Labyrinthitis

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Labyrinthitis
Other namesOtitis interna, vestibular neuronitis, vestibular neuritis
Gray920.png
Diagram of the inner ear
SpecialtyOtorhinolaryngology
Frequency35 million per year[1]

Labyrinthitis, also known as vestibular neuritis,[2][3] is the inflammation of the inner ear.[4] Vestibular neuritis derives its name from the labyrinths that house the vestibular system, which senses changes in the head's position or the head's motion.[5] This results in a sensation of the world spinning and also possible hearing loss or ringing in the ears.[5] 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 nystagmus.

The cause is often not clear. It may be due to a virus, but it can also arise from bacterial infection, head injury, extreme stress, an allergy, or as a reaction to medication. 30% of affected people had a common cold prior to developing the disease.[1] Either bacterial or viral labyrinthitis can cause a permanent hearing loss in rare cases.[6] This appears to result from an imbalance of neuronal input between the left and right inner ears.[7]

Signs and symptoms[edit]

The main symptoms of labyrinthitis are severe vertigo and nystagmus. The most common symptom for vestibular neuritis is the onset of vertigo that has formed from an ongoing infection or trauma.[8] The dizziness sensation that is associated with vertigo is thought to be from the inner ear labyrinth.[9] Rapid and undesired eye motion (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.[10]

Causes[edit]

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.[7] 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.[11]

This can also be brought on by pressure changes such as those experienced while flying or scuba diving.[12][13][14]

Mechanism[edit]

In the vestibular system, there are three canals that are semicircular in shape that input sensory clues.[15] These canals allow the brain to sense rotational motion and linear motion changes.[16] 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 systems job during activity.[16]

Treatment[edit]

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.[17]

Physical therapy[edit]

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.[18] 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).[18]

Vestibular rehabilitation therapy is a highly effective way to substantially reduce or eliminate residual dizziness from labyrinthitis.[19] VRT works by causing the brain to use already existing neural mechanisms for adaptation, neuroplasticity, and compensation.[17] Vestibular neuritis rehabilitation is an effective and safe management to improve symptoms.[20] The vestibular neuritis rehabilitation can improve symptoms or resolve the symptoms which is dependent on each individual. [20]

Rehabilitation strategies most commonly used are:[17]

  • 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 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.[21]

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.[22] 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[edit]

Vestibular neuritis is generally a self-limiting disease. Treatment with drugs is neither necessary nor possible. The effect of glucocorticoids has been studied, but they have not been found to significantly affect long-term outcome.[23]

Symptomatic treatment with antihistaminics such as cinnarizine, however, can be used to suppress the symptoms of vestibular neuritis while it spontaneously regresses.[24] Prochlorperazine is another commonly prescribed medication to help alleviate the symptoms of vertigo and nausea.

Other[edit]

Because mood disorders can interfere with the vestibular compensation and adaptive plasticity, it suggested to address any co-occurring anxiety disorder and/or depression. Severe anxiety episodes are usually addressed by short-term benzodiazapine therapy. Long-term use of benzodiazapines such as diazepam, however, is not recommended due to the tolerance issues.[25] SSRIs and SSNRIs are among a number of first - line treatments for anxiety or depression. [26]

Prognosis[edit]

Recovery from acute labyrinthine inflammation generally takes from one to six weeks, but it is not uncommon for residual symptoms (dysequilibrium and/or dizziness) to last for a couple of months.[22]

Recovery from a temporary damaged inner ear typically follows two phases:

  1. An acute period, which may include severe vertigo and vomiting
  2. approximately two weeks of sub-acute symptoms and rapid recovery

Epidemiology[edit]

Vestibular neuritis also known as labyrinthitis affects approximately 35 million people per year.[27] Vestibular neuritis typically occurs in those between 30 and 60 years of age.[27] There is no significant gender difference when determining who will get this disease.[27] In 95% of cases, vestibular neuritis is a one-time experience that results in most people fully recovering from it.[28] Vestibular rehabilitation showed a statistically significant increase in controlling symptoms over no intervention in people who have vestibular neuritis.[29]

References[edit]

  1. ^ a b Greco, A; Macri, GF; Gallo, A; Fusconi, M; De Virgilio, A; Pagliuca, G; Marinelli, C; de Vincentiis, M (2014). "Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo?". Journal of Immunology Research. 2014: 459048. doi:10.1155/2014/459048. PMC 3987789. PMID 24741601.
  2. ^ Ferri's Clinical Advisor 2016: 5 Books in 1. Elsevier Health Sciences. 2015. p. 735. ISBN 9780323378222.
  3. ^ Hogue, JD (June 2015). "Office Evaluation of Dizziness". Primary Care. 42 (2): 249–258. doi:10.1016/j.pop.2015.01.004. PMID 25979586.
  4. ^ "Labyrinthitis". National Library of Medicine. Retrieved 16 March 2018.
  5. ^ a b "Clinical Methods: The History, Physical, and Laboratory Examinations". Annals of Internal Medicine. 113 (7): 563. 1990-10-01. doi:10.7326/0003-4819-113-7-563_2. ISSN 0003-4819.
  6. ^ "NLM".
  7. ^ a b Marill, Keith (2011-01-13). "Vestibular Neuronitis: Pathology". eMedicine, Medscape Reference. Retrieved 2011-08-07.
  8. ^ Dewyer, Nicholas A.; Kiringoda, Ruwan; McKenna, Michael J. (2018), "Inner Ear Infections (Labyrinthitis)", Infections of the Ears, Nose, Throat, and Sinuses, Springer International Publishing, pp. 79–88, doi:10.1007/978-3-319-74835-1_7, ISBN 978-3-319-74834-4
  9. ^ Murdin, Louisa; Hussain, Kiran; Schilder, Anne GM (2013-08-11), "Betahistine for symptoms of vertigo", in The Cochrane Collaboration (ed.), Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, pp. CD010696, doi:10.1002/14651858.cd010696
  10. ^ "Table 1: The Single Nucleotide Polymorphisms in cathepsin B protein mined from literature (PMID: 16492714)". doi:10.7717/peerj.7425/table-1. Cite journal requires |journal= (help)
  11. ^ Keith A Marill. "Vestibular Neuronitis". Retrieved 2008-06-28.
  12. ^ Martin-Saint-Laurent A, Lavernhe J, Casano G, Simkoff A (March 1990). "Clinical aspects of inflight incapacitations in commercial aviation". Aviation, Space, and Environmental Medicine. 61 (3): 256–60. PMID 2317181.
  13. ^ Farmer, Jr JC, ed. (1973). Labyrinthine Dysfunction During Diving. 1st Undersea and Hyperbaric Medical Society Workshop. UHMS Publication Number WS6-15-74. Undersea and Hyperbaric Medical Society. p. 11. Retrieved 2009-03-11.
  14. ^ Kennedy RS (March 1974). "General history of vestibular disorders in diving". Undersea Biomedical Research. 1 (1): 73–81. PMID 4619861. Retrieved 2009-03-11.
  15. ^ "Labyrinthitis". www.audiologicaldiagnostics.com. Retrieved 2019-12-02.
  16. ^ a b "Germany". International Journal of Health Care Quality Assurance. 19 (4). 2017. doi:10.1108/ijhcqa.2006.06219dab.003. ISSN 0952-6862.
  17. ^ a b c Burton M. J.; Monsell E. M.; Rosenfeld R. M. (2008). "Extracts from the cochrane library: Vestibular rehabilitation for unilateral peripheral vestibular dysfunction (review)". Otolaryngology–Head and Neck Surgery. 138 (4): 415–417. doi:10.1016/j.otohns.2008.02.004. PMID 18359346.
  18. ^ a b Walker, MF (January 2009). "Treatment of vestibular neuritis". Current Treatment Options in Neurology. 11 (1): 41–5. doi:10.1007/s11940-009-0006-8. PMID 19094835.
  19. ^ "Vestibular Rehabilitation Therapy (VRT)". Vestibular Disorders Association. 2011-12-27. Retrieved 2018-05-19.
  20. ^ a b Fishman, Jonathan M; Burgess, Chris; Waddell, Angus (2010-07-07), "Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)", in The Cochrane Collaboration (ed.), Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, pp. CD008607, doi:10.1002/14651858.cd008607
  21. ^ "Physical Therapy Rehabilitation". Retrieved 2019-10-29.
  22. ^ a b Bronstein, Adolfo (February 2002). "Visual and psychological aspects of vestibular disease". Current Opinion in Neurology. 15 (1): 1–3. doi:10.1097/00019052-200202000-00001. PMID 11796943.
  23. ^ Fishman, JM; Burgess C; Waddell A (May 2011). "Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)". Cochrane Database Syst Rev (5): CD008607. doi:10.1002/14651858.CD008607.pub2. PMID 21563170.
  24. ^ Scholtz, AW; Steindl R; Burchardi N; Bognar-Steinberg I; Baumann W (June 2012). "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". Clin Drug Investig. 32 (6): 387–399. doi:10.2165/11632410-000000000-00000. PMID 22506537.
  25. ^ Solomon, D; Shepard, NT (July 2002). "Chronic Dizziness". Current Treatment Options in Neurology. 4 (4): 281–288. doi:10.1007/s11940-002-0028-y. PMID 12036501.
  26. ^ Vries, Ya (March 2016). "Influence of baseline severity on antidepressant efficacy for anxiety disorders: meta-analysis and meta-regression". British Journal of Psychiatry. 208 (6): 515–21. doi:10.1192/bjp.bp.115.173450. PMID 26989093.
  27. ^ a b c Greco, A.; Macri, G. F.; Gallo, A.; Fusconi, M.; De Virgilio, A.; Pagliuca, G.; Marinelli, C.; de Vincentiis, M. (2014). "Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo?". Journal of Immunology Research. 2014: 459048. doi:10.1155/2014/459048. ISSN 2314-7156. PMC 3987789. PMID 24741601.
  28. ^ "Vestibular Neuritis". Cleveland Clinic. Retrieved 2019-11-15.
  29. ^ McDonnell, Michelle N; Hillier, Susan L (2015-01-13). Cochrane ENT Group (ed.). "Vestibular rehabilitation for unilateral peripheral vestibular dysfunction". Cochrane Database of Systematic Reviews. 1: CD005397. doi:10.1002/14651858.CD005397.pub4. PMID 25581507.

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