Labyrinthitis: symptoms and treatment
Labyrinthitis is an inflammation of the inner ear caused by an infection. Also, this pathology is known as internal otitis media. The disease develops due to the ingress of harmful flora into the ear cavity, or after an injury. The labyrinth is located in the inner part of the ear, it is this organ that ensures the normal functioning of the vestibular apparatus. If it becomes inflamed, then the person has severe dizziness, nausea and vomiting. The patient's hearing deteriorates, noise occurs in the ears.
Diagnosis of labyrinthitis is not difficult, treatment gives good results, but only if it was started on time. Doctors strongly recommend seeking professional help as soon as possible. The fact is that some forms of internal otitis media threaten with serious consequences, up to complete hearing loss. Moreover, it will not be possible to restore it. The same applies to violations in the work of the vestibular apparatus.
- Causes and pathogenesis of labyrinthitis
- Classification of labyrinthitis
- Labyrinthitis symptoms
- Diagnostics of the labyrinthitis
- Labyrinthitis treatment
- Forecast for labyrinthitis
Causes and pathogenesis of labyrinthitis
The labyrinth is located in the internal structures of the ear, so the pathogenic flora can enter it only from other foci of infection that are in the body. Most often, the disease is a consequence of otitis media of the middle ear.
Inflammation can be caused by microorganisms such as:
- Influenza viruses.
Sometimes the infection gets into the inner ear from the skull cavity.
Diseases that can cause the labyrinth:
Another cause of labyrinthitis is ear injury. The infection gets into its structures if the tympanic membrane has been damaged. You can get injured mechanically. Sometimes the integrity of the tympanic membrane is violated due to the influence of chemical and thermal factors on it.
The following factors increase the likelihood of developing labyrinthitis:
- Decreased immune strength.
- Disturbances in the structure of the inner ear.
- Frequent inflammation in the ear. Labyrinthitis can act as a complication of viral and bacterial diseases. The likelihood of developing pathology increases when the site of infection is located near the structures of the inner ear. It can be otitis media or meningitis.
- Postponed operations on the inner or middle ear.
- Infection with the herpes virus.
Classification of labyrinthitis
There are several classifications of labyrinthitis. They are based on a variety of factors: features of the course of the disease, the type of causative agent of the infection, the mechanism of development of inflammation, the type of inflammatory reaction and the place of its concentration.
Depending on which microorganism triggered the development of the pathology, labyrinthitis can be of the following types:
Bacterial. Even after recovery, the person will suffer from dizziness for several days.
Viral. Causes labyrinthitis herpes zoster oticus. A person with such a pathology suffers from pain in and around the ear. Rashes appear in the ear canal. The vestibular apparatus suffers, hearing function deteriorates.
Depending on the mechanism of development of pathology, the following types of labyrinthitis are distinguished:
Tympanogenic labyrinthitis, in which pathogenic flora enters the inner ear from its middle section.
Meningogenic labyrinthitis. The subarachnoid space (the lining of the brain) becomes the source of the spread of microbes.
Hematogenous labyrinthitis. Pathogenic flora enters the inner ear with blood flow. Most often, viruses are spread in this way.
Traumatic labyrinthitis. It develops against the background of the injury. In this regard, damage to the base of the skull, as well as gunshot wounds, are especially dangerous.
Depending on the characteristics of the course of the disease, the following types are distinguished:
Acute labyrinthitis. The disease develops unexpectedly for a person. He begins to suffer from dizziness, nausea, ear pains, etc. After 2-3 weeks these symptoms disappear on their own. This does not mean that the person has recovered. It's just that the labyrinthitis has become chronic. Most often, in this way, the development of acute purulent labyrinthitis ends.
Chronic labyrinthitis. In this form of the disease, periods of remission alternate with periods of exacerbation. During remission, the symptoms of pathology will be completely absent.
Depending on whether there is pus in the inner ear, the following types of labyrinthitis are distinguished:
Purulent labyrinthitis. The inflammation spreads to the inner ear. Purulent masses begin to accumulate in it.
Serous labyrinthitis. There is no purulent discharge, but the structures of the inner ear are inflamed.
Necrotizing labyrinthitis. The cells of the labyrinth die off, which occurs against the background of tissue malnutrition. A necrotic labyrinth develops due to blockage of blood vessels by blood clots or due to clamping of a branch of the auditory artery. Injuries and severe inflammatory reactions can lead to necrotizing labyrinthitis when edematous tissues compress the vessels.
Depending on the intensity of the inflammatory process, the following types of labyrinthitis are distinguished:
Limited labyrinthitis. It occurs when there is a fistula in the eardrum. Deep inflammation develops in a specific area of the labyrinth.
Diffuse labyrinthitis. The inflammatory process spreads to all structures of the inner ear.
With labyrinthitis, the vestibular apparatus first of all suffers. Therefore, it becomes difficult for a person to maintain balance, his head begins to spin.
The full range of symptoms for otitis media is as follows:
Dizziness. It can be quite intense and lead to falls. Dizziness occurs both at rest and during movement. Both objects around and the body itself can rotate. Sometimes dizziness is manifested by unsteadiness of gait; a person with a labyrinthitis is not able to control the fall of his own body. Dizziness is paroxysmal, it can last from several minutes to several hours. When the attack is severe, the patient may vomit, he is nauseous, he sweats a lot, the face turns red.
Spontaneous nystagmus. Involuntary oscillatory eye movements during labyrinthitis will be present on an ongoing basis.
- Vestibular ataxia, which manifests itself in impaired coordination of movements. Manifestations can be very diverse: gait disturbance, falls, stumbling, sudden change in the trajectory of movements, etc.
Violations of the autonomic nervous system. The patient often has pallor of the skin, which can suddenly turn red, sometimes pain in the heart, increased heart rate.
With labyrinthitis, hearing is impaired, a person complains of constant tinnitus. This noise is dangerous because it is caused by the death of ear receptors. Sometimes in patients with labyrinthitis, damage to the facial nerve is observed.
Depending on the different forms of the disease, its manifestations can be as follows:
Meningococcal labyrinthitis. Two ears are involved in the inflammatory process at once. Pathology slowly but relentlessly progresses. Signs of hearing impairment and imbalance come to the fore.
Tuberculous labyrinthitis. The disease progresses slowly, the main functions of the labyrinth suffer.
Acute labyrinthitis. Its development lasts no more than 3 weeks. After this time, the person either recovers or the pathology becomes chronic. If the snail receptors die during the inflammatory reaction, then hearing is lost forever. The vestibular function will be performed by the semicircular canals of a healthy labyrinth. The adaptation of the body occurs slowly, with the involvement of cortical mechanisms, auditory and visual analyzer in this process.
Sometimes primary chronic labyrinthitis occurs when the symptoms of the acute phase are absent. A person is disturbed by violations of the vestibular apparatus, but they will be weak. This is often the reason for the misdiagnosis.
Diagnostics of the labyrinthitis
It will not be possible to make a correct diagnosis only on the basis of the patient's complaints. A comprehensive examination of the patient is required.
The main diagnostic measures:
Taking anamnesis, listening to the patient's complaints. The person indicates dizziness, nausea, vomiting, hearing impairment, loss of balance. As a rule, before this, the patient had an infectious disease. Symptoms of labyrinthitis appear 7-12 days after its completion. Often the labyrinthitis is preceded by a bacterial or viral infection. It can also develop after a traumatic brain injury.
Otoscopic examination. The doctor examines the condition of the tympanic membrane and the external auditory canal using an otoscope.
Audiometry. This study allows you to assess hearing acuity and understand how well the ear analyzers perceive waves of different frequencies.
- Vestibulometry, stabilography, fistula test, caloric test. The procedures are aimed at assessing the functioning of the vestibular apparatus.
ELISA, PCR. These studies make it possible to determine which infectious agent caused the disease. In addition to taking blood, your doctor will need a swab of your ear discharge.
Electronystagmography. During the study, the movements of the eyeballs are recorded. This allows you to distinguish between dizziness, which was provoked by disturbances in the functioning of the brain, from dizziness, which was provoked by a malfunction in the functioning of the labyrinth.
CT and X-ray of the temporal bone. This method allows you to assess the state of the labyrinth bone tissue.
Sometimes a patient with labyrinthitis needs to see a neurologist. To differentiate labyrinthitis with other pathologies, additional tests may be assigned to the patient. It is important to carry out a differential diagnosis of otitis media of the inner ear with Meniere's disease, with cerebellar abscess, neuritis and otosclerosis.
Treatment of labyrinthitis should be started immediately after diagnosis. Therapy is selected on an individual basis.
The main directions of treatment:
- Antibiotics, anti-inflammatory and hyposensitizing drugs, as well as diuretics are prescribed to patients with diffuse labyrinthitis, when there are no destructive processes in the ear cavity.
- The operation is performed on patients with purulent diffuse labyrinthitis. It is aimed at opening the affected lesion and reorganizing it. In parallel, the patient is prescribed drug correction. If there is a fistula, it is closed.
- Surgical treatment is indicated for patients with limited inflammation in the labyrinth. In this case, all affected tissues must be removed.
- Emergency surgery is indicated for patients with diagnosed intracranial complications. All inflamed structures of the ear are sanitized, in severe cases a labyrintectomy is performed.
Drugs that can be prescribed to the patient:
Antibiotics. They are selected after the diagnostics, when the type of infectious agent and its sensitivity to specific drugs will be known. If it is not possible to carry out the analysis quickly, then the patient is prescribed drugs of a wide spectrum of action. This can be antibiotics from the penicillin or cephalosporin group. Fluoroquinolones are sometimes used. Ototoxic antibiotics for labyrinthitis are prohibited. We are talking about Gentamicin.
Dehydration of the body. The patient is prescribed dietary food with salt restriction to 0.5 g per day. At the same time, he should drink no more than a liter of water. In parallel, the patient receives diuretics, steroid hormones. The use of hypertonic solutions is possible. To do this, use a solution of magnesium sulfate 25% (10 ml), glucose 40% (20-40 ml), calcium chloride 10% (10 ml).
- Preparations for the normalization of the trophism of labyrinthitis: vitamins C, K, P, group B, Preductal, Cocarboxylase.
- Atropine or Scopolamine is administered subcutaneously.
- To reduce the pressure in the ear cavity, glucose and urotropin are prescribed.
- To relieve the symptoms of the disease, antiemetic and sedatives are prescribed, antihistamines (Fenistil, Suprastin, Diphenhydramine).
- Methylprednisolone allows you to quickly eliminate the symptoms of inflammation.
Most often, the operation is prescribed to patients with serous and purulent labyrinthitis, which develops due to purulent otitis media.
There are 2 options for surgical treatment:
- Antromastoidotomy. The procedure is performed under general anesthesia. The doctor opens the mastoid process and removes the purulent contents from it.
- Sanitizing general cavity operation. During its implementation, an incision is made behind the ear, the back wall of the bony ear canal is opened, all pus is removed, after which the wound is sutured.
If a fistula is present, it must be closed. Emergency surgery is prescribed for patients with intracranial complications of labyrinthitis.
Forecast for labyrinthitis
The prognosis for labyrinthitis depends on the type of pathological process. This affects the ability to restore hearing. If the patient was diagnosed with acute serous internal otitis media, then the prognosis is as favorable as possible. Hearing after healing will fully recover.
With purulent labyrinthitis, the prognosis worsens. Sometimes hearing damage and disturbances in the functioning of the vestibular apparatus are irreversible. Although the launch of the adaptive mechanisms of the body allows you to normalize some functions.
In severe pathology, it will be impossible to correct the violations that have arisen. The person remains deaf.
If a patient with labyrinthitis does not receive treatment, then this threatens the development of severe complications. Inflammation concentrated in the inner ear can spread to nearby organs.
Therefore, the patient has such health disorders as:
- Mastoiditis. The site of the temporal bone is infected.
- Petrosite. The pyramid of the temporal bone is involved in the inflammatory process.
- Meningitis and encephalitis. In this case, the membranes of the brain are affected.
The most serious complication is a brain abscess. This pathology is difficult to treat and often causes death.
To prevent the development of labyrinthitis, the following preventive measures must be observed:
- Timely treat rhinitis, inflammation of the pharynx, otitis media and other ENT infections.
- Consult a doctor after the first signs of deterioration in health appear.
- Avoid head injury.
The author of the article: Lazarev Oleg Vladimirovich | ENT
Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)