Labyrinthitis and Vestibular Neuronitis

What are labyrinthitis and vestibular neuronitis?

Labrynthitis and vestibular neuronitis are conditions of true vertigo. The patient experiences a sensation that the surrounding environment is spinning. The onset is usually sudden. Half of the cases are preceded by an upper respiratory tract infection or cold. The sensation of vertigo usually lasts for several hours or several days. It is unusual for this phase to last more than 48 hours. This is caused by a viral infection of the inner ear (labrynthitis) or the nerve going to the inner ear (vestibular neuritis). Many people will seek immediate attention in the emergency room or with their primary care physician because the symptoms are so extreme.

After the powerful symptoms of vertigo have passed (usually within 48 hours), patients are usually left with a feeling of disequilibrium (unsteadiness) that can last for days to months. The viral infection weakens the inner ear on one side, which creates an asymmetry within the balance centers of the brainstem. This creates a constant sense of unsteadiness. The disequilibrium is tolerable at rest but sudden movements of the head or body will trigger vertigo or light-headedness. As the affected inner ear recovers, the sensation of balance gradually returns.

How are these conditions treated?

The treatment of this condition is usually supportive. Medications, such as Meclizine, Antivert or Valium, can be given to help with the acute vertigo. These medications will help the patient if they are having symptoms of vertigo or nausea. These medications essentially cut off communication between the inner ear and the brain, so that the patient can have temporary relief of the vertigo.

It is important to keep in mind that these medications are not therapeutic; meaning they do not cure the problem. They are prescribed to make the patient comfortable in the short-term until the inner ear recovers. In fact, if these medications are taking too regularly, they will delay recovery. The brain and the inner ear have to interface in order for the natural function of the inner ear to recover. If these medications are constantly cutting off this interface, recovery will occur much more slowly.

Unfortunately, patients have to go through a period of compensation, where they will experience some dizziness, before the inner ear will recover. This period of compensation can be seen as a time when the inner ear is returning to full strength and getting back “on-line” with the brain so that balance function can be re-established. This process usually takes several weeks, but it can take months.

Patients who do not recover with several weeks of observation will require more intervention and investigation. This can include vestibular physical therapy to help strengthen the inner ear. It may also include a CT or MRI scan of the brain and an ENG (Electronystagmogram). An ENG is a specialized test that evaluates the strength and function of the inner ear’s balance function. Sometimes, something that was believed to be labrynthitis when it initially presented, turns out to be a completely different medical problem. This is why it is important to follow up with the ENT doctor until the symptoms are resolved or controlled.

By Joseph Chang, MD

 

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