Labyrinthitis

What is labyrinthitis

Labyrinthitis is a disorder which affects the inner ear that causes swelling, inflammation and irritation.

The middle ear is also known as the labyrinth, so inflammation of the labyrinth is called labyrinthitis (the “itis” means inflammation).

Labyrinthitis seems to occur after a viral infection of the ear or an upper respiratory infection (usually caused by a virus), which can also affect the delicate middle ear.

The middle ear contains the hearing and balance organs, such as the cochlea, which contains the hearing organ that converts sounds that the brain interprets through nervous impulses.

Since the middle ear contains the hearing and balance organs, this is the reason why temporary loss of balance and loss of hearing are generally the main symptoms of labyrinthitis.

Facts about labyrinthitis

• Labyrinthitis is normally caused by a viral infection
• Labyrinthitis causes vertigo (or dizziness) symptoms quite commonly
• The immune system is usually effective at healing the labyrinthitis within a few weeks after it starts
• Some people experience many episodes of labyrinthitis throughout their life
• Antibiotics are useless as a form of treatment for labyrinthitis, because the inflammation is generally caused by a virus and antibiotics do nothing to viruses
• Labyrinthitis is part of a larger group of disorders known as vertiginous syndrome, which also includes the following: benign positional vertigo, Meniere disease and vestibular disorders
• Labyrinthitis can cause permanent hearing damage (hearing loss) or even permanent loss of balance if it is not treated promptly

Symptoms of labyrinthitis

General symptoms of labyrinthitis are:

• Dizziness
• Earache (especially in children and sensitive adults)
• Hearing loss (usually temporary, but can be permanent)
• Irritability (especially in children)
• Feeling unbalanced (loss of balance, which is temporary but can become permanent)
• Fever
• Lethargy
• Nausea
• Ringing or other noises in the ear (tinnitus)
• Vertigo
• Vomiting

There are a number of other conditions which can mimic labyrinthitis and have the same or very similar symptoms, so the only way to confirm this condition is to make an appointment to see a doctor for diagnosis and appropriate treatment. This is particularly important for children with symptoms of labyrinthitis, who may have this condition or a range of any other ear infections.

Severe, undiagnosed and untreated labyrinthitis can cause permanent hearing loss or permanent dizziness, so it is important that people who have these symptoms to see a doctor for diagnosis and appropriate treatment to avoid this complication.

Causes of labyrinthitis

The cause of labyrinthitis is not known.

There are though, some known triggers which can make it more easy for labyrinthitis to develop:

Allergy

Any type of allergy, hay fever (allergic rhinitis) that causes inflammation and irritation of the upper respiratory tract has the potential to also cause swelling and inflammation of the middle ear too (if the inflammation gets severe enough).

Immune system dysfunction (autoimmune labyrinthitis)

If there is a viral infection in the middle ear, in some people this can trigger their immune system to start an unusual or dysfunctional response to the virus and to their own body, particularly the middle ear (where the virus is located), which can result in autoimmune labyrinthitis, a very uncommon type of labyrinthitis.

Injury

Any type of injury to the ear or especially any part of the middle ear can result in labyrinthitis.

Middle ear infection (otitis media)

Any type of middle ear infection (usually caused by a virus) can trigger labyrinthitis. This is because a middle ear infection causes swelling and irritation to the labyrinth and this can get worse resulting in labyrinthitis.

Upper respiratory tract infection

Any kind of viral infection of the upper respiratory tract, including colds and flu’s, can descend into the middle ear (labyrinth) and cause a great deal of inflammation and irritation and result in labyrinthitis. Children often complain of earaches and ear infections because they are so easily prone to getting ear infections. While a viral infection of the upper respiratory tract is the normal trigger for labyrinthitis, it can also be caused, less commonly but more seriously, by a bacterial infection of the upper respiratory tract.

Prevention of labyrinthitis

Non-preventable risk factors

Labyrinthitis may be unpreventable in certain circumstances:

• Allergic rhinitis (or allergies) – people who are prone to getting allergies and experience recurrent allergic rhinitis (hay fever) tend to be more likely to develop other infections as well as labyrinthitis inflammation of the middle ear due to the close proximity of the other tissues which are affected by the allergies and which then can affect the ear as well and labyrinthitis is not easily preventable due to this cause
• Benign positional vertigo – this condition is characterised by dizziness and loss of balance and is often mistaken for labyrinthitis as these conditions tend to occur together. Vertigo is due to an imbalanced vestibular system in the middle ear (labyrinth) and can often precede labyrinthitis
• Certain medications – a number of medications are known to cause inflammation and irrational to the middle ear and long term or excessive usage can result in labyrinthitis (or even people who are just sensitive can experience it too). Medications such as: Aspirin, Lasix (a loop diuretic), Phenytoin (an anti-epileptic) as well as some ACE-inhibitors and beta blockers (used for managing heart disease)
• Infection of the middle ear – any infection of the of the middle ear has a very high chance of also causing labyrinthitis too and labyrinthitis is not easily preventable due to this cause
• Infection of the upper respiratory system – any infection of the upper respiratory system will cause swelling, irritation and inflammation of the upper respiratory tissues as they fight the infection and this may also cause labyrinthitis too, which is not easily preventable
• Meniere’s disease – this condition is a disorder of the middle ear and causes dizziness and loss of balance. This condition is a risk factor for labyrinthitis and is often mistaken for (or confused with) labyrinthitis
• Middle ear infection (otitis media) – any type of existing middle ear infection (especially common in children) is a very high risk factor for the development of labyrinthitis too, as the labyrinth is already irritated and inflamed from the existing infection

Preventable risk factors

There are ways to prevent labyrinthitis from occurring, or at least reduce severity of symptoms:

• Avoid allergens – people who have recurrent allergic reactions to specific allergens need to take care to avoid these allergens, to reduce exposure and reduce likelihood of allergic rhinitis and prevent labyrinthitis from also occurring
• Avoid cigarette exposure – any exposure to cigarette smoke (including second hand smoke from other people’s cigarettes) can aggravate and irritate the delicate tissue inside the middle ear, cause inflammation and result in labyrinthitis. Do not smoke and do not be exposed to other people’s cigarette smoke
• Avoid excessive alcohol intake – excessive alcohol intake is a known risk factor for developing labyrinthitis, so limiting alcohol intake is advisable to help prevent labyrinthitis
• Avoid injuring the ear – any injury to the ear can potentially cause labyrinthitis, so always protect the head and ears when engaging in any risky, adventure sports activities to prevent risk of labyrinthitis
• Eat fresh, unprocessed foods – a healthy diet, full of fresh unprocessed foods (vegetables, fruits, nuts, seeds, legumes, some fish and other proteins, unsaturated oils) is vital to providing the body with adequate nutrients to boost the function of the immune system, so that it can be well equipped to deal with any viruses or bacteria and reduce risk of any types of upper respiratory infections that can increase likelihood of developing labyrinthitis
• Take care if you have a colds, sinusitis or flu – try to rest as recommended by your doctor if you have a cold, sinusitis or flu infection, as rest is the only way the body can gather all its resources to fight the infection and heal more quickly and prevent worsening of the infection or complications such as labyrinthitis
• Upper respiratory infection (bacterial) – any type of bacterial infection of the upper respiratory tract can be very severe life threatening and is also a risk factor for very serious labyrinthitis, especially if there is any fluid build-up inside the ear
• Upper respiratory infection (viral) – any type of existing upper respiratory infection, including cold, flu, sinusitis, is a very high risk factor for causing labyrinthitis too, because the virus that is causing the infection can also move to the ear, infect the labyrinth and produce swelling and inflammation, resulting in labyrinthitis

Complications of labyrinthitis

There are a number of possible complications of labyrinthitis:

• Hearing loss – untreated labyrinthitis that is severe and prolonged, can possibly result in permanent hearing loss. The labyrinth may be permanently damaged (swelling, inflammation, scarring) due to the labyrinthitis, which may impede the middle ear’s ability to hear properly and that is why permanent hearing loss can result
• Loss of balance – prolonged and untreated labyrinthitis can possibly result in permanent loss of balance. The labyrinth and cochlear may be permanently damaged (swelling, inflammation, scarring) due to the labyrinthitis, which may impede the cochlear’s ability to process balance properly and that is why permanent loss of balance can result

When to see a doctor about labyrinthitis

People have have any of the symptoms of labyrinthitis should make an appointment to visit their doctor and have their symptoms evaluated to determine the cause and either confirm it is labyrinthitis or have further tests if it is ruled out.

People who have been diagnosed with labyrinthitis need to let their doctor know if:

• The symptoms suddenly get worse, if there is an issue with hearing or balance, more than usual, or
• New symptoms appear that were not present previously

Diagnosis of labyrinthitis

Labyrinthitis is initially diagnosed through the following tests:

• Medical history – the doctor will ask a series of questions about your symptoms (especially the duration and severity), your family medical history (if anyone else has similar symptoms) and some questions about whether you smoke or have any other risk factors associated with this condition
• Physical examination – the ear will be examined by the doctor to determine if there is any obvious swelling or other symptoms of inection. Your doctor may also try to reproduce symptoms (dizziness, nausea) by moving your head from side to side really quickly (but safely)

Further tests

If the initial tests are not conclusive, or if symptoms are quite severe, then further tests will be requested:

• Hearing test – a hearing test may be performed to determine if there is any hearing loss and whether it is temporary or permanent
• Other diagnostic imaging tests – other imaging tests such as MRI and CAT scans can be performed to get an image of the middle ear. These tests provide a more detailed view of the inner ear and will show if there is any damage or inflammation to the middle ear
• Referral to specialists – if symptoms do not resolve, a referral is given to an ear, nose and throat (ENT) specialist who can perform further testing

Conventional treatment of labyrinthitis

Labyrinthitis normally resolves by itself within a few weeks, but sometimes it doesn’t and that is when medication is prescribed.

Medication

There are several medications which are normally prescribed for labyrinthitis (sometimes more than one medication may be prescribed):

• Antibiotics – if a bacterial infection is suspected, then antibiotics will be prescribed to stop the infection and reduce symptoms
• Anticholinergics – these medications are prescribed to block the nerve impulses that cause spasms in the smooth muscles (such as the stomach, which in turn prevent the stomach nausea or vomiting
• Anti-nausea – these medications are prescribed to reduce the symptoms of nausea and/or vomiting associated with labyrinthitis
• Corticosteroids – these medications are prescribed to reduce inflammation in the middle ear, especially when it is severe or long-term
• Sedatives – these medications are prescribed to reduce anxiety (if it is present) which may occur in some people with longer term labyrinthitis, as well as to reduce any vomiting and nausea
• Vestibular suppressants – these medications are prescribed specifically to reduce the dizziness and feeling unbalanced symptoms associated with the middle ear not functioning properly

Lifestyle and dietary modifications

Other treatments are recommended in conjunction with medication (or alone for less serious cases) to help reduce symptoms, including certain positional therapy:

• Avoid bright lights – it may be beneficial to avoid bright lights, especially as they may exacerbate symptoms during a flare-up of the condition
• Balance exercises – there are a number of special exercises which can help the middle ear get better, by improving the balance function of the middle ear
• More fluids – drink more water, juice and herbal teas to help hydrate the middle ear and help it heal more quickly
• Rest – enabling the body to rest, by lying down and doing very little, will give the body the best chance to heal itself from the labyrinthitis
• Sit still – moving the head, especially if it is too quickly, can cause an exacerbation of symptoms

Alternative / complementary treatment of labyrinthitis

There are a number of alternative/complementary treatments for labyrinthitis, which may help to reduce severity of symptoms and prevent recurrence.

Always discuss these alternative/complementary treatments with your doctor prior to trying them, as they could conflict with current medication or conditions.

Herbs

There are a number of excellent herbs which may help to provide relief for symptoms:

• Echinacea – the herb echinacea has potent anti-viral properties which may assist with healing a labyrinthitis infection of a viral origin
• Ginger – studies show the herb ginger may assist with reducing the severity of symptoms of nausea
• Ginkgo biloba – studies show the herb ginkgo biloba may assist with reducing dizziness and feelings unbalanced
• Olive leaf – studies show that the herb olive leaf has potent anti-viral properties which may assist with healing a labyrinthitis infection of viral origin
• Slippery elm – studies show the herb slippery elm may assist with stomach queasiness and nausea symptoms

Vitamins

There are a number of vitamins which may help to provide relief for symptoms:

• Bioflavonoids – studies show that the bioflavonoids, together with vitamin C, have potent antioxidant properties that help with healing
• Vitamin A – studies show that the antioxidant vitamin A provides a boost to the immune system to fight off a viral or bacterial infection and it also may help to reduce inflammation in the middle ear, by ensuring all mucous membranes are healthy
• Vitamin B6 – studies show vitamin B6 helps to reduce symptoms of dizziness and nausea
• Vitamin C – studies show that vitamin C, together with bioflavonoids have potent antioxidant properties that help with healing
• Vitamin E – studies show the antioxidant vitamin E helps to enable healing to happen more quickly which helps to reduce symptoms overall

Minerals

There are a number of minerals which may help to provide relief for symptoms:

• Magnesium – the mineral magnesium relaxes all of the tissues in the body, especially the smooth tissues, so may help with feelings of stress and anxiety associated with long-term symptoms
• Selenium – studies show the antioxidant mineral selenium helps to boost the immune system during an infection and this may reduce the severity and duration of symptoms
• Zinc – studies show the antioxidant mineral zinc, may help the body heal more quickly from any type of viral infection, which will help to reduce the severity and duration of symptoms

Other nutrients

There are a number of other nutrients which may help to provide relief for symptoms:

• Alpha lipoic acid – studies show that alpha-lipoic acid has potent antioxidant properties that boost the function of the immune system. Alpha-lipoic acid can help to reduce the severity of symptoms, especially when the labyrinthitis is caused by any type of infection
• Garlic – studies show that the herb garlic has potent anti-viral, anti-bacterial properties and may assist with healing more quickly and reducing the symptoms of labyrinthitis, especially when it is caused (or initiated) by a viral or bacterial infection
• Omega 3 fatty acids – studies show that omega-3 essential fatty acids can assist people who have lots of ear wax in their ears, that could be causing the labyrinthitis symptoms. In addition to this, omega-3 fatty acids can help to reduce any inflammation in the middle ear that is associated with the labyrinthitis

Dietary modifications

There are a number of dietary modification strategies which may help to provide relief for symptoms:

• Avoid alcohol – heavy drinking is a risk factor for developing labyrinthitis, so limiting alcohol intake is advisable
• Eat more vegetables – eating adequate amounts of vegetables every day will provide the nutrients necessary to help the body to heal. Especially beneficial are the dark green leafy vegetables, which are dense in nutrients
• Limit processed foods – it is really important to reduce intake of processed foods, as they can cause a burden on the body to try to digest them and get rid of the toxins they produce. Besides this, processed foods have little nutritional value, so do not provide any functional benefits
• Regulate sugar intake – studies show that excessive intake of sugar can cause feelings of dizziness, as can low sugar levels, so it is advised to eat a balanced diet

Lifestyle modifications

There are a number of lifestyle modifications which may help to provide relief for symptoms:

• Avoid bright lights – it may be beneficial to avoid bright lights, especially as they may exacerbate symptoms during a flare-up of the condition
• Balance exercises – there are a number of special exercises which can help the middle ear get better, by improving the balance function of the middle ear
• Don’t smoke – cigarette smoking will only exacerbate symptoms, so dont smoke and avoid other people’s second hand smoke
• More fluids – drink more water, juice and herbal teas to help hydrate the middle ear and help it heal more quickly
• Rest – enabling the body to rest, by lying down and doing very little, will give the body the best chance to heal itself from the labyrinthitis
• Sit still – moving the head, especially if it is too quickly, can cause an exacerbation of symptoms

Alternative treatments

• Naturopath – there are a number of treatments that can be recommended by a naturopath for labyrinthitis. Consult with a naturopath to get a tailored plan for your specific symptoms with labyrinthitis once it has been diagnosed by your medical doctor

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with labyrinthitis

Self care strategies

There are a number of strategies which are recommended to help deal with labyrinthitis:

• Avoid alcohol – drinking excessive amounts of alcohol is associated with triggering and even causing symptoms of labyrinthitis, so limit intake of alcohol especially when the symptoms are most severe. People with any type of alcohol addiction should seek advice to help reduce their alcohol intake
• Drink fluids – it may be beneficial to drink more water, juice and herbal teas, as these will help to hydrate the middle ear and help it heal more quickly from the labyrinthitis
• Healthy diet – it is really important to have a healthy diet during a flare-up of labyrinthitis symptoms, as natural, unprocessed foods give the body and immune system the best chance of fighting off any infection or other cause of the labyrinthitis and heal. Especially beneficial are the dark green leafy vegetables, darker purple vegetables, fruit, nuts, seeds and legumes
• Relaxation – it is really important to engage in some sort of relaxation strategy to help with long term or recurrent labyrinthitis symptoms, as they can cause anxiety and depression in some people
• Rest – adequate rest is really vital to help the body heal from labyrinthitis, especially if it is caused or triggered by a viral or bacterial infection. Rest allows the body and immune system to function more effectively without the burden of having to deal with other bodily processes at the same time as dealing with the labyrinthitis
• Sit still – holding the head still and in one position, can help to reduce the dizziness and unsteadiness associated with labyrinthitis. There are also some balance exercises which can be performed on a daily basis to further help with the symptoms
• Stop smoking – people who smoke need to give it up or at least try to smoke less during a labyrinthitis episode, as it will only make symptoms worse

Caring for someone with labyrinthitis

Partner

There are a number of useful strategies to help a partner with labyrinthitis:

• Allow your partner to rest – it is necessary for your partner to have adequate rest in order for their body to heal from the labyrinthitis. Allow your partner to rest in a darkened room, without any bright lights, as they can make the symptoms worse
• Don’t smoke – cigarette smoke, even it is is from a second-hand source is very detrimental for people who have labyrinthitis, so if you smoke cigarettes, then do not do so around your partner
• Healthy diet – it is really important to have a healthy diet during a flare-up of labyrinthitis symptoms, as natural, unprocessed foods give the body and immune system the best chance of fighting off any infection or other cause of the labyrinthitis and heal. Especially beneficial are the dark green leafy vegetables, darker purple vegetables, fruit, nuts, seeds and legumes
• Provide adequate fluids – it will be beneficial for your partner, especially if the symptoms are at their worst, if you provide your partner with adequate fluids (such as water, diluted fruit juices and herbal tea) to ensure they stay hydrated and assist with healing the middle ear

Friends

There are a number of useful strategies to help a friend with labyrinthitis:

• Don’t smoke – cigarette smoke, even it is is from a second-hand source is very detrimental for people who have labyrinthitis, so if you smoke cigarettes, then do not do so around your friend
• No alcohol – it is not advised for people who have labyrinthitis to drink any alcohol, so when making time with a friend, do not include alcohol as that will only make their symptoms worse

Parents

There are a number of useful strategies to help a child with labyrinthitis:

• Allow your partner to rest – it is necessary for your child to have adequate rest in order for their body to heal from the labyrinthitis. Allow your child to rest in a darkened room, without any bright lights, as they can make the symptoms worse
• Don’t smoke – cigarette smoke, even it is is from a second-hand source is very detrimental for people who have labyrinthitis, so if you smoke cigarettes, then do not do so around your child
• Healthy diet – it is really important to have a healthy diet during a flare-up of labyrinthitis symptoms, as natural, unprocessed foods give the body and immune system the best chance of fighting off any infection or other cause of the labyrinthitis and heal. Especially beneficial are the dark green leafy vegetables, darker purple vegetables, fruit, nuts, seeds and legumes
• Provide adequate fluids – it will be beneficial for your child, especially if the symptoms are at their worst, if you provide your partner with adequate fluids (such as water, diluted fruit juices and herbal tea) to ensure they stay hydrated and assist with healing the middle ear

References

• Barkdull GC, Hondarrague Y, Meyer T, Harris JP, Keithley EM. AM-111 reduces hearing loss in a guinea pig model of acute labyrinthitis. Laryngoscope. 2007 Dec;117(12):2174-82
• Charles J, Fahridin S, Britt H. Vertiginous syndrome. Aust Fam Physician. 2008 May;37(5):299. Accessed 3 January 2009
• Du Y, Wu X, Li L. Mechanisms of bacterial meningitis-related deafness. Drug Discovery Today: Disease Mechanisms, 2006; 3(1): Pages 115-118
• Hartnick CJ, Kim HH, Chute PM, Parisier SC. Preventing labyrinthitis ossificans: the role of steroids. Arch Otolaryngol Head Neck Surg. 2001 Feb;127(2):180-3
• Li L, Kosugi I, Han GP, Kawasaki H, Arai Y, Takeshita T, Tsutsui Y. Induction of cytomegalovirus-infected labyrinthitis in newborn mice by lipopolysaccharide: a model for hearing loss in congenital CMV infection. Lab Invest. 2008 Jul;88(7):722-30. Epub 2008 May 12
• Osiecki H. The Physicans Handbook of Clininical Nutrition, 6th Edition. Bioconcepts Publishing QLD, 2001
• Swartz R, Longwell P. Treatment of vertigo. Am Fam Physician. 2005 Mar 15;71(6):1115-22
• Takumida M, Anniko M. Radical scavengers: A remedy for presbyacusis. A pilot study. Acta Oto-Laryngologica, 2005; 125(12):1290-1295
• Tratter R, Jones A. Better Health Through Natural Healing: How to Get Well Without Drugs or Surgery, 2nd Edition. McGraw Hill, 2001

Last reviewed and updated: 14 May 2024