Labyrinthitis – Illnesses & conditions

Labyrinthitis is usually treated using a combination of self-help techniques and medication. Chronic labyrinthitis may be treated with vestibular rehabilitation therapy (VRT).

Self-help

Drink plenty of liquid, little and often, particularly water, to avoid becoming dehydrated.

In its early stages, you may feel constantly dizzy and it can give you severe vertigo. You should rest in bed to avoid falling and injuring yourself. After a few days, the worst of these symptoms should have passed and you should no longer feel dizzy all the time.

You can do several things to minimise any remaining feelings of dizziness and vertigo. For example:

• during an attack, lie still in a comfortable position (on your side is often best)
• avoid alcohol
• avoid bright lights
• try to cut out noise and anything that causes stress from your surroundings

You should also avoid driving, using tools and machinery or working at heights if you’re feeling dizzy and unbalanced.

Medication

If your dizziness, vertigo and loss of balance are particularly severe, your GP may prescribe a short course of medication such as benzodiazepine or antiemetics (vestibular sedatives).

Benzodiazepine

Benzodiazepines reduce activity inside your central nervous system. This means your brain is less likely to be affected by the abnormal signals coming from your vestibular system.

However, long-term use of benzodiazepines is not recommended because they can be highly addictive if used for long periods.

Antiemetics

A prescription medication known as an antiemetic may be prescribed if you’re experiencing nausea and vomiting.

Prochlorperazine 5mg tablets are an antiemetic used to treat the symptoms of vertigo and dizziness. It may be considered as an alternative treatment to benzodiazepines.

Most people are able to tolerate prochlorperazine and side effects are uncommon, but can include:

• tremors (shaking)
• abnormal or involuntary body and facial movements
• sleepiness

If you are vomiting, there is a prochlorperazine 3mg tablet available which you place inside your mouth between your gums and cheek.

Corticosteroids

Corticosteroids such as prednisolone may be recommended if your symptoms are particularly severe. They are often effective at reducing inflammation.

Antibiotics

If your labyrinthitis is thought to be caused by a bacterial infection, you will be prescribed antibiotics. Depending on how serious the infection is, this could either be antibiotic tablets or capsules (oral antibiotics) or antibiotic injections (intravenous antibiotics).

Check the patient information leaflet that comes with your medicines for a full list of possible side effects.

When to seek further advice

Contact your GP if you develop additional symptoms that suggest your condition may be getting worse. If this happens, you may be admitted to hospital. These symptoms include:

• mental confusion
• slurred speech
• double vision 
• weakness or numbness in one part of your body
• a change in the way you usually walk

Also contact your GP if you do not notice any improvement after three weeks. You may need to be referred to an ear, nose and throat (ENT) specialist.

Chronic labyrinthitis

A small number of people experience dizziness and vertigo for months or even years. This is sometimes known as chronic labyrinthitis.

The symptoms are not usually as severe as when you first get the condition, although even mild dizziness can have a considerable impact on your quality of life, employment and other daily activities.

Vestibular rehabilitation therapy (VRT)

Vestibular rehabilitation therapy (VRT) is an effective treatment for people with chronic labyrinthitis. VRT attempts to “retrain” your brain and nervous system to compensate for the abnormal signals coming from your vestibular system.

VRT is usually carried out under the supervision of a physiotherapist and involves a range of exercises designed to:

• co-ordinate your hand and eye movements
• stimulate sensations of dizziness so your brain starts to get used to disruptive signals sent by your vestibular system and then ignores them
• improve your balance and walking ability
• improve your strength and fitness

The Brain and Spine Foundation is a UK charity that has more information about vestibular rehabilitation on its website.

You can ask your GP to refer you to a physiotherapist or you can pay for private treatment. If you decide to see a private physiotherapist, make sure they are fully qualified and a member of a recognised body, such as the Chartered Society of Physiotherapy (CSP).

Not all physiotherapists have training in VRT, so you need to make it clear you require this type of treatment before making an appointment.

Labyrinthitis and vestibular neuritis – NHS

Labyrinthitis and vestibular neuritis are types of inner ear infection that affect your balance. They usually get better on their own within a few weeks.

Check if you have labyrinthitis or vestibular neuritis

The most common symptoms of labyrinthitis are:

• dizziness or feeling that everything around you is spinning (vertigo)
• feeling unsteady and off balance – you might find it difficult to stay upright or walk in a straight line
• feeling or being sick
• hearing loss
• ringing in your ears (tinnitus)

The symptoms of vestibular neuritis are very similar, but it does not cause hearing loss or tinnitus.

Symptoms can start suddenly. They may be there when you wake up and get worse as the day goes on.

The symptoms often ease after a few days.

You’ll usually get your balance back over 2 to 6 weeks, although it can take longer.

Things you can do to help

Labyrinthitis or vestibular neuritis usually gets better on its own. But there are things you can do to ease the symptoms.

Do

• lie still in a dark room if you feel very dizzy

• drink plenty of water if you’re being sick – it’s best to drink little and often

• try to avoid noise and bright lights

• try to get enough sleep – tiredness can make symptoms worse

• start to go for walks outside as soon as possible – it may help to have someone with you to steady you until you become confident

• when you’re out and about, keep your eyes focused on a fixed object, rather than looking around all the time

Non-urgent advice: See a GP if:

• you have symptoms of labyrinthitis or vestibular neuritis that do not get better after a few days or are getting worse
• you’ve been diagnosed with labyrinthitis or vestibular neuritis and your symptoms have not improved within a week of starting treatment

The GP may refer you to a hospital specialist.

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:

• you have sudden hearing loss in 1 ear

You may need to be referred to a specialist for tests, and possibly treatment.

You can call 111 or get help from 111 online.

Information:

Labyrinthitis and vestibular neuritis – what’s the difference?

Labyrinthitis and vestibular neuritis are problems with different parts of the inner ear, which are needed for balance:

• labyrinthitis is inflammation of the labyrinth – a maze of fluid-filled channels in the inner ear
• vestibular neuritis is inflammation of the vestibular nerve – the nerve in the inner ear that sends messages to the brain

The symptoms of vestibular neuritis and labyrinthitis are very similar.

However, if your hearing is affected, then labyrinthitis is the cause. This is because inflammation of the labyrinth affects hearing, while inflammation of the vestibular nerve does not.

Treatment from a GP for labyrinthitis or vestibular neuritis

If you have labyrinthitis or vestibular neuritis, a GP may prescribe antihistamines or motion sickness tablets for up to 3 days. Do not take them for any longer, as they can slow down your recovery.

Labyrinthitis or vestibular neuritis is usually caused by a viral infection, such as a cold or flu, so antibiotics will not help. But a GP may prescribe antibiotics if they think your infection is bacterial.

Exercises for long-term balance problems

Sometimes, balance problems can last for much longer – for many months or even years.

Vestibular rehabilitation is a series of exercises that can help restore balance. You should only do the exercises under the supervision of a specialist such as a physiotherapist or audiologist.

You can ask a GP to refer you to a physiotherapist, or it may be possible to refer yourself directly.

Waiting lists for accessing NHS physiotherapy can be long and you may prefer to pay for private treatment. Most private physiotherapists accept direct self-referrals.

Video: labyrinthitis and vertigo (BPPV) – Hazel’s story

In this video, Hazel talks about how labyrinthitis affected her balance and perception and how she found help.

Media last reviewed: 1 July 2020
Media review due: 1 July 2023

Page last reviewed: 17 February 2023
Next review due: 17 February 2026

Vestibular disorders (dizziness, tinnitus)

Vestibular disorders (dizziness, tinnitus)

The vestibular system originates in the inner ear – in the vestibule and semicircular canals (these structures are also called the vestibular apparatus), the rest of its superior structures are located in different parts of the brain.

In this regard, there are vestibular disorders associated with diseases of the inner ear and vestibular nerve (they are mainly treated by otorhinolaryngologists), and vestibular disorders associated with damage to parts of the vestibular analyzer located in the brain (they are dealt with by physicians – neurologists).

Dizziness and imbalance caused by diseases of the inner ear and vestibular nerve:

Meniere’s disease (synonymous with chronic relapsing labyrinthopathy) is a chronic disease caused by an intermittent increase in intralabyrinthine pressure (or labyrinth hydrops). The cause of hydrops is the excessive production of the intralabyrinth fluid of the endolymph, the violation of its circulation and reabsorption. It proceeds in the form of repeated bouts of dizziness with a sensation of movement of surrounding objects or the person himself (in the English-language literature – “vertigo”), nausea and hearing loss (usually on one side). Attacks can last from several hours to days.

Acute labyrinthopathy of vascular origin – sudden loss of hearing in one ear with severe dizziness with a sensation of movement of surrounding objects (vertigo), most often caused by an acute circulatory disorder in the inner ear.

Chronic suppurative otitis media is a chronic inflammatory process in the tympanic cavity, characterized by perforation of the tympanic membrane, suppuration and hearing loss. The inflammatory process can be accompanied not only by hearing loss, but also by dizziness and imbalance. In the absence of treatment, there is a risk of developing labyrinthitis (acute inflammation in the inner ear) and intracranial complications.

Perilymphatic fistula – pathological communication between the inner and middle ear due to damage to the membranes located between them, accompanied by the outflow of fluid from the inner ear, perilymph, into the middle ear. It occurs as a result of an ear injury, barotrauma (with a drop in atmospheric pressure), and other reasons. Accompanied by dizziness and unilateral hearing loss.

Benign paroxysmal positional vertigo, BPPV (synonymous with otolithiasis) – a condition in which fragments of the otolithic membrane (calcium carbonate crystals), usually located on the threshold of the labyrinth, due to trauma, age-related changes, and other reasons, leave their location and end up in one of the semicircular canals (or several semicircular canals). The displacement of detached otoliths that occurs at certain positions of the head and inclinations causes attacks of short-term dizziness. Depending on the localization of detached otoliths, cupulo- and canalolithiasis are distinguished.

Vestibular neuronitis – acute inflammation of the vestibular portion of the vestibulo-cochlear nerve and its vestibular ganglion, most likely of viral herpetic etiology. During the first 3-7 days, it manifests itself as an acute vestibular syndrome – severe dizziness with a sensation of rotation of surrounding objects (vertigo), imbalance, nausea, followed by subsidence of symptoms within 2-4 weeks.

Acoustic neuroma (synonyms – statoacoustic neuroma, vestibular schwannoma) is a benign statoacoustic nerve lesion that causes unilateral hearing loss, often tinnitus, dizziness, and imbalance. In the absence of surgical treatment, the growth of a neuroma causes compression of various brain structures and can lead to the development of life-threatening conditions.

Motion sickness (synonyms – motion sickness, kinetosis) – a complex of symptoms in the form of nausea, increased salivation, malaise, provoked in some people by riding in transport (in a bus, car, plane, sea), riding on attractions. It is due to the development of vestibulo-vegetative symptoms, primarily in the form of nausea, in response to irritation of the vestibular apparatus in the above conditions.

Dizziness and imbalance caused by diseases of the brain and central nervous system:

• Acute and chronic disorders of cerebral circulation.
• Post-traumatic lesions of the brain.
• Consequences of past intoxications and infections of the central nervous system (meningitis, encephalitis).
• Demyelinating diseases of the central nervous system (multiple sclerosis, etc.).
• Tumors of the brain.
• Osteochondrosis of the cervical spine.

Dizziness with hearing loss treatment

It turns out that there is often a connection. Nausea, rotation before the eyes and the onset of hearing loss can signal Meniere’s disease and other disorders in the inner and middle ear, which are closely related to the vestibular apparatus.

Catch me falling

When the ground slips from under your feet

What does a layman do if for no reason at all he starts to feel dizzy, he is disoriented in space and / or experiences nausea, photophobia? She is frightened, of course, but she is in no hurry to go to the doctor. First, he tries to somehow wait out the unpleasant symptoms, blames everything on nerves, hypertension, or on the fact that he has not eaten in the morning, and women also find the reason in the peculiarities of the cycle.

When dizziness, even severe, disappears, few decide to go to the doctor for a diagnosis. After all, one must be puzzled, to which specialist to sign up, and indeed why? Nothing else worries.

“In fact, there is a wide range of diseases that lead to the so-called systemic or vestibular dizziness,” says Zinaida Morozova, an audiologist-otorhinolaryngologist at MasterSluh-Moscow LLC. – And each of these ailments once had that very first episode that the patient attributed to nerves or pressure.

Causes of dizziness can be:

• Viral infection and acute inflammation of the vestibular nerve – vestibular neuronitis.
• Entry of otolithic particles into the canals of the vestibular apparatus.
• Violation of cerebral circulation.
• Various autoimmune diseases.
• Previous traumas (probably even those you forgot about).
• Tumors.
• Cervical osteochondrosis.
• The combination of attacks of dizziness, tinnitus, photophobia and hearing loss often signals Meniere’s disease (hydrops of the ear labyrinth).

In Meniere’s disease and other inner and middle ear problems, vertigo is rare at first. Only over time, their frequency and strength increase almost to daily and extremely unpleasant: when everything around starts to rotate rapidly and you can only be saved in a lying position.

The task of the doctor is to try to catch the disease in the early stages, to find the cause. So more likely to get rid of the problem. One episode of dizziness can still be experienced (maybe the nerves really are to blame), but when the symptoms add up to the system, run to a specialist.

Which doctor should I go to with my dizziness?

It is logical – to the therapist or immediately to the neurologist. A good specialist will not brush aside if the patient is really worried about some symptom, will not say: “Well, what do you want? Age … “Or:” Yes, you have vegetative-vascular dystonia.

Unfortunately, the above diagnosis for most patients is a bit out of the ideal world. Otherwise, people would not have been looking for the root of their problems for years, turning to various neurologists and other doctors of evidence-based and not very medicine.

Therefore, the rule is this – if after the appointment of a neurologist (or even a change of doctor) the condition does not improve, or even worsens, you are not sent for new tests or put in a queue for a long time, take matters into your own hands.

The main task for the patient at any stage is not to be silent, hoping that the doctor himself will figure it out. If your head is spinning and it seems that your hearing seems to be getting worse, or your ears are buzzing / ringing, talk about everything at the reception! This way you are more likely to make a correct diagnosis.

You can, bypassing the local therapist, immediately go to the ENT or audiologist, this is usually done by those who have mild dizziness, but the ears really bother. Meniere’s disease and other disorders in the work of the inner ear are dealt with by specialized specialists.

Inner ear diseases that cause dizziness can be diagnosed with special tests that evaluate your stability, gait, eye tracking, and vestibular response to changes in body position. The stages of diagnosing dizziness include: conversation, tests, additional diagnostic research methods if necessary, diagnosis.

The medical centers of the MasterSluh network employ professionals who know everything about the functioning of the auditory system. They carry out high-quality diagnostics and accurately interpret its results, and most importantly, they are always in contact with other narrow specialists. You will not be left alone with your problem for sure.

You can make an appointment by calling the numbers listed on the contacts page of the MasterSluh centers or using a single multi-channel number 8 (800) 775-11-07.

What is the prevention and treatment?

The list of ailments associated with the work of the inner ear, not to mention other possible causes of dizziness, is huge. Everything is individual. But in any case, an excellent prevention would be a healthy lifestyle, physical education and sports with an emphasis on pumping the vestibular apparatus – Nordic walking, cycling, etc.

The general risk group is adults, often with changes in salt and calcium metabolism, the same changes are recorded in diseases of the inner and middle ear, vascular diseases, and reduced physical activity. So we draw conclusions and strive for a healthy lifestyle.

Treatment is prescribed depending on the diagnosis, because dizziness is only one of the symptoms. Until you get tested, you won’t know what’s going on. Some will need surgery, others just a couple of visits to the doctor.

Dizziness is not an independent disease, but only its symptom. In some cases, it signals serious disorders in the body, in particular in the work of the vestibular apparatus. Find out the cause, try to eliminate it or mitigate the manifestations only with the help of a doctor.