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labyrinthitis

Etiology: 1) viral (most common) - etiologic agent has not been isolated 2) bacterial a) symptoms may be severe b) often in association with bacterial meningitis 3) serous: associated with otitis media Epidemiology: 1) frequently occurs 1-2 weeks after an upper respiratory tract infection 2) most frequent in spring & early summer 3) occasionally occurs in epidemics Pathology: 1) inflammation of the inner labyrinth where cochlear &nvestibular structures are in continuity [5] 2) atrophy of one or more vestibular nerve trunks Clinical manifestations: 1) vertigo develops acutely 2) intense constant vertigo for a few days 3) nausea/vomiting 4) imbalance 5) unilateral sensorineural hearing loss [2,6] 6) tinnitus may occur 7) nystagmus directed toward the unaffected ear 8) head-thrust test may be positive 9) viral form generally not associated with auditory or neurologic symptoms 10) resolution generally within 1-2 weeks Differential diagnosis: - vestibular neuronitis (no hearing loss) - Meniere's disease (duration of vertigo < 24 hours) - benign positional vertigo - no hearing loss - episodic, not constant, duration of vertigo minutes to hours - negative Rhomberg test Management: 1) prednisone [2] 2) former recommendations a) meclizine (Antivert) 25-50 mg PO every 6 hours b) dimenhydrinate (Dramamine) 50 mg PO every 6 hours c) promethazine (Phenergan) 25-50 mg PO every 6 hours

Related

vertigo

General

vestibular disorder (vestibulopathy)

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1013
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 19. American College of Physicians, Philadelphia 1998, 2006, 2012, 2021
  3. Baloh RW Dizziness in older people. J Am Geriatric Soc 40:713, 1992 PMID: 1607589
  4. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  5. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  6. NEJM Knowledge+ Question ot the Week. August 15, 2023 https://knowledgeplus.nejm.org/question-of-week/1380/