Main menu

Pages

Labyrinthitis| causes, pathology, clinical picture, diagnosis, treatment

Definition: Inflammation of inner ear as a complication of middle ear suppuration.
Etiology: As mastoiditis.
Pathology:
1- Labyrinthine fistula (circumscribed labyrinthitis):
 Localized erosion of the bony labyrinth by cholesteatoma producing a fistula between middle and inner ears.

2- Diffuse serous labyrinthitis:
 Accumulation of serous fluid in membranous labyrinth, still no pus.
Labyrinthitis

3- Diffuse suppurative labyrinthitis:
Accumulation of pus in membranous labyrinth with degeneration of hair cells then:
- Healing by fibrosis (dead ear).
- Intra cranial extension of infection.

Clinical picture of Labyrinthitis: 

-Suppurative otitis media - Clinical picture depends on stage:

1- Labyrinthine fistula

  • Silent.
  • Vertigo: mild, transient, induced by sudden movement, tragal pressure, , no nausea or vomiting.
  • Nystagmus, rapid phase………diseased ear.
  • Positive fistula test (diagnostic)
- A test to detect labyrinthine fistula.
- Brief vertigo ± nystagmus.
- On: siegle, tragal pressure, manipulation of aural polyp.
- Positive test :vertigo ± nystagmus.
- False negative: (Very small, Non-functioning ear, Inadequate sealing, Cholesteatoma mass prevents pressure transmission).

2- Serous labyrinthitis

  • Vertigo: Severe, continuous, spontaneous with nausea and vomiting.
  • Nystagmus: Spontaneous ,directed to diseased ear.
  • Reversible sensory neural hearing loss.

3- Suppurative labyrinthitis

  • Similar to serous labyrinthitis but more severe.
  • Irreversible SNHL (dead labyrinth).
  • No or minimal general manifestation, as the amount of pus is too small.
  • Distinction between 2 and 3 is retrospective.

Investigations:

1- Hearing tests 
2- Culture and Sensitivity. 
3- C.T

Treatment of Labyrinthitis:

A- Medical: 
1- Hospitalization, rest, fluids.
2- Sedatives, antivertigo drugs.
3- Systemic massive antibiotics specially that crosses BBB: sulpha, chloramphenicol and cephalosporins.
4- Treat middle ear infection.

B- Surgical:
- In fistula: Mastoidectomy, remove the cholesteatoma and cover fistula with graft.

- In suppurative labyrinthitis with SNHL and vertigo: Surgical labyrinthectomy used to be done but nowadays it is obsolete due to powerful antibiotics, and need to preserve the skeleton of the cochlea for cochlear implant if indicated later.

- After vertigo settle, and undercover of parenteral antibiotics, radical mastoidectomy is done to control the source of infection.
References

Comments

1 comment
Post a Comment
  1. This is another testimony on how Chief Dr Lucky cured my HIV disease. Do you need a cure for your HIV disease? Do you want to be cured from your cancer disease? Or you want to be free from any type of disease. Kindly visit his website https://chiefdrluckyherbaltherapy.wordpress.com/ . He just cured my HIV disease and I’m very grateful to him, he is the only herbalist that can cure you.  
    WhatsApp number : +2348132777335 
    Via Email : chiefdrlucky@gmail.com
    Thank you all for reading,
    God bless"

    ReplyDelete

Post a Comment

Please note that we will be notified by e-mail about your comment , So be careful .
Any medical questions will be answered .

Table of Contents