Labyrinthitis — inner ear vertigo

Labyrinthitis is inflammation of the labyrinth — the inner ear structure controlling balance and hearing. It causes sudden severe vertigo — illusion of spinning — with nausea, vomiting, and unsteadiness.

Usually viral, following upper respiratory infection — distinct from BPPV (brief positional vertigo) and Ménière’s disease (recurrent attacks with hearing fluctuation).

Symptoms

Acute onset — over hours:

  • severe vertigo — room spinning — worse with head movement
  • nausea and vomiting
  • balance problems — cannot walk straight — fall risk
  • nystagmus — flickering eyes — clinician observes

Labyrinthitis may include:

  • hearing loss in affected ear
  • tinnitus — ringing

Vestibular neuritis — vertigo without hearing loss — inflammation of vestibular nerve only.

Duration:

  • worst 2 to 3 days
  • gradual improvement 2 to 6 weeks
  • residual motion sensitivity — weeks more

Causes

Viral (common)

  • common cold, flu, COVID-19
  • virus spreads to inner ear or post-viral inflammation

Bacterial (rare)

Other

  • autoimmune inner ear disease — rare
  • head injury

Stroke vs labyrinthitis — critical distinction

Isolated vertigo in young healthy person after viral illness — often inner ear.

Red flags for stroke/TIA — A&E immediately:

  • facial weakness
  • arm or leg weakness
  • speech slurred
  • severe new headache
  • ** unable to stand** with other neuro signs
  • risk factors — age, hypertension, atrial fibrillation

HINTS examination — emergency clinicians differentiate — do not self-diagnose if uncertain.

Treatment

Acute phase

  • rest in bed — head still
  • avoid driving until settled
  • antiemetics — cyclizine, prochlorperazine — GP prescription
  • short-term benzodiazepines — occasionally — sedation limits use
  • fluids — if vomiting

Steroids

Prednisolone early in vestibular neuritis — some evidence for faster recovery — GP decision within first days.

Recovery phase

Vestibular rehabilitation — physiotherapy exercises:

  • gaze stabilisation
  • balance training
  • habituation to movement

Speeds brain compensation — reduces chronic dizziness.

Avoid long-term

Prochlorperazine beyond few days — may delay compensation.

Complications

Benign paroxysmal positional vertigo (BPPV) — can follow labyrinthitis — brief vertigo on rolling in bed — Epley manoeuvre treats.

Persistent postural-perceptual dizziness (PPPD) — chronic dizziness after vestibular event — CBT and rehab help.

Permanent hearing loss — uncommon with viral labyrinthitis — ** sudden sensorineural hearing loss** — urgent ENT — steroids within 72 hours.

Self-care during recovery

  • slow head movements
  • good lighting when walking
  • avoid alcohol
  • do not drive until no vertigo on head turn
  • fall precautions — stairs, bathroom

When to return to work

When can walk safely and no active spinning — often 1 to 2 weeks — variable.

Labyrinthitis is miserable but usually temporary — sudden vertigo with stroke signs is A&E; post-viral spinning alone is GP, rest, rehab, patience.

Common questions about labyrinthitis

What is the difference between labyrinthitis and vertigo?
Vertigo is the symptom — spinning sensation. Labyrinthitis is a cause — inflammation of inner ear labyrinth (balance and hearing). BPPV is another cause — brief vertigo on head movement. Ménière's disease causes recurrent vertigo with hearing fluctuation. GP or ENT distinguishes.
How long does labyrinthitis last?
Acute severe vertigo often 2 to 3 days, then gradual improvement over 2 to 6 weeks. Residual imbalance may persist longer — vestibular rehabilitation exercises help brain compensate. Most full recovery by 6 to 8 weeks; small number have chronic dizziness.
What causes labyrinthitis?
Usually viral infection — cold, flu, or other virus spreading to inner ear. Bacterial labyrinthitis rare — follows otitis media — more serious. Autoimmune and stress sometimes implicated. Not caused by wax or outer ear infection alone.
Will labyrinthitis go away on its own?
Yes — most viral cases self-resolve as inflammation settles. Supportive care — rest, hydration, anti-sickness medicines. Steroids sometimes used early in vestibular neuritis — modest benefit in some trials. Persistent symptoms — vestibular physiotherapy referral.
Is labyrinthitis the same as vestibular neuritis?
Closely related — vestibular neuritis affects balance nerve without hearing loss; labyrinthitis involves whole labyrinth — may include hearing loss or tinnitus in affected ear. Management similar.
When is vertigo a sign of stroke?
Stroke-related vertigo often accompanied by other signs — facial droop, arm weakness, speech difficulty, severe headache, unable to walk — not just isolated brief spinning. Posterior circulation stroke can present with vertigo alone — high-risk patients need emergency assessment.

Sources

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