Labyrinthitis

Definition:
The labyrinth is a group of interconnected canals chambers located in the inner ear. It is made up of the cochlea and the semicircular canals. The cochlea is involved in transmitting sounds to the brain. The semicircular canals send information to the brain about the head’s position and how it is moving. The brain uses this information to maintain balance. Labyrinthitis is caused by the inflammation of the labyrinth. Its most frequent symptom is vertigo ( dizziness ), because the information that the semicircular canals send to the brain about the position of the head is affected.
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The labyrinth is a system of narrow fluid-filled channels in the inner ear, which is involved in the detection of body movement, helping to control balance and posture.

Labyrinthitis can cause balance disorders.

In addition to balance control problems, a labyrinthitis patient may encounter hearing loss and tinnitus. Labyrinthitis is usually caused by a virus, but it can also arise from bacterial infection, head injury, extreme stress, an allergy or as a reaction to a particular medication. Both bacterial and viral labyrinthitis can cause permanent hearing loss, although this is rare.

Labyrinthitis often follows an upper respiratory tract infection (URI).

Labyrinthitis is rare and is more likely to occur after middle ear infections, meningitis , or upper respiratory infection. It may also occur after trauma, because of a tumor, or after the ingesting of toxic substances. It is thought to be more common in females than in males.

Symptoms:
•The most common symptoms

*Vertigo

*Nausea

*Vomiting

*Loss of balance

Other possible symptoms are:

*A mild headache

*Tinnitus (a ringing or rushing noise)

*Hearing loss

•These symptoms often are provoked or made worse by moving your head, sitting up, rolling over, or looking upward.

•Symptoms may last for days or even weeks depending on the cause and severity.

*Symptoms may come back, so be careful about driving, working at heights, or operating heavy machinery for at least 1 week from the time the symptoms end.

*Rarely, the condition may last all your life, as with Meniere’s disease. This condition usually involves tinnitus and hearing loss with the vertigo. In rare cases it can be debilitating.

Causes:
Many times, you cannot determine the cause of labyrinthitis. Often, the condition follows a viral illness such as a cold or the flu. Viruses, or your body’s immune response to them, may cause inflammation that results in labyrinthitis.

Other potential causes are these:

•Trauma or injury to your head or ear

•Bacterial infections: If found in nearby structures such as your middle ear, such infections may cause the following:

*Fluid to collect in the labyrinth (serous labyrinthitis)

*Fluid to directly invade the labyrinth, causing pus-producing (suppurative) labyrinthitis

•Allergies

•Alcohol abuse

•A benign tumor of the middle ear

•Certain medications taken in high doses

*Furosemide (Lasix)

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*Aspirin

*Some IV antibiotics

*Phenytoin (Dilantin) at toxic levels

•Benign paroxysmal positional vertigo: With this condition, small stones, or calcified particles, break off within the vestibule and bounce around. The particles trigger nerve impulses that the brain interprets as movement.

•More serious causes of vertigo can mimic labyrinthitis, but these occur rarely.

*Tumors at the base of the brain

*Strokes or insufficient blood supply to the brainstem or the nerves surrounding the labyrinth

Diagnosis
Diagnosis of labyrinthitis is based on a combination of the individual’s symptoms and history, especially a history of a recent upper respiratory infection. The doctor will test the child’s hearing and order a laboratory culture to identify the organism if the patient has a discharge.

If there is no history of a recent infection, the doctor will order tests such as a commuted topography (CT) scan or a magnetic resonance imaging (MRI) scan to help rule out other possible causes of vertigo, such as tumors. If it is believed a bacterium is causing the labyrinthitis, blood tests may be done, or any fluid draining from the ear may be analyzed to help determine what type of bacteria is present.

 

Labyrinthitis, or inner ear infection, causes the labyrinth area of the ear to become inflamed.
(Illustration by GGS Information Services.)
Recovery:
Recovery from acute labyrinthine inflammation generally takes from one to six weeks; however, it is not uncommon for residual symptoms (dysequilibrium and/or dizziness) to last for many months or even years[5] if permanent damage occurs.

Recovery from a permanently damaged inner ear typically follows three phases:

1.An acute period, which may include severe vertigo and vomiting
2.approximately two weeks of sub-acute symptoms and rapid recovery
3.finally a period of chronic compensation[clarification needed] which may last for months or years.

Labyrinthitis and anxiety:
Chronic anxiety is a common side effect of labyrinthitis which can produce tremors, heart palpitations, panic attacks, derealization and depression. Often a panic attack is one of the first symptoms to occur as labyrinthitis begins. While dizziness can occur from extreme anxiety, labyrinthitis itself can precipitate a panic disorder. Three models have been proposed to explain the relationship between vestibular dysfunction and panic disorder:

*Psychosomatic model: vestibular dysfunction which occurs as a result of anxiety.

*Somatopsychic model: panic disorder triggered by misinterpreted internal stimuli (e.g., stimuli from vestibular dysfunction), that are interpreted as signifying imminent physical danger. Heightened sensitivity to vestibular sensations leads to increased anxiety and, through conditioning, drives the development of panic disorder.

*Network alarm theory: panic which involves noradrenergic, serotonergic, and other connected neuronal systems. According to this theory, panic can be triggered by stimuli that set off a false alarm via afferents to the locus ceruleus, which then triggers the neuronal network. This network is thought to mediate anxiety and includes limbic, midbrain and prefrontal areas. Vestibular dysfunction in the setting of increased locus ceruleus sensitivity may be a potential trigger.
Treatment:
Vestibular rehabilitation therapy (VRT) is a highly effective way to substantially reduce or eliminate residual dizziness from labyrinthitis. VRT works by causing the brain to use already existing neural mechanisms for adaptation, plasticity, and compensation.

Rehabilitation strategies most commonly used are:
*Gaze stability exercises – moving the head from side to side while fixated on a stationary object (aimed to restore the 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.

 

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.  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 handicap at 6 months followup.”

Prochlorperazine is commonly prescribed to help alleviate the symptoms of vertigo and nausea.

Because anxiety interferes with the balance compensation process, it is important to treat an anxiety disorder and/or depression as soon as possible to allow the brain to compensate for any vestibular damage. Acute anxiety can be treated in the short term with benzodiazepines such as diazepam (Valium); however, long-term use is not recommended because of the addictive nature of benzodiazepines and the interference they may cause with vestibular compensation and adaptive plasticity.  Benzodiazepines and any other form of mind or mood altering addictive drug should not be used on patients with addictive history.

Prognosis :
Most people who have labyrinthitis recover completely, although it often takes five to six weeks for the vertigo to disappear entirely and the individual’s hearing to return to normal. In a few cases, the hearing loss may be permanent. Permanent hearing loss is more common in cases of labyrinthitis that are caused by bacteria. For some individuals, episodes of dizziness may still occur months after the main episode is over.

Prevention :
The most effective preventive strategy includes prompt treatment of middle ear infections, as well as monitoring of patients with mumps, measles, influenza, or colds for signs of dizziness or hearing problems.

Parental concerns:
Labyrinthitis generally resolves by itself; however, in some cases permanent hearing loss can result. Labyrinthitis may cause repeated episodes of vertigo even after the main symptoms have gone away. If the episodes occur when the head is moved suddenly, this can make it difficult for a child to engage in some physical activities or sports .

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Resources:
http://www.bbc.co.uk/health/physical_health/conditions/labyrinthitis.shtml
http://www.healthofchildren.com/L/Labyrinthitis.html
http://www.dizziness-and-balance.com/disorders/unilat/vneurit.html
http://en.wikipedia.org/wiki/Labyrinthitis

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