Labyrinthitis

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Labyrinthitis , also known as vestibular neuritis , is an inner ear inflammation. This produces a whirling world sensation as well as the possibility of hearing loss or ringing in the ear. This can happen as a single attack, a series of attacks, or a persistent condition that is reduced for three to six weeks. It may be associated with nausea, vomiting, and eye nystagmus.

The cause is often unclear. Probably because of the virus, but can also arise from bacterial infections, head injuries, extreme stress, allergies, or in reaction to drugs. 30% of people affected have common colds before developing the disease. Both bacterial or viral labyrinthitis can cause permanent hearing loss in rare cases. This seems to be the result of a neuronal input imbalance between the left and right ears.

Vestibular neuritis affects about 35 people per million per year. It usually occurs between the ages of 30 and 60 years. There are no significant gender differences. It derives its name from the labyrinth that houses the vestibular system, which senses a change in the head position.

Video Labyrinthitis

Signs and symptoms

The main symptom of labyrinthitis is severe vertigo. Rapid and unwanted eye movement (nystagmus) often results from an indication of improper rotational motion. Nausea, anxiety, and general pain are common because of the distorted balance signals the brain receives from the inner ear.

Maps Labyrinthitis

Cause

Some people will report having an upper respiratory tract infection (flu) or flu before the onset of vestibular neuritis symptoms; others will not have viral symptoms before the onset of vertigo.

Some cases of vestibular neuritis are thought to be caused by a vestibular ganglion infection by type 1 herpes simplex virus. However, the cause of this condition is not fully understood, and in fact many different viruses may be able to infect the vestibular nerve.

Acute local ischaemia of this structure may also be an important cause, especially in children, vestibular neuritis may be preceded by ordinary flu symptoms. However, the underlying mechanism remains unclear.

This can also be caused by pressure changes as experienced by flying or scuba diving.

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Mechanism

The vestibular system is a set of sensory inputs consisting of three semicircular canals, perceived changes in rotational motion, and otolith, sensing changes in linear motion. The brain combines visual cues with the sensory input of the vestibular system to determine the adjustments necessary to maintain balance. The vestibular system also conveys information about the head movement to the eye muscle, forming a vestibulo-ocular reflex to maintain a continuous visual focus during movement.

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Diagnosis

Not known

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Treatment

Treatment for vestibular neuritis depends on the cause. However, symptoms of vertigo can be treated in the same way as other vestibular dysfunctions with vestibular rehabilitation.

Physical therapy

Common treatments include a combination of head and eye movements, postural changes, and walking exercises. In particular, prescribed exercises include keeping the eye fixed to a specific target while moving the head, moving the head rightward to the left on two targets at a significant distance apart, walking while keeping the eye fixed on a particular target, and walking while keeping the eyes fixed on the target certain while also turning heads in different directions. The main function behind the repetition of a combination of head and eye movement, postural and walking changes is that through this repetition, compensatory changes for dysfunction arising from peripheral vestibular structures can be promoted in the central vestibular system (brainstem and cerebellum).

Vestibular rehabilitation therapy is a very effective way to substantially reduce or eliminate the residual dizziness of labyrinthitis. VRT works by causing the brain to use existing nerve mechanisms for adaptation, neuroplasticity, and compensation.

The most common rehabilitation strategies used are:

• Reflect stability training - move the head from side to side while fixated on a still object (aiming to help the eyes to glued during head rotation without input from missing vestibulo- ocular ducts). The continued development of this exercise will run in a straight line while looking sideways by turning the head.
• Habituation training - movements designed to provoke symptoms and then reduce the negative vestibular response during repetition. Examples include Brandt-Daroff practice.
• Functional retraining - including postural control, relaxation, and balance exercises.

These exercises work by challenging the vestibular system. Progress occurs by increasing the head amplitude or the movement of the focal point, increasing the speed of movement, and incorporating movements such as walking and spinning heads.

One study found that patients who believed that their disease was out of their control showed the slowest development for full recovery, long after the initial vestibular injury had healed. This study reveals that patients who compensate well are people who, on a psychological level, are not afraid of symptoms and have positive control over them. In particular, reductions in negative beliefs over time are greater in patients treated with rehabilitation than untreated ones. "Most importantly, basic beliefs are the only predictor of change in significant disability at 6 months of follow-up."

Medication

Vestibular neuritis is generally a self-limiting disease. Treatment with drugs is not necessary and is not possible. Glucocorticoid effects have been studied, but they have not been found to significantly affect long-term outcomes.

Symptomatic treatment with antihistamines such as cinnarizine, however, may be used to suppress vestibular neuritis symptoms while spontaneously regressing. Prochlorperazine is another commonly prescribed medication to help relieve symptoms of vertigo and nausea.

Studies have shown that older adults with dementia who take antipsychotics (drugs for mental illness) such as prochlorperazine have an increased likelihood of death during treatment.

More

Because mood disorders can interfere with vestibular compensation and adaptive plasticity, it is advisable to overcome anxiety and/or depression disorders that occur together. Severe episodes of anxiety are usually treated by short-term benzodiazapine therapy. The use of long-term benzodiazepines such as diazepam, however, is not recommended because of tolerance issues. SSRIs and SSNRIs are one of a number of first-line treatments for anxiety or depression.

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Prognosis

In many cases, this condition tends to limit itself. At 95% or more, vestibular neuritis is a one-time experience with most people fully recovered.

Recovery from acute inflammatory labyrinthine usually takes one to six weeks, but it is not uncommon for residual symptoms (dysequilibrium and/or dizziness) for several months.

Recovery from a temporarily damaged inner ear usually follows two phases:

1. Acute period, which may include severe vertigo and vomiting
2. approximately two weeks of sub-acute symptoms and rapid recovery

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References

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External links

• Labyrinthitis in Curlie (based on DMOZ)

Source of the article : Wikipedia