Labyrinthitis: Causes, Diagnosis, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Labyrinthitis is inflammation of the inner ear's labyrinth, causing dizziness, nausea, and hearing loss. Diagnosis, vestibular treatment, and management in Quebec.\">\n<meta name=\"keywords\" content=\"labyrinthite traitement, labyrinthite sympt\u00f4mes, labyrinthite vertiges, labyrinthite vs n\u00e9vrite vestibulaire, labyrinthite virale bact\u00e9rienne, labyrinthite antivertigineux, neuronite vestibulaire, labyrinthite Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap*{font-family:'Poppins',sans-serif;box-sizing:border-box}\n.co-wrap{max-width:1100px;margin:0 auto;padding:30px 0 60px}\n.co-label{font-family:'Cinzel',serif;font-size:14px;font-weight:bold;letter-spacing:1px;text-transform:uppercase;color:#4D6577;margin-bottom:14px;display:block}\n.co-wrap h1{font-size:32px;font-weight:500;color:#323C52;margin:0 0 22px;line-height:1.2}\n.co-intro{font-size:16px;line-height:1.75;color:#4D6577;margin-bottom:36px;padding-bottom:32px;border-bottom:1px solid rgba(77,101,119,.2)}\n.co-wrap h2{font-size:20px;font-weight:600;color:#323C52;margin:32px 0 12px}\n.co-wrap p{font-size:15px;color:#4D6577;line-height:1.7;margin-bottom:14px}\n.co-list{list-style:none;padding:0;margin:12px 0 24px}\n.co-list li{font-size:15px;color:#4D6577;padding:10px 14px 10px 38px;margin-bottom:8px;border-radius:6px;position:relative;background:rgba(77,101,119,.06);border-left:3px solid #4D6577}\n.co-list li::before{content:\"\u2713\";position:absolute;left:12px;font-weight:700;color:#4D6577}\n.co-table{width:100%;border-collapse:collapse;margin:14px 0 22px;font-size:14px;border-radius:8px;overflow:hidden;table-layout:fixed}\n.co-table thead tr{background:#323C52;color:#fff}\n.co-table thead th{padding:11px 16px;text-align:left;font-weight:600;font-size:13px}\n.co-table tbody tr:nth-child(even){background:rgba(77,101,119,.06)}\n.co-table tbody tr:nth-child(odd){background:#fff}\n.co-table td{padding:10px 16px;color:#4D6577;border-bottom:1px solid rgba(77,101,119,.12);font-size:14px;vertical-align:top}\n.co-table td:first-child{font-weight:600;color:#323C52}\n.co-infobox{display:flex;gap:12px;background:rgba(77,101,119,.06);border-radius:8px;border-left:4px solid #4D6577;padding:14px 18px;margin:18px 0 28px;font-size:14px;color:#4D6577;line-height:1.65}\n.co-infobox .ico{font-size:18px;flex-shrink:0}\n.co-urgence{background:#fff8f8;border-left:5px solid #c0392b;border-radius:6px;padding:20px 26px;margin:24px 0 32px}\n.co-urgence .co-urgence-titre{font-size:13px;font-weight:700;color:#c0392b;letter-spacing:1.5px;text-transform:uppercase;margin-bottom:10px}\n.co-urgence p{color:#5a2020;font-size:14px;margin:0 0 10px;line-height:1.7}\n.co-urgence p:last-child{margin-bottom:0}\n.co-disclaimer{font-size:13px;color:#8a9aaa;font-style:italic;border-top:1px solid rgba(77,101,119,.15);padding-top:24px;margin-top:40px;line-height:1.6}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Neurology & ENT & Emergency Medicine & Family Medicine<\/span>\n <h1>Labyrinthitis<\/h1>\n\n <div class=\"co-intro\">\n Labyrinthitis is an inflammation of the membranous labyrinth of the inner ear, a complex anatomical structure comprising both the organs of hearing (cochlea) and balance (vestibule: utricle + saccule + semicircular canals). It is manifested by the combination of intense vertigo (rotatory type + peripheral character) and cochlear damage (hypoacusis + tinnitus), which distinguishes it from vestibular neuritis (or vestibular neuronitis) in which only the vestibular system is affected, with no cochlear component. In clinical practice, the distinction between labyrinthitis and vestibular neuritis is based primarily on the presence or absence of auditory symptoms - in the absence of auditory deficit, the condition is referred to as vestibular neuritis. However, both entities share the same acute vestibular presentation (AVS - Acute Vestibular Syndrome) and respond to the same symptomatic treatments. The most frequent etiology is viral (herpes viruses : HSV-1 + VZV zoster + EBV + CMV + enterovirus + urlian viruses) in the context of acute post-infectious or directly infectious labyrinthitis. Bacterial labyrinthitis - although rare in developed countries thanks to vaccination and early treatment of otitis - is the most serious, resulting either from direct extension of suppurative acute otitis media (AOM) or mastoiditis, or from bacterial meningitis (meningogenic labyrinthitis). Bacterial labyrinthitis is a medical emergency, as it frequently leads to permanent deafness, and can be complicated by meningitis if not treated promptly.\n <\/div>\n\n <h2>Pathophysiology, etiologies and clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Anatomy of the labyrinth and pathophysiological mechanisms of labyrinthitis:<\/strong> functional anatomy of the labyrinth: the osseous labyrinth (labyrinthus osseus) - a cavity in the rock of the temporal bone - contains the membranous labyrinth (labyrinthus membranaceus) made up of: cochlea (organ of Corti): transduction of sound vibrations into nerve signals (cochlear nerve = cochlear branch of VIII) + vestibule : utricle + saccule (otoliths - linear accelerations) + 3 semicircular canals (angular accelerations - each in one plane of space) + vestibular nerve (vestibular branch of VIII = stato-acoustic nerve) \u2192 the entire membranous labyrinth is filled with endolymph + the perilymphatic space (between the two labyrinths) is filled with perilymph \u2192 inflammation of the membranous labyrinth \u2192 disruption of endolymphatic flows + damage to cochlear hair cells + vestibular hair cells \u2192 cochlear lesions produce hypoacusis + vestibular lesions produce vertigo ; etiological mechanisms according to the type of labyrinthitis : viral labyrinthitis (most frequent - 85-90 % of labyrinthitis): reactivation of a latent virus in the geniculate or spiral ganglion (HSV-1 in the spiral ganglia of the cochlea) \u2192 or viremic infection with damage to the endothelium of labyrinthine vessels \u2192 endolymphatic edema \u2192 internal pressure + damage to hair cells \u2192 the mechanism is similar to that of vestibular neuritis (whose viral etiology is strongly suspected but not proven with certainty - Gacek 2002 - Annals of Otology Rhinology and Laryngology : HSV-1 in vestibular ganglia) + bacterial labyrinthitis: 3 routes of extension: 1\/ tympanogenic (via round or oval window from AOM or chronic otitis with cholesteatoma) \u2192 2\/ meningogenic (from subarachnoid spaces via cochlear nerve or labyrinth aqueducts \u2192 most often secondary to pneumococcal or meningococcal meningitis) \u2192 3\/ hematogenous (rarer - bacteremia) + autoimmune labyrinthitis: anti-cochlear antibodies (anti-hair cell proteins) \u2192 fluctuating + bilateral hypoacusis + responsive to corticosteroids + toxic labyrinthitis: aminoglycosides (gentamicin + streptomycin) \u2192 accumulation in endolymph \u2192 ototoxicity (outer hair cells) \u2192 hypoacusis + particularly in high frequencies \u2192 cisplatin + quinine + high-dose aspirin \u2192 tinnitus + reversible hypoacusis at low dose.<\/li>\n <li><strong>Clinical Presentation and Differential Diagnosis of Labyrinthitis<\/strong> symptoms of acute labyrinthitis : intense vertigo of the rotatory type (sensation of rotation of the environment) \u2192 abrupt or sudden onset + nausea + severe vomiting (vegetative reflex) + gait instability + unilateral hypoacusis (hearing loss on the affected side) \u2192 key cochlear component that distinguishes labyrinthitis from vestibular neuritis + unilateral tinnitus (buzzing + whistling) + sensation of a blocked ear + horizontal-spontaneous rotatory nystagmus (beating on the side contralateral to the lesion - healthy side) \u2192 nystagmus attenuates with ocular fixation + positive HIT test (Head Impulse Test - Halmagyi) on injured side + HINTS test : in emergency to distinguish a peripheral cause from a central cause (stroke): H = Head Impulse Test + I = Nystagmus type (direction) + T = Test of Skew \u2192 unidirectional nystagmus + positive HIT + no skew deviation \u2192 peripheral cause + multidirectional nystagmus + negative HIT + skew deviation \u2192 Stroke \u2192 Kattah 2009: HINTS superior to early MRI for detecting brainstem stroke in acute vestibular syndrome + evolution: acute phase (J1-J14): intense vertigo + instability + difficulty walking \u2192 compensation phase (J15-J60): progressive reduction of vertigo thanks to central compensation \u2192 residual phase: residual instability + persistent hypoacusis if severe cochlear lesion; differential diagnosis: vestibular neuritis (neuronitis): identical to labyrinthitis BUT without auditory involvement \u2192 no hypoacusis + no tinnitus + BPPV (benign paroxysmal positional vertigo): brief vertigo (<1 min) + triggered by changes in head position \u2192 positive Dix-Hallpike test \u2192 treatment with repositioning maneuver (Epley) + brainstem stroke (AICA infarct): may simulate labyrinthitis \u2192 HINTS emergency \u2192 MRI if doubt + HINTS test negative central side \u2192 Meniere's disease: recurrent episodes of vertigo + fluctuating hypoacusis + tinnitus + auricular fullness \u2192 auricular herpes zoster (Ramsay Hunt syndrome): VZV + ENT shingles \u2192 pinna vesicles + facial paralysis + vertigo + hypoacusis + intense auricular pain <\/ul>\n\n <h2>Treatment and care<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Treatment \/ appearance<\/th><th>Data, modalities, and protocols<\/th><th>Key studies and recommendations<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Symptomatic treatment \u2014 dizziness and vomiting<br><small style=\"font-weight:400;color:#7a8fa0;\">Antivertigo \u2014 dimenhydrinate Gravol \u2014 prochlorperazine \u2014 metoclopramide \u2014 ondansetron \u2014 meclizine \u2014 betahistine \u2014 duration of suppressive treatment \u2014 vestibular rehabilitation \u2014 hydration \u2014 rest<\/small><\/td>\n <td>Symptomatic treatment of acute phase (J1-J5): aim: relieve vertigo + nausea + vomiting \u2192 allow hydration and feeding \u2192 facilitate safe ambulation \u2192 allow central compensation + antivertiginous and antiemetic : dimenhydrinate (Gravol) 50 mg PO or IM \u2192 H1 antagonist + anticholinergic \u2192 reduces vertigo + nausea \u2192 50 mg PO \u00d7 4-6\/d \u2192 or 50 mg IM if severe vomiting \u2192 side effect: somnolence \u2192 prochlorperazine (Stemetil) 5-10 mg PO or IM \u2192 antidopaminergic + potent antiemetic \u2192 effective for severe vomiting \u2192 risk: extrapyramidal effects (dystonia) \u2192 promethazine (Phenergan) 25 mg IM \u2192 sedative + antiemetic + meclizine (Antivert - not available in Canada but used in USA) \u2192 dimenhydrinate analog \u2192 ondansetron (Zofran) 4-8 mg PO or IV \u2192 5-HT3 receptor antagonist \u2192 antiemetic \u2192 little sedation \u2192 useful if persistent vomiting \u2192 metoclopramide (Maxeran) 10 mg IV\/IM \u2192 prokinetic + antiemetic \u2192 extrapyramidal risk + IMPORTANT: vestibular suppressants (dimenhydrinate + prochlorperazine + benzodiazepines) should be used as little as possible (maximum 3-5 days) \u2192 they mask symptoms but slow central compensation \u2192 prolong beyond-beyond 5 days \u2192 delayed healing \u2192 betahistine (Serc) 16-24 mg \u00d7 3\/d \u2192 histamine analogue \u2192 reduces endolymphatic pressure \u2192 indicated especially in Meniere's disease + probably useful in labyrinthitis \u2192 may reduce vertigo + improve compensation + corticoids in viral labyrinthitis : prednisone 40-60 mg\/d \u00d7 5-7 days \u2192 controversy \u2192 Strupp 2004 - Lancet : methylprednisolone IV + vestibular neuritis \u2192 improved vestibular recovery at 12 months \u2192 data transposed to viral labyrinthitis + benefit on hypoacusis if started early + corticosteroids recommended if sudden significant hypoacusis (sudden deafness) \u2192 prednisone 1 mg\/kg\/d \u00d7 7-14 days \u2192 or intratympanic methylprednisolone if insufficient systemic route \u2192 hydration: IV if severe vomiting prevents oral hydration \u2192 bed rest in acute phase + avoid sudden head movements<\/td>\n <td>Strupp 2004 \u2014 Lancet: IV methylprednisolone + vestibular neuritis \u2192 improved vestibular recovery at 12 months \u2192 reference for corticosteroids in acute vestibular syndromes + Gacek 2002 \u2014 Annals of Otology Rhinology and Laryngology: HSV-1 + vestibular ganglia + viral pathophysiology \u2192 Kattah 2009 \u2014 Stroke: HINTS + acute vestibular syndrome \u2192 superior to early MRI for stroke + AAO-HNS (American Academy of Otolaryngology \u2014 Head and Neck Surgery) 2019: sudden hearing loss \u2192 oral corticosteroids \u2192 strong recommendation + NICE 2017: dizziness + labyrinthitis \u2192 symptomatic treatment + Bhattacharyya 2017 \u2014 Otolaryngology Head and Neck Surgery: vestibular neuritis + labyrinthitis \u2192 guidelines + corticosteroids + Government of Quebec + MSSS + INESSS: dimenhydrinate + prochlorperazine + ondansetron reimbursed + RAMQ: betahistine Serc reimbursed <\/tr>\n <tr>\n <td>Bacterial labyrinthitis and antibiotic therapy<br><small style=\"font-weight:400;color:#7a8fa0;\">Bacterial labyrinthitis \u2014 AOM extension \u2014 meningitis \u2014 ceftriaxone \u2014 amoxicillin-clavulanate \u2014 surgical emergency \u2014 mastoidectomy \u2014 paracentesis \u2014 permanent hearing loss \u2014 cochlear implant \u2014 vaccination prevention<\/small><\/td>\n <td>Bacterial labyrinthitis - medical and surgical emergency: etiology and context: extension of untreated or inadequately treated suppurative AOM (acute otitis media) \u2192 fever + otalgia + anterior otorrhea \u2192 then vertigo + hypoacusis \u2192 sign of complication + extension of mastoiditis \u2192 extension of chronic otitis with cholesteatoma \u2192 meningogenic extension (pneumococcal bacterial meningitis ++ ) \u2192 agents: Streptococcus pneumoniae ++ + Haemophilus influenzae + Staphylococcus aureus + gram-negative bacilli (less frequent) \u2192 urgent workup: CBC + CRP + blood cultures \u00d7 3 + lumbar puncture if meningitis suspected \u2192 CT scan of rocks + mastoids \u2192 urgent ENT consultation \u2192 MRI of posterior fossa if stroke suspected; antibiotic treatment of bacterial labyrinthitis: emergency IV antibiotic therapy: ceftriaxone (Roc\u00e9phine) 2 g IV \u00d7 1\/d \u2192 broad coverage + penetration into inner ear \u2192 if associated meningitis \u2192 ceftriaxone 2 g IV \u00d7 2\/d + dexamethasone IV 0.15 mg\/kg \u00d7 4\/d \u00d7 2-4 days \u2192 reduction of meningeal inflammation \u2192 reduction of risk of auditory sequelae \u2192 Van de Beek 2010 - NEJM : dexamethasone + bacterial meningitis \u2192 reduced neurological + auditory sequelae \u2192 if allergic to cephalosporins \u2192 chloramphenicol or vancomycin + rifampicin \u2192 meningitis: see standard protocol + if suppurative AOM with labyrinthitis + mastoiditis: myringotomy + tympanic paracentesis (drainage of AOM) \u2192 or mastoidectomy if extensive mastoiditis \u2192 double drainage: middle ear + mastoid \u2192 IV antibiotic therapy \u00d7 7-14 days \u2192 then oral relay according to antibiogram \u2192 amoxicillin-clavulanate 875\/125 mg \u00d7 2\/d \u2192 or amoxicillin if susceptible pneumococcus \u2192 auditory sequelae of bacterial labyrinthitis: severe to profound permanent hypoacusis in 20-40 % of bacterial labyrinthitis \u2192 cochlear ossification (ossified labyrinth) if severe bacterial labyrinthitis \u2192 compromises cochlear implant insertion \u2192 early cochlear implantation (before ossification if possible - within weeks of labyrinthitis) \u2192 prevention: pneumococcal vaccination (Prevnar 13 + Prevnar 20 + Pneumovax 23) \u2192 meningococcal vaccination \u2192 early and complete treatment of AOM \u2192 no use of insufficient antibiotics + ENT follow-up of any complicated AOM.<\/td>\n <td>Van de Beek 2010 \u2014 NEJM: dexamethasone + bacterial meningitis \u2192 reduced neurological + auditory sequelae \u2192 reference + Van de Beek 2016 \u2014 NEJM (meta-analysis): corticosteroids + bacterial meningitis \u2192 reduced mortality + sequelae + AAO-HNS 2019 + IDSA 2019 (Tunkel): bacterial meningitis \u2192 treatment + ceftriaxone + dexamethasone \u2192 Bhattacharyya 2017 \u2014 Otolaryngology Head and Neck Surgery: bacterial labyrinthitis \u2192 treatment \u2192 ENT emergency + SOGC + MSSS + INSPQ Quebec: pneumococcal + meningococcal vaccination \u2192 Health Canada: Prevnar 13 + Prevnar 20 + Pneumovax 23 \u2192 Quebec vaccination programs + cochlear implant: early discussion after severe bacterial labyrinthitis \u2192 RAMQ + MSSS: cochlear implant covered if criteria met <\/tr>\n <tr>\n <td>Vestibular rehabilitation and long-term recovery<br><small style=\"font-weight:400;color:#7a8fa0;\">Central vestibular compensation \u2014 vestibular rehabilitation \u2014 Cawthorne-Cooksey exercises \u2014 vestibular physiotherapy \u2014 residual instability \u2014 chronicity \u2014 vestibular neuritis \u2014 residual hearing loss \u2014 prognosis \u2014 return to work<\/small><\/td>\n <td>Recovery and central vestibular compensation: mechanism of central compensation: the central nervous system (cerebellum + brainstem) detects the asymmetry of vestibular signals (injured side vs. healthy side) \u2192 progressive compensation \u2192 reduction of vertigo \u2192 improvement of balance \u2192 this process takes 4 to 8 weeks for resting vertigo + several months for instability on walking and exertion \u2192 vestibular suppressants (dimenhydrinate + benzodiazepines) slow down this process by reducing vestibular input \u2192 hence the importance of stopping them quickly (maximum 3-5 days) + vestibular rehabilitation (specialized physiotherapy) : specific exercises to stimulate and accelerate central compensation: Cawthorne-Cooksey exercises (historical): progressive head + eye + trunk movements \u2192 progressive sensitization \u2192 adaptation + gaze stabilization exercises (VOR - Vestibulo-Ocular Reflex): head rotations with target fixation \u2192 reinforcement of residual VOR + balance + walking exercises + vestibular rehabilitation results: Yardley 1998 - Quarterly Journal of Medicine: vestibular physiotherapy + chronic vertigo \u2192 significant improvement vs. control group \u2192 Hillier 2011 - Cochrane: vestibular rehabilitation + vestibular neuritis + labyrinthitis \u2192 well-established efficacy \u2192 recommended \u2192 start: as soon as patient can mobilize (often D3-J5 post-start) \u2192 reference in vestibular physiotherapy \u2192 trained professionals + available in Quebec + viral labyrinthitis prognosis: vertigo: complete resolution in 80-90 % of cases in 6-8 weeks + residual instability: 20-30 % of patients retain mild instability on exertion or fatigue \u2192 vestibular physiotherapy helps \u2192 residual hypoacusis: if viral labyrinthitis \u2192 often partial and stable \u2192 if bacterial labyrinthitis \u2192 severe to profound deafness possible \u2192 cochlear implant + return to work: usually 2-4 weeks for non-physical professions + longer if risky work (height + driving vehicles) \u2192 Meniere's disease in differential: if recurrent vertigo (\u22652 episodes >20 min) + fluctuating hypoacusis + tinnitus + auricular fullness \u2192 diagnostic criteria (AAO-HNS 1995 + 2020) \u2192 betahistine + diuretics (hydrochlorothiazide-triamterene) + low-salt diet \u2192 intratympanic gentamicin injection if refractory (chemical ablation of vestibule)<\/td>\n <td>Hillier 2011 \u2014 Cochrane: vestibular rehabilitation + vestibular neuritis + labyrinthitis \u2192 effectiveness \u2192 strong recommendation + Yardley 1998 \u2014 Quarterly Journal of Medicine: vestibular physiotherapy + chronic vertigo \u2192 significant improvement + Strupp 2004 \u2014 Lancet: methylprednisolone + vestibular neuritis \u2192 recovery + Bhattacharyya 2017 \u2014 Otolaryngology Head and Neck Surgery: vestibular neuritis + labyrinthitis + rehabilitation + Kattah 2009 \u2014 Stroke: HINTS + acute vestibular syndrome + stroke vs. peripheral + Newman-Toker 2021 \u2014 Stroke: HINTS + MRI + vestibular syndrome + NICE 2017: labyrinthitis + vertigo \u2192 vestibular rehabilitation + AAO-HNS 1995 + 2020: Meniere's disease criteria + Ordre professionnel de la physioth\u00e9rapie du Qu\u00e9bec (OPPQ): physiotherapists trained in vestibular rehabilitation + INESSS Qu\u00e9bec + RAMQ: vestibular physiotherapy partially reimbursed + betahistine Serc reimbursed <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>Vestibular suppressants (dimenhydrinate + prochlorperazine) should not be used for more than 3-5 days\u2014they slow central compensation and delay recovery:<\/strong> Vestibular rehabilitation (specialized physical therapy with Cawthorne-Cooksey exercises and gaze stabilization) is the most effective treatment for accelerating recovery from day 3\u20135. The HINTS test (Head Impulse + Nystagmus type + Test of Skew) is more accurate than early MRI for distinguishing labyrinthitis from a brainstem stroke\u2014multidirectional nystagmus or a negative HIT in acute vestibular syndrome warrants an urgent MRI.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent consultation or a call to 911<\/div>\n <p><strong>Acute vestibular syndrome (severe vertigo + nausea + instability) + multidirectional nystagmus (changes direction with gaze) + negative HIT + skew deviation + associated neurological signs (dysphagia + dysarthria + diplopia + severe ataxia + sudden headache)<\/strong> Brainstem stroke (AICA or PICA) - not labyrinthitis - call 911 - emergency diffusion MRI - stroke management.<\/p>\n <p><strong>Child or adult with acute otitis media (ear pain + ear discharge + fever) + onset of intense dizziness + sudden hearing loss + nystagmus + stiff neck<\/strong> Bacterial labyrinthitis + possible meningitis \u2192 medical emergency \u2192 call 911 \u2192 lumbar puncture if meningitis \u2192 ceftriaxone IV 2 g + dexamethasone IV \u2192 urgent ENT consultation \u2192 myringotomy + paracentesis + or mastoidectomy as indicated.<\/p>\n <p><strong>Patient with Ramsay Hunt syndrome (vesicles on auricle + ear canal) + facial paralysis + intense vertigo + hearing loss<\/strong> \u2192 Ramsay Hunt syndrome (VZV) \u2192 geniculate herpes zoster \u2192 ENT + neurological emergency \u2192 valacyclovir 1 g TID for 7-10 days + prednisone 60 mg daily for 5 days \u2192 to reduce the risk of facial and auditory sequelae \u2192 ENT consultation within 72 hours.<\/p>\n <p><strong>Patient with a history of severe bacterial labyrinthitis (<4-6 weeks) + persistent unilateral profound hearing loss<\/strong> \u2192 ongoing cochlear ossification \u2192 urgent cochlear ENT consultation to discuss early cochlear implant BEFORE ossification \u2192 each week of delay increases the risk of inability to insert the cochlear electrode.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's doctors diagnose viral labyrinthitis (vertigo + hypoacusis + tinnitus + unilateral horizontal nystagmus + positive HIT), use the HINTS test to rule out stroke, prescribe symptomatic treatment (dimenhydrinate + prochlorperazine + corticosteroids if significant hypoacusis), refer urgently if the presentation is atypical or central, and refer for vestibular physiotherapy as soon as the patient can mobilize. Consultations are available at several points of service in Quebec, and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not substitute for the advice of a physician, neurologist, or ENT. Acute vestibular syndrome with associated neurological signs or atypical nystagmus requires urgent evaluation to rule out a brainstem stroke.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p> Neurologie & ORL & M\u00e9decine d’urgence & M\u00e9decine de famille Labyrinthite La labyrinthite est une inflammation du labyrinthe membraneux de l’oreille interne, structure anatomique complexe comprenant \u00e0 la fois les organes de l’audition (cochl\u00e9e) et de l’\u00e9quilibre (vestibule : utricule + saccule + canaux semi-circulaires). Elle se manifeste par l’association de vertiges intenses (de… <a href=\"https:\/\/cliniqueomicron.ca\/en\/labyrinthite\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Labyrinthite : vertiges et oreille interne | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Labyrinthite : causes, diagnostic | Brossard | Clinique Omicron","_metasync_otto_description":"La labyrinthite est une inflammation du labyrinthe de l'oreille interne causant vertiges, naus\u00e9es et hypoacousie. 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\n\t\t\t\t\t\n\n\n\n\nLabyrinthitis: Causes, Diagnosis, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Labyrinthitis is inflammation of the inner ear's labyrinth, causing dizziness, nausea, and hearing loss. Diagnosis, vestibular treatment, and management in Quebec.\">\n<meta name=\"keywords\" content=\"labyrinthite traitement, labyrinthite sympt\u00f4mes, labyrinthite vertiges, labyrinthite vs n\u00e9vrite vestibulaire, labyrinthite virale bact\u00e9rienne, labyrinthite antivertigineux, neuronite vestibulaire, labyrinthite Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap*{font-family:'Poppins',sans-serif;box-sizing:border-box}\n.co-wrap{max-width:1100px;margin:0 auto;padding:30px 0 60px}\n.co-label{font-family:'Cinzel',serif;font-size:14px;font-weight:bold;letter-spacing:1px;text-transform:uppercase;color:#4D6577;margin-bottom:14px;display:block}\n.co-wrap h1{font-size:32px;font-weight:500;color:#323C52;margin:0 0 22px;line-height:1.2}\n.co-intro{font-size:16px;line-height:1.75;color:#4D6577;margin-bottom:36px;padding-bottom:32px;border-bottom:1px solid rgba(77,101,119,.2)}\n.co-wrap h2{font-size:20px;font-weight:600;color:#323C52;margin:32px 0 12px}\n.co-wrap p{font-size:15px;color:#4D6577;line-height:1.7;margin-bottom:14px}\n.co-list{list-style:none;padding:0;margin:12px 0 24px}\n.co-list li{font-size:15px;color:#4D6577;padding:10px 14px 10px 38px;margin-bottom:8px;border-radius:6px;position:relative;background:rgba(77,101,119,.06);border-left:3px solid #4D6577}\n.co-list li::before{content:\"\u2713\";position:absolute;left:12px;font-weight:700;color:#4D6577}\n.co-table{width:100%;border-collapse:collapse;margin:14px 0 22px;font-size:14px;border-radius:8px;overflow:hidden;table-layout:fixed}\n.co-table thead tr{background:#323C52;color:#fff}\n.co-table thead th{padding:11px 16px;text-align:left;font-weight:600;font-size:13px}\n.co-table tbody tr:nth-child(even){background:rgba(77,101,119,.06)}\n.co-table tbody tr:nth-child(odd){background:#fff}\n.co-table td{padding:10px 16px;color:#4D6577;border-bottom:1px solid rgba(77,101,119,.12);font-size:14px;vertical-align:top}\n.co-table td:first-child{font-weight:600;color:#323C52}\n.co-infobox{display:flex;gap:12px;background:rgba(77,101,119,.06);border-radius:8px;border-left:4px solid #4D6577;padding:14px 18px;margin:18px 0 28px;font-size:14px;color:#4D6577;line-height:1.65}\n.co-infobox .ico{font-size:18px;flex-shrink:0}\n.co-urgence{background:#fff8f8;border-left:5px solid #c0392b;border-radius:6px;padding:20px 26px;margin:24px 0 32px}\n.co-urgence .co-urgence-titre{font-size:13px;font-weight:700;color:#c0392b;letter-spacing:1.5px;text-transform:uppercase;margin-bottom:10px}\n.co-urgence p{color:#5a2020;font-size:14px;margin:0 0 10px;line-height:1.7}\n.co-urgence p:last-child{margin-bottom:0}\n.co-disclaimer{font-size:13px;color:#8a9aaa;font-style:italic;border-top:1px solid rgba(77,101,119,.15);padding-top:24px;margin-top:40px;line-height:1.6}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Neurology & ENT & Emergency Medicine & Family Medicine<\/span>\n <h1>Labyrinthitis<\/h1>\n\n <div class=\"co-intro\">\n Labyrinthitis is an inflammation of the membranous labyrinth of the inner ear, a complex anatomical structure comprising both the organs of hearing (cochlea) and balance (vestibule: utricle + saccule + semicircular canals). It is manifested by the combination of intense vertigo (rotatory type + peripheral character) and cochlear damage (hypoacusis + tinnitus), which distinguishes it from vestibular neuritis (or vestibular neuronitis) in which only the vestibular system is affected, with no cochlear component. In clinical practice, the distinction between labyrinthitis and vestibular neuritis is based primarily on the presence or absence of auditory symptoms - in the absence of auditory deficit, the condition is referred to as vestibular neuritis. However, both entities share the same acute vestibular presentation (AVS - Acute Vestibular Syndrome) and respond to the same symptomatic treatments. The most frequent etiology is viral (herpes viruses : HSV-1 + VZV zoster + EBV + CMV + enterovirus + urlian viruses) in the context of acute post-infectious or directly infectious labyrinthitis. Bacterial labyrinthitis - although rare in developed countries thanks to vaccination and early treatment of otitis - is the most serious, resulting either from direct extension of suppurative acute otitis media (AOM) or mastoiditis, or from bacterial meningitis (meningogenic labyrinthitis). Bacterial labyrinthitis is a medical emergency, as it frequently leads to permanent deafness, and can be complicated by meningitis if not treated promptly.\n <\/div>\n\n <h2>Pathophysiology, etiologies and clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Anatomy of the labyrinth and pathophysiological mechanisms of labyrinthitis:<\/strong> functional anatomy of the labyrinth: the osseous labyrinth (labyrinthus osseus) - a cavity in the rock of the temporal bone - contains the membranous labyrinth (labyrinthus membranaceus) made up of: cochlea (organ of Corti): transduction of sound vibrations into nerve signals (cochlear nerve = cochlear branch of VIII) + vestibule : utricle + saccule (otoliths - linear accelerations) + 3 semicircular canals (angular accelerations - each in one plane of space) + vestibular nerve (vestibular branch of VIII = stato-acoustic nerve) \u2192 the entire membranous labyrinth is filled with endolymph + the perilymphatic space (between the two labyrinths) is filled with perilymph \u2192 inflammation of the membranous labyrinth \u2192 disruption of endolymphatic flows + damage to cochlear hair cells + vestibular hair cells \u2192 cochlear lesions produce hypoacusis + vestibular lesions produce vertigo ; etiological mechanisms according to the type of labyrinthitis : viral labyrinthitis (most frequent - 85-90 % of labyrinthitis): reactivation of a latent virus in the geniculate or spiral ganglion (HSV-1 in the spiral ganglia of the cochlea) \u2192 or viremic infection with damage to the endothelium of labyrinthine vessels \u2192 endolymphatic edema \u2192 internal pressure + damage to hair cells \u2192 the mechanism is similar to that of vestibular neuritis (whose viral etiology is strongly suspected but not proven with certainty - Gacek 2002 - Annals of Otology Rhinology and Laryngology : HSV-1 in vestibular ganglia) + bacterial labyrinthitis: 3 routes of extension: 1\/ tympanogenic (via round or oval window from AOM or chronic otitis with cholesteatoma) \u2192 2\/ meningogenic (from subarachnoid spaces via cochlear nerve or labyrinth aqueducts \u2192 most often secondary to pneumococcal or meningococcal meningitis) \u2192 3\/ hematogenous (rarer - bacteremia) + autoimmune labyrinthitis: anti-cochlear antibodies (anti-hair cell proteins) \u2192 fluctuating + bilateral hypoacusis + responsive to corticosteroids + toxic labyrinthitis: aminoglycosides (gentamicin + streptomycin) \u2192 accumulation in endolymph \u2192 ototoxicity (outer hair cells) \u2192 hypoacusis + particularly in high frequencies \u2192 cisplatin + quinine + high-dose aspirin \u2192 tinnitus + reversible hypoacusis at low dose.<\/li>\n <li><strong>Clinical Presentation and Differential Diagnosis of Labyrinthitis<\/strong> symptoms of acute labyrinthitis : intense vertigo of the rotatory type (sensation of rotation of the environment) \u2192 abrupt or sudden onset + nausea + severe vomiting (vegetative reflex) + gait instability + unilateral hypoacusis (hearing loss on the affected side) \u2192 key cochlear component that distinguishes labyrinthitis from vestibular neuritis + unilateral tinnitus (buzzing + whistling) + sensation of a blocked ear + horizontal-spontaneous rotatory nystagmus (beating on the side contralateral to the lesion - healthy side) \u2192 nystagmus attenuates with ocular fixation + positive HIT test (Head Impulse Test - Halmagyi) on injured side + HINTS test : in emergency to distinguish a peripheral cause from a central cause (stroke): H = Head Impulse Test + I = Nystagmus type (direction) + T = Test of Skew \u2192 unidirectional nystagmus + positive HIT + no skew deviation \u2192 peripheral cause + multidirectional nystagmus + negative HIT + skew deviation \u2192 Stroke \u2192 Kattah 2009: HINTS superior to early MRI for detecting brainstem stroke in acute vestibular syndrome + evolution: acute phase (J1-J14): intense vertigo + instability + difficulty walking \u2192 compensation phase (J15-J60): progressive reduction of vertigo thanks to central compensation \u2192 residual phase: residual instability + persistent hypoacusis if severe cochlear lesion; differential diagnosis: vestibular neuritis (neuronitis): identical to labyrinthitis BUT without auditory involvement \u2192 no hypoacusis + no tinnitus + BPPV (benign paroxysmal positional vertigo): brief vertigo (<1 min) + triggered by changes in head position \u2192 positive Dix-Hallpike test \u2192 treatment with repositioning maneuver (Epley) + brainstem stroke (AICA infarct): may simulate labyrinthitis \u2192 HINTS emergency \u2192 MRI if doubt + HINTS test negative central side \u2192 Meniere's disease: recurrent episodes of vertigo + fluctuating hypoacusis + tinnitus + auricular fullness \u2192 auricular herpes zoster (Ramsay Hunt syndrome): VZV + ENT shingles \u2192 pinna vesicles + facial paralysis + vertigo + hypoacusis + intense auricular pain <\/ul>\n\n <h2>Treatment and care<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Treatment \/ appearance<\/th><th>Data, modalities, and protocols<\/th><th>Key studies and recommendations<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Symptomatic treatment \u2014 dizziness and vomiting<br><small style=\"font-weight:400;color:#7a8fa0;\">Antivertigo \u2014 dimenhydrinate Gravol \u2014 prochlorperazine \u2014 metoclopramide \u2014 ondansetron \u2014 meclizine \u2014 betahistine \u2014 duration of suppressive treatment \u2014 vestibular rehabilitation \u2014 hydration \u2014 rest<\/small><\/td>\n <td>Symptomatic treatment of acute phase (J1-J5): aim: relieve vertigo + nausea + vomiting \u2192 allow hydration and feeding \u2192 facilitate safe ambulation \u2192 allow central compensation + antivertiginous and antiemetic : dimenhydrinate (Gravol) 50 mg PO or IM \u2192 H1 antagonist + anticholinergic \u2192 reduces vertigo + nausea \u2192 50 mg PO \u00d7 4-6\/d \u2192 or 50 mg IM if severe vomiting \u2192 side effect: somnolence \u2192 prochlorperazine (Stemetil) 5-10 mg PO or IM \u2192 antidopaminergic + potent antiemetic \u2192 effective for severe vomiting \u2192 risk: extrapyramidal effects (dystonia) \u2192 promethazine (Phenergan) 25 mg IM \u2192 sedative + antiemetic + meclizine (Antivert - not available in Canada but used in USA) \u2192 dimenhydrinate analog \u2192 ondansetron (Zofran) 4-8 mg PO or IV \u2192 5-HT3 receptor antagonist \u2192 antiemetic \u2192 little sedation \u2192 useful if persistent vomiting \u2192 metoclopramide (Maxeran) 10 mg IV\/IM \u2192 prokinetic + antiemetic \u2192 extrapyramidal risk + IMPORTANT: vestibular suppressants (dimenhydrinate + prochlorperazine + benzodiazepines) should be used as little as possible (maximum 3-5 days) \u2192 they mask symptoms but slow central compensation \u2192 prolong beyond-beyond 5 days \u2192 delayed healing \u2192 betahistine (Serc) 16-24 mg \u00d7 3\/d \u2192 histamine analogue \u2192 reduces endolymphatic pressure \u2192 indicated especially in Meniere's disease + probably useful in labyrinthitis \u2192 may reduce vertigo + improve compensation + corticoids in viral labyrinthitis : prednisone 40-60 mg\/d \u00d7 5-7 days \u2192 controversy \u2192 Strupp 2004 - Lancet : methylprednisolone IV + vestibular neuritis \u2192 improved vestibular recovery at 12 months \u2192 data transposed to viral labyrinthitis + benefit on hypoacusis if started early + corticosteroids recommended if sudden significant hypoacusis (sudden deafness) \u2192 prednisone 1 mg\/kg\/d \u00d7 7-14 days \u2192 or intratympanic methylprednisolone if insufficient systemic route \u2192 hydration: IV if severe vomiting prevents oral hydration \u2192 bed rest in acute phase + avoid sudden head movements<\/td>\n <td>Strupp 2004 \u2014 Lancet: IV methylprednisolone + vestibular neuritis \u2192 improved vestibular recovery at 12 months \u2192 reference for corticosteroids in acute vestibular syndromes + Gacek 2002 \u2014 Annals of Otology Rhinology and Laryngology: HSV-1 + vestibular ganglia + viral pathophysiology \u2192 Kattah 2009 \u2014 Stroke: HINTS + acute vestibular syndrome \u2192 superior to early MRI for stroke + AAO-HNS (American Academy of Otolaryngology \u2014 Head and Neck Surgery) 2019: sudden hearing loss \u2192 oral corticosteroids \u2192 strong recommendation + NICE 2017: dizziness + labyrinthitis \u2192 symptomatic treatment + Bhattacharyya 2017 \u2014 Otolaryngology Head and Neck Surgery: vestibular neuritis + labyrinthitis \u2192 guidelines + corticosteroids + Government of Quebec + MSSS + INESSS: dimenhydrinate + prochlorperazine + ondansetron reimbursed + RAMQ: betahistine Serc reimbursed <\/tr>\n <tr>\n <td>Bacterial labyrinthitis and antibiotic therapy<br><small style=\"font-weight:400;color:#7a8fa0;\">Bacterial labyrinthitis \u2014 AOM extension \u2014 meningitis \u2014 ceftriaxone \u2014 amoxicillin-clavulanate \u2014 surgical emergency \u2014 mastoidectomy \u2014 paracentesis \u2014 permanent hearing loss \u2014 cochlear implant \u2014 vaccination prevention<\/small><\/td>\n <td>Bacterial labyrinthitis - medical and surgical emergency: etiology and context: extension of untreated or inadequately treated suppurative AOM (acute otitis media) \u2192 fever + otalgia + anterior otorrhea \u2192 then vertigo + hypoacusis \u2192 sign of complication + extension of mastoiditis \u2192 extension of chronic otitis with cholesteatoma \u2192 meningogenic extension (pneumococcal bacterial meningitis ++ ) \u2192 agents: Streptococcus pneumoniae ++ + Haemophilus influenzae + Staphylococcus aureus + gram-negative bacilli (less frequent) \u2192 urgent workup: CBC + CRP + blood cultures \u00d7 3 + lumbar puncture if meningitis suspected \u2192 CT scan of rocks + mastoids \u2192 urgent ENT consultation \u2192 MRI of posterior fossa if stroke suspected; antibiotic treatment of bacterial labyrinthitis: emergency IV antibiotic therapy: ceftriaxone (Roc\u00e9phine) 2 g IV \u00d7 1\/d \u2192 broad coverage + penetration into inner ear \u2192 if associated meningitis \u2192 ceftriaxone 2 g IV \u00d7 2\/d + dexamethasone IV 0.15 mg\/kg \u00d7 4\/d \u00d7 2-4 days \u2192 reduction of meningeal inflammation \u2192 reduction of risk of auditory sequelae \u2192 Van de Beek 2010 - NEJM : dexamethasone + bacterial meningitis \u2192 reduced neurological + auditory sequelae \u2192 if allergic to cephalosporins \u2192 chloramphenicol or vancomycin + rifampicin \u2192 meningitis: see standard protocol + if suppurative AOM with labyrinthitis + mastoiditis: myringotomy + tympanic paracentesis (drainage of AOM) \u2192 or mastoidectomy if extensive mastoiditis \u2192 double drainage: middle ear + mastoid \u2192 IV antibiotic therapy \u00d7 7-14 days \u2192 then oral relay according to antibiogram \u2192 amoxicillin-clavulanate 875\/125 mg \u00d7 2\/d \u2192 or amoxicillin if susceptible pneumococcus \u2192 auditory sequelae of bacterial labyrinthitis: severe to profound permanent hypoacusis in 20-40 % of bacterial labyrinthitis \u2192 cochlear ossification (ossified labyrinth) if severe bacterial labyrinthitis \u2192 compromises cochlear implant insertion \u2192 early cochlear implantation (before ossification if possible - within weeks of labyrinthitis) \u2192 prevention: pneumococcal vaccination (Prevnar 13 + Prevnar 20 + Pneumovax 23) \u2192 meningococcal vaccination \u2192 early and complete treatment of AOM \u2192 no use of insufficient antibiotics + ENT follow-up of any complicated AOM.<\/td>\n <td>Van de Beek 2010 \u2014 NEJM: dexamethasone + bacterial meningitis \u2192 reduced neurological + auditory sequelae \u2192 reference + Van de Beek 2016 \u2014 NEJM (meta-analysis): corticosteroids + bacterial meningitis \u2192 reduced mortality + sequelae + AAO-HNS 2019 + IDSA 2019 (Tunkel): bacterial meningitis \u2192 treatment + ceftriaxone + dexamethasone \u2192 Bhattacharyya 2017 \u2014 Otolaryngology Head and Neck Surgery: bacterial labyrinthitis \u2192 treatment \u2192 ENT emergency + SOGC + MSSS + INSPQ Quebec: pneumococcal + meningococcal vaccination \u2192 Health Canada: Prevnar 13 + Prevnar 20 + Pneumovax 23 \u2192 Quebec vaccination programs + cochlear implant: early discussion after severe bacterial labyrinthitis \u2192 RAMQ + MSSS: cochlear implant covered if criteria met <\/tr>\n <tr>\n <td>Vestibular rehabilitation and long-term recovery<br><small style=\"font-weight:400;color:#7a8fa0;\">Central vestibular compensation \u2014 vestibular rehabilitation \u2014 Cawthorne-Cooksey exercises \u2014 vestibular physiotherapy \u2014 residual instability \u2014 chronicity \u2014 vestibular neuritis \u2014 residual hearing loss \u2014 prognosis \u2014 return to work<\/small><\/td>\n <td>Recovery and central vestibular compensation: mechanism of central compensation: the central nervous system (cerebellum + brainstem) detects the asymmetry of vestibular signals (injured side vs. healthy side) \u2192 progressive compensation \u2192 reduction of vertigo \u2192 improvement of balance \u2192 this process takes 4 to 8 weeks for resting vertigo + several months for instability on walking and exertion \u2192 vestibular suppressants (dimenhydrinate + benzodiazepines) slow down this process by reducing vestibular input \u2192 hence the importance of stopping them quickly (maximum 3-5 days) + vestibular rehabilitation (specialized physiotherapy) : specific exercises to stimulate and accelerate central compensation: Cawthorne-Cooksey exercises (historical): progressive head + eye + trunk movements \u2192 progressive sensitization \u2192 adaptation + gaze stabilization exercises (VOR - Vestibulo-Ocular Reflex): head rotations with target fixation \u2192 reinforcement of residual VOR + balance + walking exercises + vestibular rehabilitation results: Yardley 1998 - Quarterly Journal of Medicine: vestibular physiotherapy + chronic vertigo \u2192 significant improvement vs. control group \u2192 Hillier 2011 - Cochrane: vestibular rehabilitation + vestibular neuritis + labyrinthitis \u2192 well-established efficacy \u2192 recommended \u2192 start: as soon as patient can mobilize (often D3-J5 post-start) \u2192 reference in vestibular physiotherapy \u2192 trained professionals + available in Quebec + viral labyrinthitis prognosis: vertigo: complete resolution in 80-90 % of cases in 6-8 weeks + residual instability: 20-30 % of patients retain mild instability on exertion or fatigue \u2192 vestibular physiotherapy helps \u2192 residual hypoacusis: if viral labyrinthitis \u2192 often partial and stable \u2192 if bacterial labyrinthitis \u2192 severe to profound deafness possible \u2192 cochlear implant + return to work: usually 2-4 weeks for non-physical professions + longer if risky work (height + driving vehicles) \u2192 Meniere's disease in differential: if recurrent vertigo (\u22652 episodes >20 min) + fluctuating hypoacusis + tinnitus + auricular fullness \u2192 diagnostic criteria (AAO-HNS 1995 + 2020) \u2192 betahistine + diuretics (hydrochlorothiazide-triamterene) + low-salt diet \u2192 intratympanic gentamicin injection if refractory (chemical ablation of vestibule)<\/td>\n <td>Hillier 2011 \u2014 Cochrane: vestibular rehabilitation + vestibular neuritis + labyrinthitis \u2192 effectiveness \u2192 strong recommendation + Yardley 1998 \u2014 Quarterly Journal of Medicine: vestibular physiotherapy + chronic vertigo \u2192 significant improvement + Strupp 2004 \u2014 Lancet: methylprednisolone + vestibular neuritis \u2192 recovery + Bhattacharyya 2017 \u2014 Otolaryngology Head and Neck Surgery: vestibular neuritis + labyrinthitis + rehabilitation + Kattah 2009 \u2014 Stroke: HINTS + acute vestibular syndrome + stroke vs. peripheral + Newman-Toker 2021 \u2014 Stroke: HINTS + MRI + vestibular syndrome + NICE 2017: labyrinthitis + vertigo \u2192 vestibular rehabilitation + AAO-HNS 1995 + 2020: Meniere's disease criteria + Ordre professionnel de la physioth\u00e9rapie du Qu\u00e9bec (OPPQ): physiotherapists trained in vestibular rehabilitation + INESSS Qu\u00e9bec + RAMQ: vestibular physiotherapy partially reimbursed + betahistine Serc reimbursed <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>Vestibular suppressants (dimenhydrinate + prochlorperazine) should not be used for more than 3-5 days\u2014they slow central compensation and delay recovery:<\/strong> Vestibular rehabilitation (specialized physical therapy with Cawthorne-Cooksey exercises and gaze stabilization) is the most effective treatment for accelerating recovery from day 3\u20135. The HINTS test (Head Impulse + Nystagmus type + Test of Skew) is more accurate than early MRI for distinguishing labyrinthitis from a brainstem stroke\u2014multidirectional nystagmus or a negative HIT in acute vestibular syndrome warrants an urgent MRI.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent consultation or a call to 911<\/div>\n <p><strong>Acute vestibular syndrome (severe vertigo + nausea + instability) + multidirectional nystagmus (changes direction with gaze) + negative HIT + skew deviation + associated neurological signs (dysphagia + dysarthria + diplopia + severe ataxia + sudden headache)<\/strong> Brainstem stroke (AICA or PICA) - not labyrinthitis - call 911 - emergency diffusion MRI - stroke management.<\/p>\n <p><strong>Child or adult with acute otitis media (ear pain + ear discharge + fever) + onset of intense dizziness + sudden hearing loss + nystagmus + stiff neck<\/strong> Bacterial labyrinthitis + possible meningitis \u2192 medical emergency \u2192 call 911 \u2192 lumbar puncture if meningitis \u2192 ceftriaxone IV 2 g + dexamethasone IV \u2192 urgent ENT consultation \u2192 myringotomy + paracentesis + or mastoidectomy as indicated.<\/p>\n <p><strong>Patient with Ramsay Hunt syndrome (vesicles on auricle + ear canal) + facial paralysis + intense vertigo + hearing loss<\/strong> \u2192 Ramsay Hunt syndrome (VZV) \u2192 geniculate herpes zoster \u2192 ENT + neurological emergency \u2192 valacyclovir 1 g TID for 7-10 days + prednisone 60 mg daily for 5 days \u2192 to reduce the risk of facial and auditory sequelae \u2192 ENT consultation within 72 hours.<\/p>\n <p><strong>Patient with a history of severe bacterial labyrinthitis (<4-6 weeks) + persistent unilateral profound hearing loss<\/strong> \u2192 ongoing cochlear ossification \u2192 urgent cochlear ENT consultation to discuss early cochlear implant BEFORE ossification \u2192 each week of delay increases the risk of inability to insert the cochlear electrode.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's doctors diagnose viral labyrinthitis (vertigo + hypoacusis + tinnitus + unilateral horizontal nystagmus + positive HIT), use the HINTS test to rule out stroke, prescribe symptomatic treatment (dimenhydrinate + prochlorperazine + corticosteroids if significant hypoacusis), refer urgently if the presentation is atypical or central, and refer for vestibular physiotherapy as soon as the patient can mobilize. Consultations are available at several points of service in Quebec, and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not substitute for the advice of a physician, neurologist, or ENT. Acute vestibular syndrome with associated neurological signs or atypical nystagmus requires urgent evaluation to rule out a brainstem stroke.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p> Neurologie & ORL & M\u00e9decine d’urgence & M\u00e9decine de famille Labyrinthite La labyrinthite est une inflammation du labyrinthe membraneux de l’oreille interne, structure anatomique complexe comprenant \u00e0 la fois les organes de l’audition (cochl\u00e9e) et de l’\u00e9quilibre (vestibule : utricule + saccule + canaux semi-circulaires). Elle se manifeste par l’association de vertiges intenses (de… <a href=\"https:\/\/cliniqueomicron.ca\/en\/labyrinthite\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Labyrinthite : vertiges et oreille interne | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Labyrinthite : causes, diagnostic | Brossard | Clinique Omicron","_metasync_otto_description":"La labyrinthite est une inflammation du labyrinthe de l'oreille interne causant vertiges, naus\u00e9es et hypoacousie. Diagnostic, traitement vestibulaire et pris...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Labyrinthite : causes, diagnostic | Brossard | Clinique Omicron","_metasync_otto_og_description":"La labyrinthite est une inflammation du labyrinthe de l'oreille interne causant vertiges, naus\u00e9es et hypoacousie. Diagnostic, traitement vestibulaire et pris...","_metasync_otto_twitter_title":"Labyrinthite : causes, diagnostic | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"La labyrinthite est une inflammation du labyrinthe de l'oreille interne causant vertiges, naus\u00e9es et hypoacousie. 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