Labyrinthitis or vestibular neuritis: what it is, how it is diagnosed and what treatments are available

By Cristiano Antonino On Oct 25, 2022

Widely used today in common parlance but no longer used by specialists, the term ‘labyrinthitis’ originated in the pre-antibiotic era when otitis media could complicate into otomastoiditis and thus affect the inner ear (or labyrinth) and from there evolve into meningitis

Today, the correct term is vestibular neuritis, an inflammation of the cells (neurons) of the vestibular nerve ganglion (8th pair of cranial nerves) due to reactivation of the herpes virus.

More rarely, especially in elderly patients, the cause of vestibular neuritis is obstruction of one of the small arteries (ischaemia) that carry blood to the labyrinth or vestibular nuclei.

How labyrinthitis manifests itself: characteristic symptoms of vestibular neuritis

The vestibular nerve is part of the vestibular system, i.e. the receptors in the labyrinth of the inner ear that regulate the static and dynamic balance of our body, as well as being responsible for clear vision during head movements. Their malfunctioning causes falls or instability, vertigo, nystagmus (involuntary oscillatory movement of the eyes).

The most common clinical picture of labyrinthitis is characterised by:

violent vertigo with sudden onset
nausea
vomiting
inability to walk or stand.

These symptoms gradually improve over days or weeks although modest instability and mild, transient vertigo may persist for months.

Labyrinthitis or vestibular neuritis: the diagnosis

For the diagnosis of labyrinthitis, the ENT specialist first uses anamnestic data, i.e. the patient’s medical history.

Subsequently, the picture of acute vestibular syndrome can be documented with a vestibular examination, with which the specialist assesses

the inability to walk and stand;
the deviation in walking and in outstretched arms;
nystagmus, which can best be visualised with Frenzel glasses or a nystagmographic recording.

The diagnosis can be completed with a neurological examination and an MRI scan, which are useful to rule out neurological damage as the cause of the disorder.

Treatment of labyrinthitis: how to treat vestibular neuritis

The large vertiginous crisis that characterises the onset of labyrinthitis can be treated with antiemetics and vestibulosuppressants, the drugs used to reduce nausea and vomiting. In the case of inflammation of viral origin, the treatment of neuritis involves the use of corticosteroids.

It is then fundamental to follow a rehabilitation course to favour vestibular compensation processes: essentially movement and physical activity of any kind, as soon as the initial acute symptoms regress and the patient’s general condition allows it.

The Vestibular Rehabilitation Of Vertiginous Patients