ASK THE DOCTORS

Labyrinthitis causes difficulties with balance

Dear Doctor: Would you please discuss labyrinthitis? I am an 81-yearold female and have been troubled with this for several months. I have improved, but I still have balance problems and a full feeling in my head. What causes labyrinthitis? Is there a treatment that can help?

Dear Reader: Labyrinthitis occurs when inflammation or swelling of the inner ear causes difficulties with balance.

Although all three parts of the ear — the outer, middle and inner — play a role in hearing, only the inner ear is responsible for balance. It’s located in a small compartment within the temporal bones, which help to form the sides and base of the skull. It consists of the cochlea, which is the hearing portion of the inner ear, and a complex of fluidfilled tubes and other structures, which deal with balance. Taken together, these tubes and structures are known as the vestibular system, or the labyrinth. They specialize in sensing various types of movement of the head, such as tilting up or down, tilting left or right, turning sideways and acceleration. Tiny hairs located throughout the vestibular system decode movement and turn it into nerve impulses. These are sent to the brain via the eighth cranial nerve, also known as the auditory nerve. The brain translates the information and instructs the body how to proceed.

The most common cause of labyrinthitis is a viral infection, such as a cold or the flu. The viruses that cause shingles, measles, mumps and rubella can also affect the inner ear. The condition can be caused by a bacterial infection that has spread from the middle ear, but this is more common in children than adults. It can also arise as the result of an allergic reaction.

Inflammation and swelling affect the auditory nerve, and also interfere with the proper functioning of the fluid and fine hairs in the vestibular system. As a result, they receive garbled input relating to movement and balance and send that misinformation to the brain. The symptoms of labyrinthitis include dizziness, vertigo, impaired balance, a sense of spinning or falling, or nausea. If inflammation affects the cochlea, tinnitus and hearing loss are possible, as well. Treatment depends on the individual’s specific symptoms, age and general health. These can include medications such as corticosteroids to reduce inflammation, antiviral medications to combat the infection, and medications to control nausea and alleviate dizziness.

In most cases, labyrinthitis resolves over time and doesn’t cause lasting problems. Although your case is lasting longer than what is usually seen, your continued improvement is encouraging. The feeling of fullness you describe suggests the middle ear may be involved. If you haven’t already done so, you should speak with your health care provider about it. If a bacterial infection is suspected, antibiotics may be prescribed.

Patients who experience ongoing symptoms of labyrinthitis can benefit from an exercise program known as vestibular rehabilitation. This involves exercises that help the brain learn to cope with the altered signals it is receiving from the vestibular system. If your symptoms persist, we recommend you ask your doctor for a referral to a vestibular rehab specialist.