Editing Labyrinthitis

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{{Infobox medical condition (new)
| name            = Labyrinthitis and vestibular neuritis
| image           = Right osseous labyrinth svg hariadhi.svg
| caption         = Diagram of the [[inner ear]]
| field           = [[Otorhinolaryngology]]
| synonyms        = Otitis interna, vestibular neuronitis, vestibular neuritis
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| symptoms        = 
| complications   = 
| onset           = 
| duration        = 
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| causes          = 
| risks           = 
| diagnosis       = 
| differential    = 
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| frequency       = 3.5 cases per 100,000<ref name=Gre2014>{{cite journal|last1=Greco|first1=A|last2=Macri|first2=GF|last3=Gallo|first3=A|last4=Fusconi|first4=M|last5=De Virgilio|first5=A|last6=Pagliuca|first6=G|last7=Marinelli|first7=C|last8=de Vincentiis|first8=M|title=Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo?|journal=Journal of Immunology Research|date=2014|volume=2014|pages=459048|pmid=24741601|doi=10.1155/2014/459048|pmc=3987789|doi-access=free}}</ref>
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<!-- Definition and symptoms -->

'''Labyrinthitis''' is inflammation of the [[Membranous labyrinth|labyrinth]], a maze of fluid-filled channels in the inner ear. '''Vestibular neuritis''' is inflammation of the vestibular nerve (the nerve in the ear that sends messages related to motion and position to the brain).<ref>{{cite web | url=https://www.nhs.uk/conditions/labyrinthitis/ | title=Labyrinthitis and vestibular neuritis | date=23 October 2017 }}</ref><ref>{{cite book| title= Ferri's Clinical Advisor 2016: 5 Books in 1|date= 2015| publisher= Elsevier Health Sciences| isbn= 9780323378222 |page= 735| url= https://books.google.com/books?id=bbLSCQAAQBAJ&pg=PA735}}</ref><ref name=Hog2015>{{cite journal |last1= Hogue| first1= JD| title= Office Evaluation of Dizziness |journal= Primary Care| date=June 2015| volume= 42| issue=2|pages=249–258| pmid= 25979586| doi= 10.1016/j.pop.2015.01.004}}</ref> Both conditions involve [[inflammation]] of the [[inner ear]].<ref>{{cite web| title= Labyrinthitis|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0027300/|website= [[National Library of Medicine]] | access-date=16 March 2018|language=en}}</ref> [[Bony labyrinth|Labyrinths]] that house the [[vestibular system]] sense changes in the head's position or the head's motion.<ref name=":1">{{Cite journal |date=1990-10-01|title=Clinical Methods: The History, Physical, and Laboratory Examinations| journal= Annals of Internal Medicine| volume=113|issue=7|pages=563|doi=10.7326/0003-4819-113-7-563_2|issn=0003-4819}}</ref> Inflammation of these inner ear parts results in a [[vertigo]] (sensation of the world spinning) and also possible [[hearing loss]] or [[tinnitus]] (ringing in the ears).<ref name=":1" /> It can occur as a single attack, a series of attacks, or a persistent condition that diminishes over three to six weeks. It may be associated with [[nausea]], [[vomiting]], and eye [[pathologic nystagmus|nystagmus]].

<!-- Cause -->
The cause is often not clear. It may be due to a [[virus]], but it can also arise from [[bacteria]]l infection, [[head injury]], extreme [[stress (biological)|stress]], an [[allergy]], or as a reaction to [[medication]]. 30% of affected people had a common cold prior to developing the disease.<ref name=Gre2014/> Either bacterial or viral labyrinthitis can cause a permanent hearing loss in rare cases.<ref>{{cite web|title=NLM|url=https://www.nlm.nih.gov/medlineplus/ency/article/001054.htm}}</ref> This appears to result from an imbalance of neuronal input between the left and right inner ears.<ref name="Marill">{{cite web |last=Marill |first=Keith |title=Vestibular Neuronitis: Pathology |url=http://emedicine.medscape.com/article/794489-overview#showall |publisher=eMedicine, Medscape Reference |access-date=2011-08-07 |date=2011-01-13}}</ref>

==Signs and symptoms==
The main symptoms are severe [[vertigo (medical)|vertigo]] and [[Pathologic nystagmus|nystagmus]]. The most common symptom of vestibular neuritis is the onset of vertigo that has formed from an ongoing infection or trauma.<ref>{{Citation|last1=Dewyer|first1=Nicholas A.|title=Inner Ear Infections (Labyrinthitis)|date=2018|work=Infections of the Ears, Nose, Throat, and Sinuses|pages=79–88|publisher=Springer International Publishing|isbn=978-3-319-74834-4|last2=Kiringoda|first2=Ruwan|last3=McKenna|first3=Michael J.|doi=10.1007/978-3-319-74835-1_7}}</ref> The dizziness sensation that is associated with vertigo is thought to be from the inner ear labyrinth.<ref>{{Citation|last1=Murdin|first1=Louisa|chapter=Betahistine for symptoms of vertigo|date=2013-08-11|pages=CD010696|editor-last=The Cochrane Collaboration|publisher=John Wiley & Sons, Ltd|language=en|doi=10.1002/14651858.cd010696|last2=Hussain|first2=Kiran|last3=Schilder|first3=Anne GM|title=Cochrane Database of Systematic Reviews|doi-access=free}}</ref> Rapid and undesired eye motion ([[pathologic nystagmus|nystagmus]]) often results from the improper indication of rotational motion.  Nausea, anxiety, and a general ill feeling are common due to the distorted balance signals that the brain receives from the inner ear system.<ref>{{Cite journal|title=Table 1: The Single Nucleotide Polymorphisms in cathepsin B protein mined from literature (PMID: 16492714). |journal=PeerJ BIOINFORMATICS AND GENOMICS|doi = 10.7717/peerj.7425/table-1|doi-access=free}}</ref> Other common symptoms include [[tinnitus]], ear ache, and a feeling of fullness in the ear.<ref>{{Cite web|title=Infections of the Inner Ear|url=https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/labyrinthitis-and-vestibular-neuritis/|website=Vestibular Disorders Association}}</ref><ref>{{Cite web|title=Inner Ear Infection (Labyrinthitis) Symptoms, Causes, Contagious, Treatment Cure|url=https://www.medicinenet.com/labyrinthitis_inner_ear_inflammation/article.htm|access-date=2021-02-28|website=MedicineNet|language=en}}</ref>

==Causes==
Some people will report having an upper respiratory infection (common cold) or flu prior to the onset of the symptoms of vestibular neuritis; others will have no viral symptoms prior to the vertigo attack.

Some cases of vestibular neuritis are thought to be caused by an infection of the vestibular ganglion by the [[herpes simplex]] type 1 virus.<ref name="Marill"/> However, the cause of this condition is not fully understood, and in fact, many different viruses may be capable of infecting the vestibular nerve.

Acute localized [[ischemia]] of these structures also may be an important cause. Especially in children, vestibular neuritis may be preceded by symptoms of a common cold.  However, the causative mechanism remains uncertain.<ref>{{cite web| url=http://www.emedicine.com/emerg/TOPIC637.HTM | title=Vestibular Neuronitis | author=Keith A Marill |access-date=2008-06-28}}</ref>

This can also be brought on by pressure changes such as those experienced while [[Aviation|flying]] or [[scuba diving]].<ref name="pmid2317181">{{cite journal |vauthors=Martin-Saint-Laurent A, Lavernhe J, Casano G, Simkoff A |title=Clinical aspects of inflight incapacitations in commercial aviation |journal=Aviation, Space, and Environmental Medicine |volume=61 |issue=3 |pages=256–60 |date=March 1990 |pmid=2317181 }}</ref><ref name=farmer>{{cite conference |editor=Farmer, Jr JC |title=Labyrinthine Dysfunction During Diving |conference=1st [[Undersea and Hyperbaric Medical Society]] Workshop. |volume=UHMS Publication Number WS6-15-74. |publisher=Undersea and Hyperbaric Medical Society |year=1973 |pages=11 |url=http://archive.rubicon-foundation.org/4291 |archive-url=https://web.archive.org/web/20081007191953/http://archive.rubicon-foundation.org/4291 |url-status=usurped |archive-date=October 7, 2008 |access-date=2009-03-11}}</ref><ref name="pmid4619861">{{cite journal |author=Kennedy RS |title=General history of vestibular disorders in diving |journal=Undersea Biomedical Research |volume=1 |issue=1 |pages=73–81 |date=March 1974 |pmid=4619861 |url=http://archive.rubicon-foundation.org/2663 |archive-url=https://web.archive.org/web/20090703175002/http://archive.rubicon-foundation.org/2663 |url-status=usurped |archive-date=July 3, 2009 |access-date=2009-03-11}}</ref>

==Mechanism==
In the vestibular system, there are three [[Semicircular canals|canals]] that are semicircular in shape that input sensory clues.<ref>{{Cite web|url=http://www.audiologicaldiagnostics.com/labyrinthitis|title=Labyrinthitis|website=www.audiologicaldiagnostics.com|access-date=2019-12-02|archive-date=2019-11-23|archive-url=https://web.archive.org/web/20191123203817/http://www.audiologicaldiagnostics.com/labyrinthitis|url-status=dead}}</ref> These canals allow the [[brain]] to sense rotational motion and linear motion changes.<ref name=":2">{{Cite journal|date=2017|title=Germany|journal=International Journal of Health Care Quality Assurance|volume=19|issue=4|doi=10.1108/ijhcqa.2006.06219dab.003|issn=0952-6862}}</ref> The brain then uses the sensory input clues and the visual input clues from the vestibular system to retain balance. The [[vestibulo-ocular reflex]] retains continuous visual focus during motion which is also the vestibular system's purpose during activity.<ref name=":2" />

==Treatment==
The treatment for vestibular neuritis depends on the cause. However, symptoms of vertigo can be treated in the same way as other vestibular dysfunctions with vestibular rehabilitation.<ref name="Burton">{{cite journal |author1=Burton M. J. |author2=Monsell E. M. |author3=Rosenfeld R. M. | year = 2008 | title = Extracts from the cochrane library: Vestibular rehabilitation for unilateral peripheral vestibular dysfunction (review) | journal = Otolaryngology–Head and Neck Surgery | volume = 138 | issue = 4| pages = 415–417 | doi=10.1016/j.otohns.2008.02.004|pmid=18359346 |s2cid=9907751 }}</ref>

===Physical therapy===
Typical treatments include combinations of head and eye movements, postural changes, and walking exercises. Specifically, exercises that may be prescribed include keeping eyes fixated on a specific target while moving the head, moving the head right to left at two targets at a significant distance apart, walking while keeping eyes fixated on a specific target, and walking while keeping eyes fixated on a specific target while also turning the head in different directions.<ref name=PT2009>{{cite journal|last=Walker|first=MF|title=Treatment of vestibular neuritis.|journal=Current Treatment Options in Neurology|date=January 2009|volume=11|issue=1|pages=41–5|pmid=19094835|doi=10.1007/s11940-009-0006-8|s2cid=37693582}}</ref>
The main function behind repeating a combination of head and eye movements, postural changes and walking is that through this repetition, compensatory changes for the dysfunctions arising from peripheral vestibular structures may be promoted in the central [[vestibular system]] ([[brainstem]] and [[cerebellum]]).<ref name=PT2009/>

[[Vestibular rehabilitation]] therapy is a highly effective way to substantially reduce or eliminate residual dizziness from labyrinthitis.<ref>{{Cite news|url=https://vestibular.org/understanding-vestibular-disorder/treatment/treatment-detail-page#|title=Vestibular Rehabilitation Therapy (VRT)|date=2011-12-27|work=Vestibular Disorders Association|access-date=2018-05-19|language=en}}</ref> VRT works by causing the brain to use already existing neural mechanisms for adaptation, [[neuroplasticity]], and compensation.<ref name="Burton" /> Vestibular neuritis rehabilitation is an effective and safe management to improve symptoms.<ref name=":12">{{Citation|last1=Fishman|first1=Jonathan M|chapter=Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)|date=2010-07-07|pages=CD008607|editor-last=The Cochrane Collaboration|publisher=John Wiley & Sons, Ltd|language=en|doi=10.1002/14651858.cd008607|last2=Burgess|first2=Chris|last3=Waddell|first3=Angus|title=Cochrane Database of Systematic Reviews}}</ref> The vestibular neuritis rehabilitation can improve symptoms or resolve the symptoms which is dependent on each individual.<ref name=":12" />

Rehabilitation strategies most commonly used are:<ref name="Burton" />

*'''Gaze stability exercises''' – moving the head from side to side while fixated on a stationary object (aimed at assisting the eye to fixate during head rotation without the input from the lost canal [[vestibulo-ocular reflex]]).  An advanced progression of this exercise would be walking in a straight line while looking side to side by turning the head.
*'''Habituation exercises''' – movements designed to provoke symptoms and subsequently reduce the negative vestibular response upon repetition. Examples of these include [[Benign paroxysmal positional vertigo#Brandt–Daroff exercises|Brandt–Daroff exercises]].
*'''Functional retraining''' – including postural control, relaxation, and balance training.

These exercises function by challenging the vestibular system.  Progression occurs by increasing the amplitude of the head or focal point movements, increasing the speed of movement, and combining movements such as walking and head turning.<ref>{{Cite news|url=https://www.fisioterapialabirintica40.com.br/publicacoes|title=Physical Therapy Rehabilitation|access-date=2019-10-29|language=en}}</ref>

One study found that patients who believed their illness was out of their control showed the slowest progression to full recovery, long after the initial vestibular injury had healed.<ref name="Bronstein" /> The study revealed that the patient who compensated well was one who, at the psychological level, was not afraid of the symptoms and had some positive control over them. Notably, a reduction in negative beliefs over time was greater in those patients treated with rehabilitation than in those untreated. "Of utmost importance, baseline beliefs were the only significant predictor of change in a handicap at 6 months follow-up."

===Medication===
Vestibular neuritis is generally a self-limiting disease. Treatment with drugs is neither effective nor necessary. The effect of [[glucocorticoid]]s has been studied, but they have not been found to significantly affect long-term outcome.<ref>{{cite journal |last=Fishman |first=JM |author2=Burgess C |author3=Waddell A |title=Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis) |journal=Cochrane Database Syst Rev |issue=5 |pmid=21563170 |doi=10.1002/14651858.CD008607.pub2 |date=May 2011 |pages=CD008607}}</ref>

[[Symptomatic treatment]] with [[antihistaminic]]s such as [[cinnarizine]], however, can be used to suppress the symptoms of vestibular neuritis while it spontaneously regresses.<ref>{{cite journal |last=Scholtz |first=AW |author2=Steindl R |author3=Burchardi N |author4=Bognar-Steinberg I |author5=Baumann W |title=Comparison of the therapeutic efficacy of a fixed low-dose combination of cinnarizine and dimenhydrinate with betahistine in vestibular neuritis: a randomized, double-blind, non-inferiority study |journal=Clin Drug Investig |volume=32 |issue=6 |pages=387–399 |pmid=22506537 |doi=10.2165/11632410-000000000-00000 |date=June 2012|s2cid=207301804 }}</ref> [[Prochlorperazine]] is another commonly prescribed medication to help alleviate the symptoms of vertigo and nausea.

===Mental disorders===
Because mood disorders can hamper recovery from labyrinthitis, treatment may also include any co-occurring [[anxiety disorder]] or [[clinical depression|depression]]. Severe anxiety episodes are usually addressed by short-term [[benzodiazepine]] therapy.<ref>{{cite journal|last1=Solomon|first1=D|last2=Shepard|first2=NT|title=Chronic Dizziness.|journal=Current Treatment Options in Neurology|date=July 2002|volume=4|issue=4|pages=281–288|pmid=12036501|doi=10.1007/s11940-002-0028-y|s2cid=38952122}}</ref>

==Prognosis==
Recovery from acute labyrinthine inflammation generally takes from one to six weeks, but it is not uncommon for residual symptoms such as dysequilibrium and dizziness to last for a couple of months.<ref name="Bronstein">{{cite journal  | last = Bronstein  | first = Adolfo  | title = Visual and psychological aspects of vestibular disease  | journal = Current Opinion in Neurology  | volume = 15  | issue = 1  | pages = 1–3  | date = February 2002  | doi = 10.1097/00019052-200202000-00001  | pmid = 11796943}}</ref>

Recovery from a temporarily damaged inner ear typically follows two phases:
# An acute period, which may include severe vertigo and vomiting
# approximately two weeks of sub-acute symptoms and rapid recovery

== Epidemiology ==
Labyrinthitis affects approximately 35 million people per year{{dubious|date=November 2023|1=Epidemiology}} (approximately 3.5 cases per 100,000 people).<ref name="Gre201422">{{Cite journal|last1=Greco|first1=A.|last2=Macri|first2=G. F.|last3=Gallo|first3=A.|last4=Fusconi|first4=M.|last5=De Virgilio|first5=A.|last6=Pagliuca|first6=G.|last7=Marinelli|first7=C.|last8=de Vincentiis|first8=M.|date=2014|title=Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo?|journal=Journal of Immunology Research|volume=2014|pages=459048|doi=10.1155/2014/459048|issn=2314-7156|pmc=3987789|pmid=24741601|doi-access=free}}</ref> It typically occurs in those between 30 and 60 years of age,<ref name="Gre201422" /> and there are no significant differences between male and female incidence rates.<ref name="Gre201422" /> In 95% of cases, sufferers experience a single attack and fully recover.<ref>{{Cite web|url=https://my.clevelandclinic.org/health/diseases/15227-vestibular-neuritis|title=Vestibular Neuritis|website=Cleveland Clinic|language=en|access-date=2019-11-15}}</ref> Vestibular rehabilitation showed a statistically significant increase in controlling symptoms over no intervention in people who have vestibular neuritis.<ref>{{Cite journal|last1=McDonnell|first1=Michelle N|last2=Hillier|first2=Susan L|date=2015-01-13|editor-last=Cochrane ENT Group|title=Vestibular rehabilitation for unilateral peripheral vestibular dysfunction|journal=Cochrane Database of Systematic Reviews|volume=1|issue=1 |pages=CD005397|language=en|doi=10.1002/14651858.CD005397.pub4|pmid=25581507|doi-access=free|pmc=11259236}}</ref>

==References==
{{reflist|30em}}

== External links ==
{{Medical resources
| DiseasesDB      = 29290
| ICD10           = {{ICD10|H|81|2|h|80}}, {{ICD10|H|83|0}}
| ICD9            = {{ICD9|386.3}},{{ICD9|386.12}}
| ICDO            = 
| OMIM            = 
| MedlinePlus     = 001054
| eMedicineSubj   = 
| eMedicineTopic  = 
| MeshID          = D007762
| SNOMED CT       = 23919004
}}
{{Hearing and balance}}

[[Category:Inflammations]]
[[Category:Diseases of inner ear]]