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labyrinthitis is an inflammation of the inner ear that occurs against the background of an infection. Also, this pathology is known as otitis media. The disease develops due to the entry 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 a person experiences severe dizziness, nausea and vomiting. The patient’s hearing deteriorates, there is noise in the ears.
Diagnosis of labyrinthitis is not difficult, treatment gives good results, but only on condition that 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. And 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
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 present in the body. Most often, the disease is a consequence of otitis media.
Microorganisms such as:
Streptococci.
Meningococci.
Pneumococci.
Influenza viruses.
Sometimes the infection enters the inner ear from the cranial cavity.
Diseases that can cause a labyrinth:
Flu.
Measles.
Tuberculosis.
Meningitis.
Another cause of labyrinthitis is an ear injury. The infection enters its structures if the eardrum has been damaged. The injury can be mechanical. Sometimes the integrity of the eardrum is broken due to the influence of chemical and thermal factors on it.
The following factors increase the likelihood of developing labyrinthitis:
Decreased immune forces.
Violations 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 focus of infection is located near the structures of the inner ear. It could be otitis media or meningitis.
Postponed operations on the inner or middle ear.
Infection with the herpes virus.
Syphilis.
Labyrinthite classification
There are several classifications of labyrinthitis. They are based on a variety of factors: the characteristics of the course of the disease, the type of infectious agent, the mechanism of inflammation, the type of inflammatory reaction and the place of its concentration.
Depending on which microorganism provoked the development of pathology, labyrinthitis can be of the following types:
Fungal.
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 the ear and next to it. Eruptions appear in the ear canal. The vestibular apparatus suffers, hearing function worsens.
Depending on the mechanism of development of pathology, the following types of labyrinthitis are distinguished:
Tympanogenic labyrinthitis, in which the pathogenic flora enters the inner ear from its middle section.
Meningogenic labyrinthitis. The subarachnoid space (the membrane of the brain) becomes the source of the spread of microbes.
Hematogenous labyrinthitis. Pathogenic flora penetrates into 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 varieties are distinguished:
Acute labyrinthitis. The disease develops unexpectedly for a person. He begins to suffer from dizziness, he develops nausea, pains in the ear, 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, the development of acute purulent labyrinthitis ends in this way.
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.
Necrotic 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 necrotic labyrinthitis, when edematous tissues compress blood vessels.
Depending on the intensity of the inflammatory process, the following types of labyrinthitis are distinguished:
Limited labyrinth. It occurs when there is a fistula in the eardrum. Deep inflammation develops in a certain part of the labyrinth.
Diffuse labyrinthitis. The inflammatory process extends to all structures of the inner ear.
Symptoms of labyrinthitis
With labyrinthitis, the vestibular apparatus primarily suffers. Therefore, it becomes difficult for a person to maintain balance, his head begins to spin.
The full set of symptoms for inflammation of the middle ear 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 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, feel sick, sweat profusely, and his face becomes 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, a sudden change in the trajectory of movements, etc.
Disorders of the autonomic nervous system. The patient often has pallor of the skin, which can suddenly become red, sometimes worried about pain in the heart, an increase in its rhythm.
With labyrinthitis, hearing is impaired, a person complains of constant tinnitus. This noise is dangerous, as it is caused by the death of ear receptors. Sometimes patients with labyrinthitis have facial nerve involvement.
Depending on the different forms of the disease, its manifestations may be as follows:
Meningococcal labyrinthitis. Two ears are immediately involved in the inflammatory process. Pathology is slowly but relentlessly progressing. 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 during the inflammatory reaction the death of cochlear receptors occurred, then hearing is lost forever. The vestibular function will be performed by the semicircular canals of a healthy labyrinth. 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 there are no symptoms of the acute phase. A person is concerned about violations of the vestibular apparatus, but they will be weakly expressed. This often leads to misdiagnosis.
Diagnosis of 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:
Collection of anamnesislistening to patient complaints. A person indicates dizziness, nausea, vomiting, hearing loss, loss of balance. As a rule, before this the patient suffered an infectious disease. Symptoms of labyrinthitis appear 7-12 days after its completion. Often, labyrinthitis is preceded by a bacterial or viral infection. It can also develop after a traumatic brain injury.
Otoscopic examination. The doctor uses an otoscope to examine the condition of the tympanic membrane and the external auditory canal.
Audiometry. This study allows you to assess the acuity of hearing 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 work of the vestibular apparatus.
ELISA, PCR. These studies allow you to determine which infectious agent caused the disease. In addition to drawing blood, the doctor will need a smear of discharge from the ear.
Electronystagmography. During the study, movements of the eyeballs are recorded. This makes it possible to distinguish 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 bone tissue of the labyrinth.
Sometimes a patient with labyrinthitis needs to visit a neurologist. To distinguish between labyrinthitis and other pathologies, additional tests may be prescribed to the patient. It is important to make a differential diagnosis of otitis media of the inner ear with Meniere’s disease, with cerebellar abscess, with neuritis and otosclerosis.
Treatment labyrinthitis
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 in patients with purulent diffuse labyrinthitis. It is aimed at opening the affected focus and its sanitation. In parallel, the patient is prescribed medication 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 labyrinthectomy is performed.
Medication Therapy
Drugs that can be prescribed to the patient:
Antibiotics. They are selected after the diagnosis, when the type of pathogen and its sensitivity to specific drugs is known. If it is not possible to conduct an analysis quickly, then the patient is prescribed broad-spectrum drugs. It can be antibiotics from the group of penicillins or cephalosporins. Sometimes fluoroquinolones are used. Ototoxic antibiotics for labyrinthitis are prohibited. We are talking about Gentamicin.
Dehydration of the body. The patient is prescribed a diet with salt restriction to 0,5 g per day. At the same time, he should drink no more than a liter of water.
Surgery
Most often, the operation is prescribed for 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 performs an opening of the mastoid process and removes purulent contents from it.
Sanitizing general cavity operation. During its implementation, an incision is made behind the ear, the back wall of the bony auditory meatus is opened, all the pus is removed, after which the wound is sutured.
If there is a fistula, it must be closed. Emergency surgery is prescribed for patients with intracranial complications of labyrinthitis.