What is labyrinthitis?

There are three types of ear infection – inner ear infection, middle ear infection (otitis media) and outer ear infection (otitis externa). Middle ear infections usually affect children, while outer ear infections tend to mostly develop in adults aged 45 to 75 (i). However inner ear infections – including labyrinthitis – can affect anyone.
 
Labyrinthitis causes symptoms such as vertigo, sickness and hearing loss, as a result of inflammation of the labyrinth (the medical term for the inner ear). Responsible for both hearing and balance, the labyrinth sends information to the brain via the vestibulocochlear nerve (one of the eight cranial nerves), and consists of two main parts:
 

• The cochlea (a shell-like structure that’s responsible for hearing by converting vibrations from sounds into nerve impulses that travel to the brain)

• The vestibular system (a network of three fluid-filled semicircular canals positioned roughly at right angles to each other that sense movement and help with your sense of balance)

 

Labyrinthitis vs Vestibular Neuronitis

 
Labyrinthitis is often confused with another condition that causes similar symptoms called vestibular neuritis. In the past the two names were often used interchangeably – in fact, the two are so similar it’s not always possible to tell one from the other.
 
Vestibular neuritis – or vestibular neuronitis – means inflammation of the vestibular nerve, which is part of the vestibulocochlear nerve (the other part is the cochlear nerve). The vestibular nerve transports messages from the semicircular canals of the vestibular system to the brain. However, if you’re experiencing hearing loss along with other associated symptoms the cause is always labyrinthitis. This is because vestibular neuritis doesn’t involve the nerve that’s involved in hearing, the cochlear nerve.
 

Labyrinthitis causes

 
There are different types of labyrinthitis, each of which has a different cause.
 

Viral Labyrinthitis

Viral labyrinthitis, as the name suggests, is caused by a virus. You can develop it after having a sore throat, a cold or the flu, for instance, if the virus spreads to your inner ear. Other viruses that can cause labyrinthitis include:
 

• Herpes simplex virus (the cold sore virus) 

• Epstein-Barr virus (which causes glandular fever)

• Varicella-zoster virus (which causes shingles)

• Viruses that cause respiratory illnesses such as bronchitis 

• Rubeola virus (which causes measles) 

 

Bacterial Labyrinthitis

 
Bacterial labyrinthitis is far less common than viral labyrinthitis but potentially much more serious. It can develop when you have a middle-ear infection caused by bacteria, which then spreads to your inner ear. Most middle-ear infections, however, don’t spread into the inner ear.
 
Other causes of bacterial labyrinthitis include meningitis – this happens when the infection spreads from the brain lining to the inner ear. Having a head injury can also cause bacterial labyrinthitis when it allows bacteria to get into your inner ear.
 
Labyrinthitis can occasionally be a side-effect of some medicines. It can also develop in people who have an autoimmune condition. Smoking, heavy drinking, stress and having a history of allergies may also increase your risk of developing labyrinthitis.
 

How long can labyrinthitis last      

 
While labyrinthitis may not be pleasant, it’s not life-threatening, with symptoms often starting to subside after a few days and full recovery achieved after a few weeks (though some people may feel slightly unsteady for a few months, with symptoms persisting for even longer in a small number of cases). The other good news is that for more than 95 per cent of people who experience labyrinthitis, it doesn’t come back (iii).
 

Labyrinthitis symptoms      

 
The main symptom of labyrinthitis is vertigo. This is a specific type of dizziness that makes you feel as if everything around you is moving or spinning when you’re standing still. This happens because the nerve is inflamed or damaged, and sends different signals to your brain than your normal ear. The two conflicting signals confuses your brain, which reacts by causing vertigo.
 
With labyrinthitis the dizzy sensation often starts suddenly and can be quite intense for a few days. When that happens it can affect your ability to walk or to leave your house, as you may find it hard to balance. The dizziness of vertigo can also be accompanied by feelings of nausea and vomiting, and you may feel worse when you’re moving around.
 
Some people with labyrinthitis also experience mild to total hearing loss on the affected side.
 
Other symptoms and problems that can affect people with labyrinthitis include:
 

• Ear pain (this is usually associated with bacterial labyrinthitis)

• Tinnitus (ringing or other noises in your ear or ears)

• Raised temperature and other symptoms of viral infections

• Fluid or pus leaking out of your ear

• Headache or migraine 

• Involuntary eye movements such as your eyes moving side to side or in a circular movement (this is called nystagmus)

• Problems with your vision (blurred vision or double vision, for instance) 

• Inability to concentrate

• Problems with reading (especially from computer screens)

• Tiredness and fatigue

• Feeling emotional

• Feeling uncomfortable in busy places

 

What causes vertigo      

 
Labyrinthitis is often confused with vestibular neuritis, but there are many things that can cause vertigo. Depending on your symptoms, your doctor may want to rule out the following:
 

• Benign paroxysmal positional vertigo (BPPV): this often triggers a short bout of vertigo when you move your head in a specific way or when you stand up, bend over or turn over in bed

• Vestibular migraine (a type of migraine that causes dizziness and balance problems that can last from five minutes to 72 hours (ii))

• Ramsay Hunt syndrome

• Stroke 

• Ménière's disease 

• Multiple sclerosis 

• Cervical spondylosis (wear and tear of the vertebrae and discs in the neck)

• Carbon monoxide poisoning

• Brain tumours or tumours of the vestibulocochloear nerve (acoustic neuroma)

• Autoimmune inner ear disease

 
Complications of labyrinthitis, meanwhile, include permanent hearing loss – this can happen when a child develops bacterial labyrinthitis from having meningitis. In fact, as many as one in five children will develop hearing loss after having meningitis (iv). Some people, on the other hand, can develop BPPV as a result of having labyrinthitis.
 

Labyrinthitis treatment      

 
If you have any of the symptoms of labyrinthitis it’s important to see a doctor, as labyrinthitis can cause serious problems such as hearing loss and permanent damage to the inner ear if you don’t get any treatment.
 

Viral labyrinthitis treatment

 
If your doctor diagnoses you as having viral labyrinthitis, you won’t need any treatment to clear the virus but you may have to rest until the worst of the dizziness and other symptoms have subsided. There are drugs available on prescription to tackle nausea and vomiting if you need them, plus some medicines can help ease the sensation of vertigo. Steroid medication can also help reduce the inflammation in your inner ear if you have particularly severe symptoms. However you shouldn’t expect to take any of these medications for more than a few days, as experts believe taking medication for longer can mean you’ll take longer to recover fully.
 

Bacterial labyrinthitis treatment

 
If you have bacterial labyrinthitis you’ll need antibiotics to clear the infection. However if you have a sudden attack of vertigo with deafness in one ear, get medical help immediately, as it could be a sign that the blood vessels to part of your brain are blocked and need urgent treatment.
 
In either case, if your symptoms don’t improve after three weeks your GP will usually refer you to a hospital specialist who may recommend vestibular rehabilitation therapy. This is a specific type of physiotherapy designed to treat vertigo and balance disorders that works by retraining the brain’s ability to adjust.
 
Vestibular rehabilitation therapy includes exercises that you have to do throughout the day. Your therapist will show you how to do them properly, but to give you an idea of what they entail here are a couple of examples:
 
Exercise 1: Sit down and choose an object that you can focus on at eye level. Keep looking at it while turning your head one way and then the other. Keep practising and gradually increase the amount of time you do this exercise until you can do it for one minute without stopping. To make things more difficult, try doing the same exercise while standing up. Then try doing it while walking forwards and backwards (make sure there’s something you can hold on to if you feel suddenly dizzy and need support)
 
Exercise 2: Start by standing up straight, feet together. When you feel ready, try to balance on one leg – build up to standing on one leg for 20 seconds. Remember to do the same on the other leg too. When you start to find this exercise easy, try closing your eyes at the same time – but again, make sure there’s something you can hold on to for support if you need it. 
 

Labyrinthitis treatment at home      

 
In the early stages of labyrinthitis you may feel constantly dizzy, if this happens, the only thing you’ll be able to do is to rest. When you feel suddenly dizzy, sit down immediately, and avoid any sudden movements or changes in your position. When the dizziness is so severe that you can’t stand up without feeling you’re going to fall over, it’s a good idea to lie down and close your eyes – try lying on your side, as this may be helpful. After lying down, sit up very slowly and wait for a few more moments before you stand up.
 
It’s also really important to always avoid driving, using tools and machinery and working at heights if you’re experiencing vertigo or taking medication for vertigo symptoms.
 
To help reduce the sensation of dizziness, you should avoid bright lights and anything that may add to your stress levels. Avoid activities like watching TV or reading during vertigo, as they can exacerbate symptoms. Steer clear of smoking and being around smokers, and limit alcohol and caffeine intake for added comfort. Consider stress-reduction practices like mindfulness, deep breathing, meditation, yoga, or t'ai chi when possible    
 
Meanwhile if you have labyrinthitis and you’re feeling sick and vomiting, try to take frequent sips of water to avoid becoming dehydrated.
 
Finally, as soon as your dizziness starts to subside, try to get outside for a gentle walk once a day, gradually increasing the distance you walk each time. It may feel strange at first – it may even make you feel worse initially – but doing some gentle exercise such as walking can really help with your recovery.
 
Other lifestyle choices you can make to help you cope more effectively with labyrinthitis include getting plenty of sleep and eating a healthy, nutritious diet. Certain nutritional supplements may also be useful, including a multivitamin and mineral supplement to make sure you’re getting all the essential nutrients you need, especially if your symptoms stop you cooking or if you don’t feel like eating very much.
 
Find out more about multivitamin and mineral supplements by reading our guide to multivitamins and daily requirements. Other nutritional and herbal supplements that may be beneficial include the following:
 

Ginkgo biloba

 
Used for a range of health problems in traditional Chinese herbal medicine – and taken most commonly these days to help boost blood circulation and memory – ginkgo may also help relieve the symptoms of vertigo. For instance, there’s evidence that ginkgo extract works better than a placebo (dummy pill) at reducing vertigo symptoms, with 47 per cent of people recovering after three months compared with just 18 per cent of those taking a placebo (vi).
 
Other researchers have found that ginkgo extract may be as effective as a popular anti-vertigo drug called betahistine (vii). Another study suggests ginkgo may help reduce dizziness, this time in people who have been treated for BPPV (viii).
 
Several medications can interact with ginkgo, so check with your GP before taking it if you’re also taking any prescription medicines.
 

Vitamin D   

 
Dizziness is often associated with vitamin D deficiency, with some studies suggesting it may lead to BPPV (ix). One small-scale study has also found that treating people with BPPV and low vitamin D levels by giving them supplements leads to fewer episodes of vertigo when compared to others with BPPV who don’t take vitamin D (x). Meanwhile researchers suggest vitamin D supplements may provide additional benefits to people with vitamin D deficiency who are having a type of rehabilitation therapy called the Epley manoeuvre to help with BPPV (xi).
 
Vitamin D deficiency is common in the UK, especially during autumn and winter when sunlight exposure is limited. The Department of Health and Social Care recommends a daily 10-microgram vitamin D supplement for all UK residents during these periods and year-round for those at high risk, including individuals who are housebound, frequently indoors, wear sun-protective clothing, or have darker skin.      
 
The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, plus you can now get them in veggie-friendly drops too. Most vitamin D3 supplements, however, are made from the fat of lamb’s wool, which means they’re unsuitable for vegans – but thankfully vegan vitamin D3 supplements sourced from lichen are now more widely available.
 

B complex

 
Low levels of vitamin B12 have also been linked with dizziness, vertigo, lack of co-ordination and generally feeling off-balance. You can become deficient in this nutrient if you don’t eat many foods that contain it – if you’re following a vegetarian or vegan diet, for instance – or if you’re taking certain medicines that are thought to cause vitamin B12 depletion. Vitamin B12 foods include meat, dairy foods and fortified products such as cereals. However supplements are widely available (including products that are suitable for vegetarians and vegans), or you may prefer to take a B complex formula, as these can help make sure you’re getting your fair share of all the B vitamins.
 

Ginger

 
It may alleviate vertigo-related nausea by promoting digestive fluids and neutralising acids in the gut. Research suggests ginger can also help with motion sickness, a common treatment for vertigo-induced nausea. Powdered ginger root has shown promise in reducing induced vertigo compared to a placebo.    
 

Lysine  

Often called L-lysine this is an essential amino acid, which means you have to get it from foods or supplements because your body cannot make its own supply. Unfortunately, however, some of the symptoms you may experience if you’re low in lysine include nausea and dizziness (xv). Additionally, according to the Vestibular Disorders Association, there’s anecdotal evidence lysine may help reduce vertigo (xvi).
 
Foods that contain lysine include protein-rich foods such as meat, poultry, eggs, cheese and fish, with lower levels found in plant-based foods including soya foods, peas, peanuts and lentils. You can also find lysine in nutritional supplements, including products that can be safely taken by vegetarians and vegans.
 

Need more information?

 
Labyrinthitis is just one condition that can cause vertigo and nausea. You can read more about vertigo and some of its causes in our guide to vertigo causes and treatments. Persistent postural perceptual dizziness (PPPD) can also cause persistent dizziness  and light-headedness – find out more about it by reading What is PPPD? Meanwhile there’s lots more information about a wide range of health issues in our pharmacy health library.

References:

1. Available online: https://www.nhs.uk/conditions/ear-infections/

2. Available online: https://patient.info/doctor/vestibular-neuritis-and-labyrinthitis-pro

3. Available online: https://www.royalberkshire.nhs.uk/media/xvzp12xv/labyrinthitis-and-neuritis_feb20.pdf

4. Available online: https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/labyrinthitis#complications-of-labyrinthitis

5. Available online: https://patient.info/signs-symptoms/dizziness/vestibular-neuritis-and-labyrinthitis-causes-and-treatment

6. Haguenauer JP et al., Treatment of equilibrium disorders using Ginkgo biloba extract. A multicenter, double-blind, drug versus placebo study [translated from French]. Presse Med. 1986;15:1569-1572. Available online: https://pubmed.ncbi.nlm.nih.gov/2947102/#:~:text=The effectiveness of Ginkgo biloba,those who received the placebo.

7. Sokolova L, Hoerr R, Mishchenko T. Treatment of vertigo: a randomized, double-blind trial comparing efficacy and safety of ginkgo biloba extract EGb 761 and betahistine. Int J of Otolaryngology. 2014:682439. Available online: https://pubmed.ncbi.nlm.nih.gov/25057270-treatment-of-vertigo-a-randomized-double-blind-trial-comparing-efficacy-and-safety-of-ginkgo-biloba-extract-egb-761-and-betahistine/

8. Swain SK, Behera IC, Sahu MC. Role of Ginkgo biloba for controlling residual dizziness after successful treatment of benign paroxysmal positional vertigo: Our experiences at a tertiary care teaching hospital of Eastern India. Int J of Health & Allied Sci 2018, vol 7, issue 3, pages 196-200. Available online: https://www.ijhas.in/article.asp?issn=2278-344X;year=2018;volume=7;issue=3;spage=196;epage=200;aulast=Swain

9. Jeong SH et al. Decreased serum

10. Sheikhzadeh M et al., Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study. Caspian J Intern Med 2016 Spring; 7(2): 93-98. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913711/

11. Available online: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/

12. Betz O et al., Is ginger a clinically relevant antiemetic? A systematic review of randomized controlled trials. Forsch Komplementarmed Klass Naturheilkd. 2005;12:14-23. Available online: https://pubmed.ncbi.nlm.nih.gov/15772458-is-ginger-a-clinically-relevant-antiemetic-a-systematic-review-of-randomized-controlled-trials/

13. Grontved A, Hentzer E. Vertigo-reducing effect of ginger root. A controlled clinical study. ORL J Otorhinolaryngol Relat Spec. 1986;48(5):282-6. Available online: https://pubmed.ncbi.nlm.nih.gov/3537898-vertigo-reducing-effect-of-ginger-root-a-controlled-clinical-study/

14. Available online: https://www.mountsinai.org/health-library/supplement/lysine

15. Available online: https://vestibular.org/article/diagnosis-treatment/treatments/complementary-alternative-medicine/supplements

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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