Labyrinthitis

affecting the labyrinth and other structures inside the ear; it is a "one-sided alteration of vestibular function.

Inner Ear Labyrinth

Before proceeding with the analysis of the labyrinthitis, let us briefly remember that the labyrinth corresponds to a small internal auricular portion, consisting of organs used to maintain balance and to listen to words and music. The labyrinth, containing the nerve of the ear , is normally filled with a fluid (endolymph) that detects the slightest movements of the head: if the brain receives the order to rotate or move the head, the liquid contained inside the labyrinth moves, thus stimulating the ear nerve indoor.

After this premise, it is evident how a loss of functionality of the labyrinth can cause balance disturbances, up to, in severe cases, hearing loss and the formation of permanent tinnitus.
It should be pointed out that labyrinthitis is not synonymous with dizziness: these two terms are often mistaken as equivalent; in reality, vertigo is a symptom common to several pathologies, while labyrinthitis is recognized as a disease in all respects.

and "acute otitis: an" infection affecting the upper respiratory tract could spread up to the level of the inner ear. In the etiopathological research of labyrinthitis, head injuries, violent allergic reactions to a drug (especially antibiotics ) or to another substance, and extreme stress.
Generally, labyrinthitis manifests itself in its serous variant, as a consequence of the passage of bacteria or toxins through an ear canal (perilymphatic fistula of the lateral semicircular canal): in this case, the patient suffering from labyrinthitis complains of dizziness of varying intensity , generally transitory and occasional. It has been observed that some factors or situations can predispose the patient to suffer attacks of labyrinthitis: a particularly violent cough, a sudden movement or, again, an effort led to excess, can constitute elements of risk for the manifestation of labyrinthitis crises, especially in predisposed subjects.
Following meningitis or meningoencephalitis, labyrinthitis can also manifest itself in the purulent variant, responsible for the progressive and inevitable damage to the internal structures of the labyrinth: in this case, the symptoms, always sudden, materialize in the loss of balance and functionality of the vestibular system in general, and in the disappearance of hearing capacity. The hearing loss is unfortunately irreversible and almost always total.

Labyrinthitis begins with generally acute and violent symptoms, in which dizziness constitutes the common element in all patients who are affected by it. In addition to this mini-manifestation, labyrinthitis can involve: anxiety, confusion, difficulty in maintaining balance, ringing in the ears (tinnitus), dizziness, nausea, nystagmus, stomach pain, paleness and hearing loss.
These symptoms essentially derive from a "sudden inability of the vestibular system to ensure the" equilibrium of the organism: we are witnessing a blockage of the regulation of this complex system, involved in the detection of the change of motion of the person. Not surprisingly, all the symptoms listed above may occur, albeit to a lesser extent, even during a trip by plane, ship or diving.

it is a very common symptom in the context of labyrinthitis, responsible for the manifestation of panic attacks, depression, palpitations and tremors, which certainly do not help the disease in progress, rather aggravate the problem by prolonging the healing times. Not surprisingly, panic attacks are some of the very first symptoms that occur almost simultaneously with the crises of labyrinthitis.

While dizziness can appear in the case of particularly severe anxiety, without however precipitating into more complex disorders, labyrinthitis can lead to serious problems, such as depression and panic attacks.

, proceeds with the physical examination, useful to ascertain if the dizziness and the sensation of loss of balance are due to a problem of the vestibular system and the labyrinth. In some cases, patients are subjected to specific tests, useful for inducing dizziness: although this test is not kindly accepted by patients, it is often indispensable for diagnostic purposes.
The assessment of the diagnosis proceeds by subjecting the affected patient to a series of more or less complex tests; the choice of test clearly depends on the intensity of the symptoms and the difficulty of ascertaining the disease. Among the most popular tests, we remember:

1. Test of the auditory response of the brainstem: this test, which consists in the application of special earphones to the patient in which some sounds or words are reproduced, is useful for verifying the patient's response to stimuli;
2. Electronystagmography: this diagnostic test is used to analyze vestibular disorders and is useful for analyzing any further inability to control balance. The technique uses electrodes that are placed around the patient's eyes and forehead; , these electrodes are connected to an apparatus which amplifies and records the voluntary ocular motion induced by several factors (luminous, sensory, positioning stimulation, etc.);
3. Bacterial culture test: since labyrinthitis is often caused by bacteria, the culture test is essential to identify the pathogen responsible for the disease;
4. CT scan (computerized axial tomography): the patient undergoes a CT scan, a radiological diagnostic examination in which ionizing radiation is used to obtain detailed images of the patient's skull;
5. MRI (magnetic resonance tomography): This diagnostic test is used to reproduce images of the brain, including the capillaries and structures of the head. From the result it is possible to detect any brain lesions associated with labyrinthitis.

and the symptoms accompanying the disorder. When labyrinthitis depends on a bacterial insult, antibiotics are the most commonly used drugs in therapy, while antivirals (eg. Aciclovir, valaciclovir) are indicated to kill the virus: the removal of the pathogen, consequently, also involves the healing of the labyrinthitis (mild form). Furthermore, since the disease is accompanied by dizziness and loss of balance associated with nausea and vomiting, antiemetic drugs can be a valuable aid; there are also specific drugs for the control of vertigo: these active ingredients are essential to cancel the feeling of loss, to relax and calm the patient who is affected by them. Anticholinergic drugs (e.g. prochlorperazine) are the most used for this purpose. Steroids (eg prednisone) are occasionally prescribed to reduce inflammation, especially in cases of proven viral labyrinthitis.
Furthermore, we have seen that labyrinthitis is often closely linked to anxiety disorders and depression: for this reason, it is possible to take specific drugs, such as benzodiazepines (eg diazepam) and selective serotonin reuptake inhibitor drugs. It is recommended to respect the guidelines. doses prescribed by your doctor and not to stop treatment suddenly.

Clinical evidence shows that SSRIs are particularly useful for relieving symptoms accompanying labyrinthitis, as well as speeding up recovery.
When drugs are not sufficient to ensure definitive healing, the patient can be subjected to invasive treatments, such as surgery: this technique corrects some damage to the ear and head, in turn implicated in the onset of labyrinthitis.
As a completion of the labyrinthitis therapy, it is possible to direct the patient towards the so-called "vestibular rehabilitation", which essentially consists of specific exercises aimed at improving balance and removing dizziness.
It is recommended to start the therapy as soon as possible after the diagnosis of labyrinthitis: in this way, it is possible to avoid permanent damage to the ear.

For further information: Drugs to Treat Labyrinthitis