Labyrinthitis is inflammation of the inner ear, usually after a viral infection, that causes sudden vertigo together with hearing loss. Vestibular neuritis is the same picture without the hearing loss.
Key symptoms
- Sudden, constant spinning vertigo lasting days
- Nausea and vomiting
- Hearing loss and ringing in one ear
- Unsteady walking after a recent cold or flu
What you find on exam
- Horizontal nystagmus beating away from the affected ear
- HINTS exam: an abnormal head impulse test points to an inner ear cause
- Hearing check with whisper and tuning fork tests
- Full neurological exam, including gait
Tests
- Audiogram to confirm sensorineural hearing loss
- MRI of the brain if HINTS suggests stroke or there are neurological signs
- CT of the temporal bone if spread from a middle ear infection is suspected
Treatment basics
- Short course of meclizine or ondansetron for symptoms only
- Fluids and rest
- Oral prednisone for sudden hearing loss, started early
- Antibiotics for bacterial labyrinthitis from an ear infection
- Vestibular rehabilitation exercises
Red flags
- Normal head impulse test, vertical nystagmus or skew deviation (stroke signs)
- Cannot walk, new headache, double vision or slurred speech
- Fever with ear discharge or signs of meningitis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.