Jul 4, 2018


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- In suppurative labyrinthitis with SNHL and vertigo: Surgical labyrinthectomy used to be done but nowadays it is obsolete due to powerful antibiotics, and need to preserve the skeleton of the cochlea for cochlear implant if indicated later.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

About Author

Tamer Mobarak, E.N.T resident at Qasr-Elainy teaching hospital, Cairo university.


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