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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Labyrinthitis

The semicircular canals and vestibule of the inner ear contain a fluid called endolymph that moves in response to head movement, triggering nerve signals to the brain that help maintain balance.

What is it?

Labyrinthitis is an inflammation of the portion of the inner ear that houses the semicircular canals—the three small, curved tubes in the inner ear that help maintain balance. Each canal is filled with a fluid called endolymph and contains tiny calcium stones known as otoliths. The walls of these canals are lined with crops of specialized cells capped with hairlike fibers. Movement of the head causes the fluid and the otoliths to move and press upon the fibers. When bent, these fibers send signals to the brain so it can calculate the head's position. Inflammation of the semicircular canals interferes with this process, generating conflicting signals to the brain, which causes severe dizziness and nausea. Although these symptoms may be frightening, full spontaneous recovery of balance function is common; recovery of hearing, however, is less predictable.

What Causes It?

  • Bacterial or viral infections.
  • Allergies.
  • Certain medications, such as aminoglycosides.
  • Head injury.
  • Labyrinthitis may occur as a complication of cholesteatoma (see Cholesteatoma).

Prevention

  • Obtain prompt treatment for ear infections, bacterial infections elsewhere in the body, and allergies (especially allergies of the upper respiratory tract).

Diagnosis

  • Patient history and physical examination are needed.
  • A culture of any ear discharge will be taken.

How to Treat It

  • No specific cure exists for labyrinthitis. Treatment is aimed at easing symptoms as recovery occurs spontaneously, usually after a period of several weeks.
  • Labyrinthitis associated with a bacterial infection of the middle ear may require large doses of antibiotics.
  • Fluid replacement is needed to prevent dehydration if severe vomiting has occurred. .
  • Medications such as meclizine (an antihistamine with an antinausea effect), prochlorperazine (an antinausea drug), scopolamine (a motion-sickness drug), and diazepam (a tranquilizer) may be prescribed.
  • Rarely, surgery may be required to drain pus from the middle ear or to remove a cholesteatoma.
  • A balance rehabilitation program involving self-administered physical therapy may help patients compensate for the loss of the ear's balance inputs.
  • During recovery, try to avoid positions that trigger or exacerbate dizziness. Rest in bed in a dark, quiet room with your head immobilized between pillows.
  • Until vertigo subsides, do not drive or perform other activities in which loss of balance may be dangerous.

When to Call a Doctor

  • See your doctor if you experience persistent dizziness or other symptoms of labyrinthitis.