (Neuronitis)\|vestibular neuritis]]:~~'''~~ Labyrinthitis includes ~~'''~~hearing loss~~'''~~ in addition to vertigo		*Key distinction from [[Vestibular Neuritis (Neuronitis)\|vestibular neuritis]]: Labyrinthitis includes hearing loss in addition to vertigo
	*Types:		*Types:
	**~~'''~~Viral/serous:~~'''~~ Most common; follows viral URI; self-limited (similar course to vestibular neuritis)		**Viral/serous: Most common; follows viral URI; self-limited (similar course to vestibular neuritis)
	**~~'''~~Suppurative (bacterial):~~'''~~ Extension from [[otitis media]], [[meningitis]], or [[mastoiditis]] — ~~'''~~requires urgent treatment~~'''~~		**Suppurative (bacterial): Extension from [[otitis media]], [[meningitis]], or [[mastoiditis]] — requires urgent treatment

	==Clinical Features==		==Clinical Features==
Line 14:		Line 14:
	*Unidirectional horizontal nystagmus (fast phase away from affected ear)		*Unidirectional horizontal nystagmus (fast phase away from affected ear)
	*Normal neurologic exam otherwise		*Normal neurologic exam otherwise
	*~~'''~~Suppurative form:~~'''~~ Fever, otorrhea, signs of systemic toxicity, concurrent [[otitis media]] or [[mastoiditis]]		*Suppurative form: Fever, otorrhea, signs of systemic toxicity, concurrent [[otitis media]] or [[mastoiditis]]

	==Differential Diagnosis==		==Differential Diagnosis==
Line 20:		Line 20:

	==Evaluation==		==Evaluation==
	*~~'''~~[[HINTS Exam]]:~~'''~~ Differentiates peripheral from central cause of acute vestibular syndrome		*[[HINTS Exam]]: Differentiates peripheral from central cause of acute vestibular syndrome
	**HI: Head impulse test (positive/corrective saccade = peripheral)		**HI: Head impulse test (positive/corrective saccade = peripheral)
	**N: Nystagmus (unidirectional = peripheral; direction-changing = central)		**N: Nystagmus (unidirectional = peripheral; direction-changing = central)
Line 26:		Line 26:
	*Hearing assessment (bedside finger rub; formal audiometry outpatient)		*Hearing assessment (bedside finger rub; formal audiometry outpatient)
	*Assess for otitis media/mastoiditis on otoscopy		*Assess for otitis media/mastoiditis on otoscopy
	*~~'''~~CT/MRI brain:~~'''~~ If HINTS concerning for central cause, or if suppurative form suspected		*CT/MRI brain: If HINTS concerning for central cause, or if suppurative form suspected

	==Management==		==Management==
	*~~'''~~Viral/serous:~~'''~~		*Viral/serous:
	**Vestibular suppressants (short-term, 24-72 hours only): [[meclizine]] 25 mg PO q6h, [[diazepam]] 2-5 mg PO q8h, or [[promethazine]]		**Vestibular suppressants (short-term, 24-72 hours only): [[meclizine]] 25 mg PO q6h, [[diazepam]] 2-5 mg PO q8h, or [[promethazine]]
	**Antiemetics: [[ondansetron]], [[prochlorperazine]]		**Antiemetics: [[ondansetron]], [[prochlorperazine]]
	**Early vestibular rehabilitation (encourage mobilization after acute phase)		**Early vestibular rehabilitation (encourage mobilization after acute phase)
	**Corticosteroids controversial but may hasten recovery		**Corticosteroids controversial but may hasten recovery
	*~~'''~~Suppurative:~~'''~~ IV antibiotics targeting middle ear pathogens; urgent ENT consult		*Suppurative: IV antibiotics targeting middle ear pathogens; urgent ENT consult

	==Disposition==		==Disposition==
	*Viral: discharge with vestibular suppressants (limit to 3 days), antiemetics, PCP/ENT follow-up		*Viral: discharge with vestibular suppressants (limit to 3 days), antiemetics, PCP/ENT follow-up
	*Suppurative: admit for IV antibiotics and ENT evaluation		*Suppurative: admit for IV antibiotics and ENT evaluation
	*~~'''~~Return if:~~'''~~ New neurologic symptoms, severe headache, inability to tolerate PO		*Return if: New neurologic symptoms, severe headache, inability to tolerate PO

	==See Also==		==See Also==

Danbot: Expand: HINTS exam integration, viral vs suppurative distinction, vestibular suppressant time limits

2026-03-21T01:50:02Z

Expand: HINTS exam integration, viral vs suppurative distinction, vestibular suppressant time limits

← Older revision		Revision as of 01:50, 21 March 2026
Line 1:		Line 1:
	''Some sources consider [[vestibular neuritis]] and labyrinthitis to be the same ~~thing (some differentiate~~ based on auditory symptoms)''		''Some sources consider [[Vestibular Neuritis (Neuronitis)\|vestibular neuritis]] and labyrinthitis to be the same condition; differentiation is based on the presence of auditory symptoms.''

	==Background==		==Background==
	*~~Infection~~ of cochlear and vestibular apparatus ~~(from middle ear via round/oval windows~~)		*Inflammation of the inner ear (cochlear and vestibular apparatus)
	*~~Acute suppurative labyrinthitis is only cause of peripheral vertigo requiring urgent treatment~~		*'''Key distinction from [[Vestibular Neuritis (Neuronitis)\|vestibular neuritis]]:''' Labyrinthitis includes '''hearing loss''' in addition to vertigo
	*Some sources consider [[vestibular ~~Neuritis~~]] ~~and labyrinthitis~~ to ~~be the same thing~~		*Types:
	**~~Some differentiate based on auditory symptoms~~		**'''Viral/serous:''' Most common; follows viral URI; self-limited (similar course to vestibular neuritis)
			**'''Suppurative (bacterial):''' Extension from [[otitis media]], [[meningitis]], or [[mastoiditis]] — '''requires urgent treatment'''

	==Clinical Features==		==Clinical Features==
	*~~Peripheral~~ [[vertigo]] + [[hearing loss]] ~~+ middle ear findings~~		*Acute, continuous peripheral [[vertigo]] (not positional)
	**Severity depends on type of labyrinthitis:		*Unilateral sensorineural [[hearing loss]] and/or [[tinnitus]] (distinguishes from vestibular neuritis)
	***Acute suppurative labyrinthitis		*[[Nausea/vomiting]]
	****Caused by extension of infection from [[otitis media]], [[~~meningitis~~]], [[~~mastoiditis~~]]		*Unidirectional horizontal nystagmus (fast phase away from affected ear)
	****Signs of toxicity		*Normal neurologic exam otherwise
	***Serous labyrinthitis		*'''Suppurative form:''' Fever, otorrhea, signs of systemic toxicity, concurrent [[otitis media]] or [[mastoiditis]]
	****Caused by inflammatory response to nearby infections (~~including viral~~)
	*****May find serous serous fluid behind tympanic membrane
	****Clinical course similar to [[~~Vestibular Neuritis (Neuronitis)~~]]

	==Differential Diagnosis==		==Differential Diagnosis==
Line 21:		Line 20:

	==Evaluation==		==Evaluation==
	~~See~~ [[~~Vertigo~~]]		*'''[[HINTS Exam]]:''' Differentiates peripheral from central cause of acute vestibular syndrome
			**HI: Head impulse test (positive/corrective saccade = peripheral)
			**N: Nystagmus (unidirectional = peripheral; direction-changing = central)
			**TS: Test of skew (vertical skew deviation = central)
			*Hearing assessment (bedside finger rub; formal audiometry outpatient)
			*Assess for otitis media/mastoiditis on otoscopy
			*'''CT/MRI brain:''' If HINTS concerning for central cause, or if suppurative form suspected

	==Management==		==Management==
	*~~Suppurative form requires~~ [[~~antibiotics~~]]		*'''Viral/serous:'''
	*[[~~Prochlorperazine~~]] ~~10mg~~ PO ~~q6 PRN for~~ [[~~nausea/vomiting~~]]		**Vestibular suppressants (short-term, 24-72 hours only): [[meclizine]] 25 mg PO q6h, [[diazepam]] 2-5 mg PO q8h, or [[promethazine]]
	*[[~~Lorazepam~~]] '''OR''' ~~diazepam as vestibular depressant~~		**Antiemetics: [[ondansetron]], [[prochlorperazine]]
	*Bed rest and hydration		**Early vestibular rehabilitation (encourage mobilization after acute phase)
	*[[Corticosteroids]] controversial especially in concomitant suppurative form		**Corticosteroids controversial but may hasten recovery
			*'''Suppurative:''' IV antibiotics targeting middle ear pathogens; urgent ENT consult

	==Disposition==		==Disposition==
	*Suppurative ~~form require admission~~ for ~~definitive~~ ENT ~~treatment~~		*Viral: discharge with vestibular suppressants (limit to 3 days), antiemetics, PCP/ENT follow-up
			*Suppurative: admit for IV antibiotics and ENT evaluation
			*'''Return if:''' New neurologic symptoms, severe headache, inability to tolerate PO

	==See Also==		==See Also==
	*[[Vertigo]]		*[[Vertigo]]
			*[[Vestibular Neuritis (Neuronitis)]]
			*[[HINTS Exam]]
			*[[Benign paroxysmal positional vertigo]]
	*[[Dizziness]]		*[[Dizziness]]
	*[[Vestibular Neuritis (Neuronitis)]]

	==References==		==References==
	<references/>		<references/>

	[[Category:ENT]]		[[Category:ENT]]

Elcatracho: /* Clinical Features */

2021-02-11T00:54:32Z

Clinical Features

← Older revision		Revision as of 00:54, 11 February 2021
Line 14:		Line 14:
	***Serous labyrinthitis		***Serous labyrinthitis
	****Caused by inflammatory response to nearby infections (including viral)		****Caused by inflammatory response to nearby infections (including viral)
			*****May find serous serous fluid behind tympanic membrane
	****Clinical course similar to [[Vestibular Neuritis (Neuronitis)]]		****Clinical course similar to [[Vestibular Neuritis (Neuronitis)]]

ClaireLewis at 21:01, 30 September 2019

2019-09-30T21:01:38Z

← Older revision		Revision as of 21:01, 30 September 2019
Line 3:		Line 3:
	*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 [[~~Vestibular~~ Neuritis]] and ~~Labyrinthitis~~ to be the same thing		*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 ~~respones~~ to nearby infections (including viral)		****Caused by inflammatory response to nearby infections (including viral)
	****Clinical course similar to [[Vestibular Neuritis (Neuronitis)]]		****Clinical course similar to [[Vestibular Neuritis (Neuronitis)]]

Line 23:		Line 23:

	==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==

Mholtz: Text replacement - "==References== " to "==References== "

2017-07-24T01:12:47Z

Text replacement - "==References== " to "==References== <references/> "

← Older revision		Revision as of 01:12, 24 July 2017
Line 38:		Line 38:

	==References==		==References==
			<references/>
	[[Category:ENT]]		[[Category:ENT]]

Mholtz: Text replacement - "prn" to "PRN"

2017-07-07T10:32:27Z

Text replacement - "prn" to "PRN"

← Older revision		Revision as of 10:32, 7 July 2017
Line 24:		Line 24:
	==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

Mholtz: Text replacement - "OR" to "'''OR'''"

2017-05-31T02:05:43Z

Text replacement - "OR" to "'''OR'''"

← Older revision		Revision as of 02:05, 31 May 2017
Line 25:		Line 25:
	*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

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T08:27:31Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 08:27, 22 July 2016
Line 19:		Line 19:
	{{Vertigo DDX}}		{{Vertigo DDX}}

	==~~Diagnosis~~==		==Evaluation==
	See [[Vertigo]]		See [[Vertigo]]

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-21T03:14:50Z

Text replacement - "0 mg" to "0mg"

← Older revision		Revision as of 03:14, 21 July 2016
Line 24:		Line 24:
	==Management==		==Management==
	*Suppurative form requires antibiotics		*Suppurative form requires antibiotics
	*Prochlorperazine ~~10 mg~~ 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

Rossdonaldson1: Text replacement - "tx" to "treatment"

2016-07-14T15:03:36Z

Text replacement - "tx" to "treatment"

← Older revision		Revision as of 15:03, 14 July 2016
Line 2:		Line 2:
	==Background==		==Background==
	*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 tx		*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 sources consider [[Vestibular Neuritis]] and Labyrinthitis to be the same thing
	**Some differentiate based on auditory symptoms		**Some differentiate based on auditory symptoms