Vestibular Labyrinthitis

Labyrinthitis is an inflammation of the inner ear caused by a viral or bacterial infection. It is

characterized by hearing loss, vertigo, and usually nausea and vomiting. for other causes of vertigo,
including benign paroxysmal positional vertigo.
Pathophysiology and Etiology
1. Bacterial labyrinthitis is usually associated with acute otitis media or cholesteatoma. Infectious
organisms may enter the inner ear through the oval or round window. Bacterial meningitis can
cause labyrinthitis by spread of the bacterial infection via the cochlear aqueduct and internal
auditory canal.
2. Viral labyrinthitis can occur as a result of viral illnesses of the respiratory tract system and may
include measles, mumps, rubella, or herpetic infections of the facial or acoustic nerve. This may
be seen in Ramsey-Hunt syndrome.
3. Vestibular neuronitis or neuritis is a disorder of the vestibular nerve (CN XII) characterized by
severe, sudden onset of vertigo with normal hearing. Etiology most commonly from viral illness,
but may be attributed to other causes. The course is usually self-limiting. The patient may have an
unsteady gait but is able to walk. (This is differentiated by cerebellar disease, in which the patient
has vertigo and nystagmus and is usually unable to walk.) Treatment is supportive with meclizine,
benzodiazapines, anti-emetics, or vestibular rehabilitation.
Clinical Manifestations
1. Sudden onset of incapacitating vertigo, with varying degrees of nausea and vomiting, hearing
loss, and tinnitus.
2. Persists; does not occur in episodic attacks like Ménière’s disease.
Management
1. The rare cases of bacterial labyrinthitis are treated with antibiotics, as with the suspected
predisposing infection. Bacterial labyrinthitis is treated by antibiotics, anti-emetics, vestibular
suppresssants, and vestibular rehabilitiation. Diagnostic imaging may include CT of temporal
bone, MRI of internal auditory canal with gadolinium, and lumbar puncture, if bacterial meningitis
suspected.
2. Viral and physiologic causes are treated with symptomatic support. In patients with viral
labyrinthitis, management may include antiviral therapy, anti-emetics, vestibular suppressants, and
later in illness, vestibular rehabilitation.
3. Vestibular suppressant and anti-emetic medication as with Ménière’s disease (meclizine,
diazepam, promethazine).
4. Audiometric evaluation should be obtained with all patients with vertigo to differentiate between
vestibular labyrinthitis and vestibular neuronitis. MRI of brain and internal auditory canal is
obtained when assymetrical hearing loss is present to rule out acoustic neuroma.
Complications
1. Permanent hearing loss.
2. Injury from fall.
Nursing Assessment
1. Assess frequency and severity of attacks and how patient handles them.
2. Assess for fever related to bacterial infection.
3. Assess for additional neurologic symptoms—visual changes, change in mental status, sensory
and motor deficits—that may indicate CNS pathology.
4. Assess for effectiveness of vestibular stimulants and antiemetics.
5. If fall occurs, assess for injury.
Nursing Diagnoses-
Risk for Injury related to gait disturbance secondary to vertigo.
Anxiety related to sudden onset of symptoms.
Risk for Deficient Fluid Volume related to vomiting and impaired intake.
Bathing and Hygiene Self-Care Deficit related to vertigo.
Nursing Interventions
Preventing Injury
1. At onset of attack, have the patient lie still in darkened room with eyes closed or fixed on
stationary object until the vertigo passes.
2. Make sure that the patient can obtain help at all times through use of call system, close proximity
to staff, or companion.
3. Remove obstacles in the patient’s environment.
4. Make sure that sensory aids are available—glasses, hearing aid, proper lighting.
5. Use side rails while the patient is in bed.
6. Administer medications, as directed; assess for and avoid oversedation.

Minimizing Anxiety
1. Explain the physiology behind vertigo and the possible triggers.
2. Support patient and family through the diagnostic process
3. Assist the patient to adjust activities to minimize the impact.
4. Teach stress-reduction techniques, such as deep breathing, talking and asking questions, and
distraction.
Ensuring Adequate Fluid
1. Keep diet light while vertigo is present.
2. Administer anti-emetics, as directed.
3. Assess intake and output, as indicated.
4. Encourage fluids and small feedings while patient is feeling better.
Encouraging Safe Self-Care
1. Encourage activity while vertigo is minimal; rest during attacks.
2. Set up environment for the patient’s safety and convenience—chair near sink, walker to hold on
to while walking, if necessary, and so forth.
3. Assist the patient with hygiene and other care, as needed.
Patient Education and Health Maintenance
1. Teach patients with viral labyrinthitis that attacks are self- limiting, will become less severe,
and should leave no permanent disability.
2. Teach safety measures during vertigo attacks.
3. Tell the patient that vertigo is best tolerated while lying flat in bed in a darkened room, with
eyes closed or looking at stable object.
4. Teach patients how to take medications and to avoid other CNS depressants such as alcohol.
5. Encourage follow-up..