Labyrinthitis and vestibular neuritis are two types of inner ear infections, which are different and less common than typical middle ear infections.
Inner ear infections can lead to a severe form of dizziness, called vertigo, as well as hearing symptoms.
Most inner ear infections are caused by a virus and will go away on their own in a couple of days.
There are three categories of ear infections based on the part of the ear that is affected. When most people talk about an ear infection, they’re likely thinking of a middle ear infection. Swimmer’s ear — an infection of the outer ear — is also common. Inner ear infections are the least common, and so people are less familiar with the symptoms. But the symptoms can be quite disconcerting.
To understand inner ear infections, let’s first examine the parts of the inner ear. It consists of three main parts:
The cochlea:This is the part of the ear that helps the body hear sounds.
The vestibule and semicircular canals: These structures are important for balance.
Sometimes, infections — either viral or bacterial — can cause inflammation of the nerves and structures of the inner ear. When that happens, it can affect both our balance and hearing.
What are symptoms of an inner ear infection?
There are two types of inner infections:
Vestibular neuritis is an infection of the vestibule and semicircular canals.
Labyrinthitis is an infection of the entire inner ear, including the cochlea.
Unlike middle and outer ear infections, pain is not a symptom of inner ear infections. Vestibular neuritis leads to dizziness, nausea and vomiting, and inability to balance. This is called vertigo and can often make you feel as if the room is spinning. Vertigo is often worse when you move your head, stand up, or try to walk. Getting out of bed and walking to the bathroom might feel impossible.
Labrynthitis can lead to vertigo, just like vestibular neuritis. But because it also affects the cochlea, it can lead to hearing changes as well. This can be a ringing in the ears or temporarily decreased hearing. Sometimes the hearing loss is subtle, and you might not realize your hearing is different.
How is an inner ear infection diagnosed?
Inner ear infections are usually diagnosed based on your symptoms and a physical exam. Many times, a healthcare provider can diagnose an inner ear infection on symptoms alone. And that’s good, because it’s impossible to directly look at the inner parts of the ear on a physical exam. Your provider may also examine your eyes, because certain eye movements get affected when our balance is a little off.
Most of the time, no specific testing is needed to diagnose an inner ear infection. But if the diagnosis is a little less certain, it’s possible that your provider will recommend an additional evaluation. This may include:
Imaging of your head, such as a CT scan or an MRI
A formal hearing test to see if that is also affected
A referral to an ear, nose, throat (ENT) specialist
Inner ear infections are mostly caused by viruses, so there is no role for antibiotics (which treat bacteria). But the good news is that the infection usually resolves on its own in a few days.
And while you are recovering, there are medicines that can help decrease your symptoms:
Antiemetics: These are medicines that help with nausea and vomiting. Examples include ondansetron or promethazine.
Antihistamines: These include diphenhydramine (Benadryl) or meclizine. In addition to helping the dizziness, these medicines can also help you get some much-needed rest.
Sometimes, steroids are prescribed to decrease the inflammation from inner ear infections. But there is no convincing evidence that shows this helps, and so this treatment remains controversial.
What’s the bottom line?
Inner ear infections — both vestibular neuritis and labyrinthitis — are usually viral infections that resolve on their own. Although the diagnosis is usually an easy one to make, it is still a good idea to see your healthcare provider when experiencing these symptoms. They can rule out other possible conditions and also provide recommendations for medicines that will make your recovery more comfortable.
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Since inner ear infections are mostly caused by common cold viruses, they usually don't require antibiotics (which treat bacteria). Many inner ear infections resolve on their own in a few days. So, treatment often focuses on managing symptoms and staying safe while the vertigo improves.
Sometimes, your healthcare provider may prescribe antivirals or antibiotics to treat your inner ear infection. More often, however, they'll focus on treating your symptoms rather than the infection itself. For example, steroids are often prescribed to ease inflammation.
Inner ear infections tend to stick around longer than infections of the middle or outer ear. And infections caused by bacteria usually last longer than ones caused by viruses.
Benadryl (diphenhydramine ) and Antivert (meclizine ) are two OTC medications that can be used to treat the dizziness and nausea caused by an inner ear infection. While OTC medications can alleviate the symptoms of an inner ear infection, they do not treat the infection itself.
A person with labyrinthitis may also experience hearing issues. Inner ear infections often go away without treatment after a period of time. However, a doctor may prescribe medication to treat the symptoms of the infection.
Antibiotics are a medicine prescribed by your doctor. If you're dealing with an ear infection caused by bacteria, you'll likely need antibiotics. They are the best way of quickly getting rid of a bacterial infection and preventing it from spreading to other parts of the body.
Severe symptoms usually go away within a week. Most people are completely better within 2 to 3 months. Older adults are more likely to have dizziness that lasts longer.
hearing loss (from mild to total loss of hearing)a feeling of pressure inside your ear(s)ringing or humming in your ear(s) (tinnitus)feeling sick (nausea) or being sick.
They may also examine your eyes, hearing, and balance. Most of the time, no specific testing is needed to diagnose an inner ear infection. But if the diagnosis is a little less certain, you may need further evaluation.
Inner ear infection symptoms such as dizziness and loss of balance can resemble other medical problems, so a doctor will rule out conditions that may cause the symptoms such as head injury, heart disease, stroke, side effects of medications, anxiety, and neurological disorders.
Garlic has both antibiotic and pain-relieving properties. Soak crushed garlic for several minutes in warm olive or sesame oil. Strain the garlic out and apply the oil to the ear canal.
One of the most commonly prescribed antibiotics for ear infections is amoxicillin. However, some types of bacteria are becoming resistant to it because of its frequent, and usually unnecessary, use. Ciprofloxacin is another commonly used antibiotic for fighting bacterial ear infections.
Diuretics work by restricting the overproduction of fluid in the inner ear. Diuretics are long-term medications. They help reduce the number of vertigo attacks, and in some cases, they help stabilize hearing. Commonly used diuretics are Diamox (acetazolamide) and Dyazide (triamterene/HCTZ).
Basic understanding of the ear structure and how fluid usually drains can be helpful. Effective home remedies for safe fluid drainage include jiggling the earlobe, using gravity, creating a vacuum, using a blow dryer, trying ear drops or sprays, trying more water, inhaling steam, and gargling with saltwater.
A myringotomy is a procedure to create a hole in the ear drum to allow fluid that is trapped in the middle ear to drain out. The fluid may be blood, pus and/or water. In many cases, a small tube is inserted into the hole in the ear drum to help maintain drainage.
Amoxicillin is a first-choice antibiotic for ear infections in adults and children. The “watch and wait” strategy can be used in kids with ear infection symptoms. It involves waiting 2 to 3 days to see if the infection clears on its own before starting an antibiotic.
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