How does infection get into the inner ear?
The labyrinth is separated from the middle ear by thin membranes of the oval and round windows, and from the cranial cavity by a bone wall and the internal auditory canal. With purulent otitis media, toxins and microbes penetrate through these structures, causing first serous and then purulent inflammation. In chronic otitis with cholesteatoma, the bone may be destroyed and a direct connection is formed. Viruses enter the labyrinth through the bloodstream. Inflammation damages sensory cells, and if they die, hearing and vestibular function are not fully restored.
- Tympanogenic pathway in otitis media
- Bone destruction due to cholesteatoma
- Meningogenic pathway in meningitis
- Hematogenous route in viral infections
- Serous and purulent forms
- Limited and diffuse labyrinthitis
- Damage to sensitive cells
Causes and risk factors
The main cause is inflammation of the middle ear, especially untreated or chronic. Significantly increases the risk of cholesteatoma, which destroys the bone wall of the labyrinth. Viral forms are associated with past infections, including influenza, measles and mumps, so vaccination is of preventive value. Some variants occur after injuries to the temporal bone, ear surgeries, and against the background of meningitis. The disease is more severe in people with diabetes and reduced immunity.
- Acute purulent otitis media
- Chronic otitis and cholesteatoma
- Viral infections, including mumps and measles
- Temporal bone injuries
- Ear surgeries
- Meningitis
- Diabetes mellitus and immunodeficiency
Symptoms
The disease manifests itself as a combination of vestibular and auditory disorders. Severe rotational dizziness occurs with nausea and vomiting, which intensifies with head movements, instability appears, and the person deviates to the side. At the same time, hearing in the affected ear decreases, noise and congestion occur. With the purulent form, ear pain, suppuration and high fever are associated, the condition worsens quickly. The appearance of facial asymmetry, severe headache or confusion indicates the spread of inflammation.
- Rotational vertigo with nausea and vomiting
- Hearing loss in one ear
- Noise and congestion in the ear
- Unsteadiness and deviation when walking
- Involuntary eye movements
- Ear pain and suppuration in purulent form
- Fever and weakness
Diagnostics
The doctor examines the ear, assesses the condition of the eardrum, the presence of pus and signs of a chronic process. Hearing must be examined, since it is precisely its decrease that distinguishes labyrinthitis from vestibular neuronitis. Computed tomography of the temporal bones shows the condition of the bone structures, cholesteatoma and destruction of the wall of the labyrinth, and MRI focusing on the inner ear reveals inflammatory changes and complications. A neurological examination is necessary to rule out stroke and intracranial complications.
- Otoscopy and examination by an ENT doctor
- Hearing test
- Evaluation of nystagmus and vestibular tests
- CT scan of the temporal bones
- MRI focusing on the inner ear
- General blood test
- Neurological examination
Treatment and prevention
In case of a purulent form, treatment is carried out in a hospital: antibiotics are prescribed, the drainage of pus from the middle ear is ensured, and in case of chronic otitis media with cholesteatoma, an operation is performed to remove the lesion. For viral labyrinthitis, symptomatic medications are used, and, according to the doctor’s decision, glucocorticosteroids. Drugs that suppress dizziness are used only for a short course. After acute manifestations subside, vestibular exercises are prescribed. For persistent hearing loss, hearing aids are discussed.
- Hospitalization for purulent form
- Antibacterial therapy and drainage of the middle ear
- Surgery for cholesteatoma
- Glucocorticosteroids as prescribed by a doctor
- A short course of anti-vertigo medications
- Vestibular rehabilitation
- Hearing replacement for persistent hearing loss
- Complete treatment of otitis media and vaccination
