Labyrinthitis

Labyrinthitis, also known as “internal otitis”, is an infectious inflammation of the ear labyrinth. This organ is located in the depth of the ear, its inner part and is responsible for the normal operation of the vestibular apparatus. Because of such functions of the labyrinth, its inflammation promises the strongest dizziness that occurs both by themselves and from body movements. This often causes severe nausea and vomiting. In addition, labyrinthitis is characterized by hearing disorders and a constant feeling of tinnitus.

The content of the article:
Classification of labyrinthitis
Causes and pathogenesis of labyrinthitis
Symptoms of labyrinthitis
Diagnosis of labyrinthitis
Complications of labyrinthitis
Treatment of labyrinthitis
Prognosis for labyrinthitis
Labyrinthitis
Labyrinthitis is an acute inflammatory disease, so it is necessary to contact a doctor with its symptoms in a short time. Diagnosis of this disease is carried out using a wide range of ENT procedures and analyses, computed tomography, audiometry, ecletrocochleography and special samples. Labyrinthitis is treated with medications or surgery, and after carrying out the necessary manipulations, the patient needs to restore hearing. Hearing prosthetics or implantation are used.

Due to the difficulties in the course of the disease, diagnosis and possible complications of labyrinthitis, doctors strongly emphasize the need for urgent treatment to a specialist when symptoms are detected. This will save time and preserve the patient’s health, because the consequences of some forms of labyrinthitis are irreversible. Hearing after acute forms of this disease cannot be restored, the same applies to some functions of the vestibular apparatus.

Classification of labyrinthitis
There are several ways to classify this disease. Labyrinthitis can be typified by the type of inflammation, the prevalence of the inflammatory process, the nature of the course of the disease, the mechanism of occurrence and the nature of the causative agent of infection.

According to the mechanism of occurrence, it is divided into:
Tympathogenic — the infection penetrates into the labyrinth from the middle ear.
Meningogenic — from the membranes of the brain, most often — in the presence of meningitis in the patient.
Hematogenic — the infection enters the labyrinth through the bloodstream.
Traumatic — labyrinthitis occurs as a complication after a cranial or ear injury.
By the nature of the pathogen , labyrinthitis is divided into:
Viral.
Bacterial:
specific;
nonspecific.
Fungal.
According to the nature of inflammation, labyrinthitis is divided into:
Serous — pronounced changes in the labyrinths; increased production of endolymph; the appearance of blood cells and fibrin in the endolymph.
Purulent — spontaneous inflammation; permanent formation of granulations; occurrence of leukocyte infiltration.
Necrotic — tissue necrosis; violation of the blood supply to the areas of the labyrinth; thrombosis or compression of the artery; damage to the artery, disruption of the vessels due to edema.
According to the prevalence of the inflammatory focus, labyrinthitis is divided into:
Diffuse;
Limited.
According to the nature of the course of the disease, labyrinthitis is divided into:
Acute — the inflammation disappears after 2-3 weeks, may have a protracted character or go into a chronic form;
Chronic — an asymptomatic course, a gradual increase in the manifestation of symptoms.
Causes and pathogenesis of labyrinthitis
An inflammatory infection attacking the labyrinth can be caused by several reasons. In each case, internal otitis is caused by the movement of bacteria from the focus of inflammation, but the reason why this happens may be different.

The focus of inflammation that causes labyrinthitis may be otitis media, which destroys the connective tissue membranes of the ear, and this gives the infection the opportunity to penetrate the labyrinth, causing suppuration and hearing impairment.

Infection is also unlikely to penetrate through the cranial cavity, for example, due to meningitis or influenza. The cause of such inflammation can be measles, tuberculosis, typhus, syphilis, herpes, scarlet fever. Infection may also enter through the blood here.

Ear injury, due to which the patient’s eardrum was damaged, also causes purulent inflammation and labyrinthitis. This includes those cases when the injury of the eardrum arose due to the penetration of a foreign body, manipulation with a sharp object, traumatic brain injury.

Symptoms of labyrinthitis
The main spectrum of symptoms of labyrinthitis falls on disorders in the vestibular system, since the defeat of the labyrinth is fraught with dysfunction of the sense of balance, since this organ is responsible for this ability of the body. The symptoms of this aspect include:

Severe dizziness that occurs by themselves, or during body movements. They are systemic in nature, and patients characterize it as a definitely directed rotation of objects or their own body, felt almost constantly. Sometimes it takes on a different character: a person with labyrinthitis may feel unstable while walking, but he cannot predict exactly where he will fall, having lost his balance. In other cases, dizziness manifests itself in seizures, the duration of which ranges from several minutes to several hours. A strong feeling of dizziness is characterized not only by the above-mentioned consequences, but also by an increasing feeling of nausea, vomiting, sweating, facial hyperemia.
The occurrence of spontaneous nystagmus. This symptom of labyrinthitis is characterized by a change in direction throughout the time.
Balance coordination dysfunction, the so—called vestibular ataxia, is a violation of human movements. It manifests itself in various ways, from instability when walking, falls, stumbles and the inability to maintain a straight trajectory of movement, and to the refusal of independent movement. Depending on the position of the patient’s head, it may deviate from the normal position in different ways.
Vegetative disorders. It includes a wide range of symptoms and manifestations, for example, skin discoloration, bradycardia, discomfort in the heart area.
In addition to the above symptoms, labyrinthitis is also characterized by hearing disorders and a constant feeling of tinnitus. These manifestations of the disease occur because the receptors of the ear that perceive sound begin to die during the disease. So, serous labyrinthitis promises recoverable hearing loss, but a purulent type of the disease can seriously damage the ability to perceive sound to complete deafness.

If symptoms of labyrinthitis occur, it is urgently necessary to consult an ENT specialist, since not only the consequences of this disease are serious. Labyrinthitis is also insidious because it has many possible complications.

Diagnosis of labyrinthitis
Diagnosis of this disease involves the use of a wide range of ENT procedures, analyses, samples and studies. In addition, many specialists are usually involved in the diagnosis, since labyrinthitis has not only many varieties, but also a variety of complications.

So, ENT may ask for advice from another specialist, depending on the cause of labyrinthitis. Accordingly, the examination of the patient can be carried out by a venereologist, an otoneurologist, an infectious disease specialist, a traumatologist.

The spectrum of ENT manipulations used to diagnose labyrinthitis includes targeted radiography, otoscopy, CT of the temporal part, microtoscopy, magnetic resonance imaging of the brain, lumbar puncture.

In addition, hearing impairment and its degree are detected using impedancometry, audiometry, promontory test and other modern medical procedures.

Problems with the patient’s vestibular apparatus are diagnosed using stabilography, fistula test, vestibulometry, caloric test.

ELISA and PCR tests are performed separately to determine the causative agent of the disease, and the discharge from the ear is also checked for the source of infection.

For accurate diagnosis, additional tests are performed that check the patient for other diseases in order to exclude them from the overall picture. So, procedures are prescribed to determine otosclerosis, neuritis, cerebellar abscess or Meniere’s disease.

Complications of labyrinthitis
Labyrinthitis is dangerous for the patient with the possibility of the transition of the focus of inflammation to the nearby structures of the ear, and the transfer of infection, suppuration to other organs of hearing or face.

The spread of infection to the fallopian canal, which can occur through the inner ear, is fraught with inflammation of the facial nerve. This disease is called neuritis of the facial nerve.
The spread of infection to the mastoid process can cause the disease mastoiditis.
If the inflammation passes to the temporal bone, causing the formation of pus, then this qualifies as petrositis.
Complication of purulent labyrinthitis, the transition of infection into the cranial cavity, can cause a whole range of acute inflammatory diseases, such as brain abscess, meningitis, encephalitis.
Complications from labyrinthitis are serious diseases that have not only unpleasant, painful symptoms, but also consequences, often irreversible. In addition, infections of the cranial cavity are simply dangerous to health and are considered very complex diseases. Therefore, at the slightest suspicion of labyrinthitis, it is necessary to seek advice, diagnosis and treatment from a doctor, without letting the development of the disease take its course.

Treatment of labyrinthitis
Since the disease causes a wide range of symptoms, most of which are painful for a person; affects an important organ; causes many complications, it is not surprising that its treatment is a complex, systemic and complex process that includes not only taking medications, but also regular examinations and procedures. Surgical intervention is also possible. During the recovery period after the disease, hearing prosthetics are sometimes shown.

Medications prescribed for labyrinthitis are anti—inflammatory drugs, antibiotics, drugs to enhance blood circulation, neuroprotectors. The symptoms of the disease are stopped by ballataminal and betahistine — vestibulolytics.

Surgical intervention can be aimed at the rehabilitation of the middle ear, the plastic fistula of the labyrinth, the opening of the pyramid of the temporal skin, or even the complete removal of the labyrinth with drainage of the cranial cavity.

Recovery after surgery may involve the need to install an auditory prosthesis to preserve the patient’s current state of health and prevent deterioration of the ability to perceive sounds. To do this, either cochlear implantation is performed — an invasive manipulation that restores hearing. Or prosthetics is shown, the selection and adjustment of the device is carried out by a specialist hearing prosthetist.

Prognosis for labyrinthitis
Depending on the type of disease and the nature of its course, different forecasts are formed for the possibility of hearing restoration. In the case of acute serous labyrinthitis, a complete restoration of the ability to perceive sounds is predicted, a return to a state of complete health.

The presence of purulent labyrinthitis causes less comforting forecasts. Usually, a doctor can predict auditory disorders and the presence of individual problems in the work of the vestibular apparatus. The situation may be better if the patient’s body adapts after recovery and the body independently establishes a balance in the balance mechanism, transferring some functions to a healthy ear.

If the lesion was severe, and the disease acquired complications or severe forms of course, then the dysfunction of the diseased ear will not disappear after recovery. The hearing loss of the side where the labyrinthitis was transferred is predicted.

In order to avoid a difficult recovery period, the prospect of hearing prosthetics or rehabilitation after the disease, it is recommended to consult a doctor at the first problems with hearing, vestibular apparatus and well-being in general. ENT spectrum problems are characterized by a large range of complications and unpleasant course, therefore, in order to protect yourself from possible consequences, you must immediately go to a specialist for advice, fulfilling all the requirements of the doctor and his prescriptions.

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