Labyrinthitis

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As with vestibular neuronitis, labyrinthitis causes sudden and severe vertigo. In contrast to vestibular neuronitis, the patient also has tinnitus and hearing loss. The hearing loss is sensorineural, is often severe, and can be permanent. Laby-rinthitis is caused by inflammation within the inner ear. The cause is most often a viral infection but can be bacterial. Bacterial labyrinthitis usually results from extension of a bacterial otitis media into the inner ear. A noninfectious serous labyrinthitis can also occur after an episode of acute otitis media. Other, less common causes include treponemal infections (syphilis) and rickettsial infection (Lyme disease).

Symptomatic treatment of labyrinthitis is similar to that for vestibular neuronitis. Antibiotics are recommended if a bacterial cause is suspected. As with acute otitis media, bacterial labyrinthitis can, in rare cases, lead to meningitis. Few other conditions cause the constellation of hearing loss, tinnitus, and vertigo, but cerebrovascular ischemia, meningitis, brain abscess, and encephalitis should all be considered. Although the vertigo should resolve over days to weeks, hearing loss and tinnitus can persist.

Drugs known to be ototoxic can cause acute onset of hearing loss and disequilibrium, although this is not true labyrin-thitis. These drugs include salicylates, aminoglycosides, loop diuretics, and various chemotherapeutic agents. This cause should be considered in patients who complain of hearing loss or dizziness while taking these medications.

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