Labyrinthitis: causes, symptoms, risk factors and treatments

Labyrinthitis is an inflammation in the labyrinth, usually caused by microorganisms such as bacteria or viruses. “Its correct name is actually labyrinthopathy, which corresponds to labyrinth diseases. It is a condition of change in the perception of movement, whether due to imbalance, sensation of movement of the environment, sensation of floating, sensation of rotation”, explains Larissa Camargo, otorhinolaryngologist at Hospital Santa Lúcia, in Brasília, and a member of the Brazilian Society. of Otorhinolaryngology.

Labyrinthitis can manifest itself in a subtle way or even in cases in which the person is unable to perform activities or move around. Generally speaking, it is not a serious health problem, but it can be quite debilitating in some cases.

Causes of labyrinthitis

There are numerous factors related to labyrinth diseases, some examples are:

• Food with excess carbohydrates;
• Stress;
• Sleep deprivation;
• Metabolic conditions such as diabetes, thyroid, cholesterol decompensation;
• Excessive medication use;
• Suspension of controlled medications abruptly;
• Ingestion of alcoholic beverages (which can be a maze stimulant);
• Head injuries;
• Airway infections and/or ear manifestations;
• Sudden change of position, benign paroxysmal positional vertigo, one of the main causes in young patients;
• Osteoporosis;
• TPM;
• Climacteric;
• stroke (cerebrovascular accident).

Finding the cause of the problem will be essential for indicating the best form of treatment for labyrinthitis, taking into account the particularities of each case.

Risk factors

Jeanne Oiticica, an otorhinolaryngologist and Head of the Tinnitus Research Group at the Hospital das Clínicas, Faculty of Medicine, USP, points out that labyrinthitis can occur in any age group, including children and/or babies, but it is less frequent in this age group.

“It is much more frequent in the elderly, due to the aging of the system, associated comorbidities and medications. Among adults, women are the most affected, in particular due to lifelong hormonal fluctuations,” she says.

Also belonging to the risk group:

• People in the age group of 40 to 50 years;
• Patients who have already undergone ear surgery;
• People who have been victims of head trauma.

Symptoms

Larissa highlights as the main symptoms of labyrinthitis:

• Inability to walk in a straight line
• feeling of imbalance
• floating sensation
• Inability to move such as turning over in bed, getting up
• Nausea or vomiting (accompanying other symptoms such as those mentioned above);
• Auditory sensations such as pressure in the ear or a sensation of altered perception of sound (tinnitus).

All these symptoms, explains the otolaryngologist, can last for seconds or last for days.

Jeanne points out that dizziness can be described by the patient in several ways, including vertigo, instability, visual dimming, spatial disorientation, empty head, imbalance. “It may or may not be accompanied by other symptoms such as nausea, vomiting, neck pain. There may be tinnitus and associated hearing loss, as well as a feeling of being plugged in. Dizziness can only occur when lying down and getting out of bed etc,” she adds.

Also according to Jeanne, labyrinthitis is not a serious problem, but it can be quite debilitating in some cases. “Depending on the person, labyrinthitis can lead to falls, loss of consciousness, restriction of activities, reduced quality of life. There are cases where an acute attack of vertigo can be related to a stroke or stroke, then yes it is serious, but this is not the most frequent”, she explains.

Diagnosis

Jeanne explains that the diagnosis is confirmed by the clinical history described by the patient and can be complemented by tests, including blood tests, imaging tests, electrophysiological tests of hearing, labyrinth, among others, all according to the clinical suspicion.

Larissa emphasizes that it is always necessary to rule out central causes, that is, of the brain, such as strokes, injuries, tumors. “There are tests that outline for central (brain) or peripheral (labyrinth) causes, as well as locate which branch of the vestibular nerve may be compromised (nerve responsible for carrying information from the labyrinth to the brain). We often have to resort to imaging exams for better clinical elucidation”, she highlights.

Treatment

The treatments available for labyrinthitis are divided into: treatment of symptoms, treatment of causes, rehabilitation of the labyrinth and treatment with drugs.

Symptom treatments

Jeanne explains that there are several non-drug treatment strategies, such as canalicular replacement maneuvers, vestibular rehabilitation, physical therapy, among others.

Regarding medication, Larissa points out that there are medications to reduce the stimulation of the labyrinth (labyrinth depressants), which reduce symptoms, as well as medications that reduce nausea and vomiting.

Treatments of the causes

The treatments are as varied as possible depending on the cause of labyrinth disease. A very frequent labyrinth disease, according to Jeanne, is Benign Paroxysmal Positional Vertigo (BPPV), which has sudden episodes of vertigo, feeling that the environment is spinning, and that last up to one minute.

“The labyrinth has small crystals of calcium carbonate (like very delicate stones) that are in a pocket in the center of this organ and are essential for the proper functioning of the ear. However, when these crystals detach from the surface, they start to float and, then, BPPV occurs”, comments Jeanne. “In this case, the treatment is based on the canalicular replacement maneuver, performed in the office by the Otoneurologist”, she highlights.

However, Jeanne points out, there are other types of labyrinth disease and treatments can vary a lot: restrictive diet of certain foods, hydrotherapy, vestibular rehabilitation (a kind of exercises to strengthen the labyrinth), introduction of drugs for the labyrinth in some cases, withdrawal of drugs causing labyrinth disease, physical therapy, sensory replacement, among others.

labyrinth rehabilitation

Larissa explains that labyrinth rehabilitation consists of specific and repetitive exercises, planned by a physical therapist or speech therapist, and aims to improve tolerance to changes in position. “There is an improvement in movements, improvement in gait, in the tolerance of simple movements, such as getting out of bed or putting out clothes – functions that, for the patient with an unstable labyrinth, could be impossible. These exercises help to return to daily activities earlier,” she highlights.

Otolaryngologist Jeanne adds that labyrinth rehabilitation is always directed on a case-by-case basis. “It is never the same strategy for each and every patient. It depends on the type of clinical complaint presented, whether acute, whether chronic, what restrictions and disabilities are presented, what residual function of the labyrinth is present, what can be recovered”, she says.

Medicines

Larissa explains that acute phase medications (cinnarizine and flunarizine, usually limited use, up to a week) and medications to prevent further episodes (ginko biloba and betahistine – these for prolonged use) can be used.

“In addition, to reduce nausea and vomiting, medications such as dimenhydrate, meclizine, ondansetron and corticosteroids can be used. Depending on the intensity of the symptoms, intravenous medication and hydration or even hospitalizations are necessary”, highlights Larissa.

“Remembering that patients with a condition that is difficult to control, rehabilitation has excellent results. In addition, several foods stimulate the labyrinth, such as coffee, teas, carbohydrates and alcoholic beverages, so, until the balance is restored, it is important to reduce intake”, adds the otolaryngologist.

It is worth noting that, in the case of labyrinthitis, excess medication can cause excessive sleepiness and reduced reflexes and concentration. “Therefore, medications only under medical prescription”, warns Larissa.

The greatest risk of self-medication, as Jeanne points out, is the worsening of labyrinth disease symptoms. “In addition to the problem not improving or chronification without proper solution. Another highlight that should be given is the side effects resulting from self-medication, including Parkinsonism, headache, drowsiness, hand and extremity tremors, increased blood sugar levels, among others”, explains the doctor.

Living with the disease

Larissa explains that emotional stability, quality of sleep, balanced diet and control of chronic diseases are related to the reduction of vertigo attacks. “In chronic cases of labyrinth disease, follow-up with an otorhinolaryngologist is of paramount importance. It is always good to reinforce that good emotional balance greatly reduces the chance of episodes of dizziness, or makes it lighter,” she says.

In this sense, there are some practical tips that help a person to live with labyrinthitis in the best possible way and avoid dizziness:

• Have a healthy diet, avoiding, for example, processed foods (which contain excess salt), sugar, trans fats and fast-absorbing carbohydrates;
• Do not do prolonged fasting;
• Have a regular health check-up;
• Do not use over-the-counter medications;
• Do not smoke;
• Avoid alcoholic beverages;
• Do physical activity regularly;
• Cherish for a good sleep, using, for example, comfortable clothes, quality pillows and mattresses, etc.;
• Do not use drugs;
• Drink plenty of water;
• Avoid stress as much as possible;
• Look for ways to control anxiety.

An important piece of information, according to otolaryngologist Larissa, is that dizziness will never last forever, however, there is no permanent permanent cure. “The labyrinth itself, together with the aforementioned treatments, usually end up restoring balance”, she concludes.

Now you know that labyrinth disease, popularly called labyrinthitis, can generate very unpleasant symptoms, however, it is usually not a serious disease. Even so, it must be closely monitored by an otolaryngologist who will indicate the best form of treatment.

The information contained on this page is for informational purposes only. They do not replace the advice and follow-up of doctors, nutritionists, psychologists, physical education professionals and other specialists.