Kembara Xtra - Medicine - Labyrinthitis
Vertigo that appears out of nowhere, lasts hours to days, and is accompanied by sensorineural hearing loss and tinnitus. It is brought on by an acute infection or inflammation of the labyrinth. When there are no neurologic abnormalities, labyrinthitis is a clinical diagnosis and can be classified as either suppurative or serous/toxic. Usually appears with a sudden unilateral sensorineural hearing loss and a subjective impression of motion or room-spinning vertigo that lasts for hours or days. Frequently accompanied by vestibular hypofunction in the affected ear. With central compensation, peripheral vertigo gets better over time. Serous labyrinthitis typically results in an improvement in hearing loss, whereas suppurative labyrinthitis results in permanent hearing loss. Nervous, particular sensory (auditory, vestibular) system(s) affected Caution The phrases "vertigo" and "dizziness" are frequently used. Give other descriptions of the symptoms, such as dizziness, disarray, room-spinning vertigo, or unbalance, to help explain the symptoms. In individuals with vertigo, hearing loss and the length of the symptoms can aid to focus the differential diagnosis. When the vestibular nerve becomes inflamed, vertigo that lasts for hours to days without the auditory symptoms of labyrinthitis results. This condition is known as vestibular neuritis/neuronitis. BPPV, or benign paroxysmal positional vertigo, is the most typical cause of dizziness. BPPV is episodic as opposed to labyrinthitis, with severe symptoms lasting less than a minute. Using the Dix-Hallpike technique, BPPV is diagnosed. It is not connected to hearing loss like labyrinthitis is. Ménière disease is characterized by episodic vertigo, tinnitus, and hearing loss and is more sporadic than labyrinthitis; it comes and goes rather than persisting continuously. The second most frequent cause of recurrent dizziness, vestibular migraine typically has a migraine history and lasts for hours. Up to 10% of cases can be headache-free. Epidemiology There aren't enough studies on labyrinthitis alone. If vestibular neuritis is included, it affects 10% of all patients with vertigo and is most prevalent in people between the ages of 30 and 50 (4). Female = male is the dominant sex. Incidence Viral labyrinthitis is the most prevalent cause, with an estimated incidence of 3.5 per 100,000 people if vestibular neuritis is taken into account. It is becoming less common for labyrinthitis to suppurate as a result of meningitis or otitis media. 20–30% of adults will seek medical attention for vertigo at some point in their lives. The true labyrinthitis is uncommon. Pathophysiology and Etiology Cochlea and vestibular apparatus are both involved in the labyrinth's acute inflammation and injury. In the event of serous labyrinthitis, viral or bacterial toxins may enter the labyrinth directly from the middle ear through the round or oval window. Suppurative labyrinthitis is characterized by bacterial invasion of the inner ear, which may result from meningitis or a middle ear infection. Viruses that are commonly contracted include cytomegalovirus, mumps, varicella zoster, rubella, influenza, parainfluenza, herpes simplex, adenovirus, coxsackievirus, respiratory syncytial virus, and HIV. – Common bacteria include Borrelia burgdorferi, Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitidis, Streptococcus pneumoniae, and Staphylococcus spp. Treponema pallidum is a treponemal. Genetics no established genetic relationship Risk factors include meningitis, otitis media, cholesteatoma, head trauma, and viral upper respiratory infections. Prevention • Scheduled vaccines (to avoid common viral diseases); • avoid maternal transmission of pathogens, such as syphilis and HIV; • Early treatment of acute otitis media to prevent complications. Head injuries, otitis media, cholesteatoma, and viral upper respiratory infection are associated conditions. Vertigo is acute in onset and lasts for hours to days in the history. It is also accompanied by sensorineural hearing loss in one ear. Vomiting and nausea are frequent. Fullness of the affected ear Tinnitus (roaring, ringing) of the affected ear Signs of an upper respiratory infection Otorrhea or otalgia, which are uncommon viral causes Meningitis-related symptoms of a severe headache, fever, and nuchal rigidity should raise the possibility of an autoimmune etiology. Extreme imbalance or related focal neurologic symptoms are unusual and should trigger imaging. clinical assessment Nystagmus - Fast-beating nystagmus away from the injured ear during the convalescent phase, 48 to 72 hours later; during the acute phase, fast-beating nystagmus toward the affected ear. Eyes open and concentrate on a single object alleviate symptoms. Otologic examination may not reveal anything unusual in the presence of viral labyrinthitis. Retraction of the tympanic membrane and keratinaceous debris may be present with cholesteatoma, as well as serous/purulent effusion in the middle ear. Vestibular neuritis/neuronitis (vertigo without hearing loss): Differential diagnosis BPPV, which is episodic vertigo that lasts seconds to minutes and is worse when lying down or looking up; Ménière disease, which causes hearing loss, tinnitus, and episodic vertigo; vestibular migraine; autoimmune inner ear disease; postconcussive syndrome; acute otitis media; ototoxicity; cerebellopontine-angle tumors (such as vestibular schwannoma); and less common causes, such as parainfect Laboratory Results Regular lab tests are useless unless an autoimmune cause is thought to be the cause. When choosing an antibiotic, take into account the otorrhea or middle ear fluid culture. When there is a cholesteatoma or complicated otitis media, a temporal bone CT scan may be recommended. Only if meningitis is suspected should lumbar puncture be considered. When risk factors or a patient's medical history suggest it clinically, think about getting tested for HIV or syphilis. The diagnosis of acute labyrinthitis does not need imaging. An MRI of the internal auditory canals and/or MRA of the brain and brainstem are advised in cases of acute sensorineural hearing loss or other related neurologic symptoms. Tests in the Future & Special Considerations Following bacterial meningitis, internal auditory canal fibrosis known as labyrinthitis ossificans is believed to be caused by a suppurative labyrinthitis. Particularly following meningitis caused by S. pneumoniae, this might happen quickly. Other/Diagnostic Procedures Vestibular testing are normally not recommended in the acute environment. An audiogram should be acquired. Videonystagmography should be utilized if vertigo and wooziness continue after the anticipated improvement of symptoms. Caloric testing may reveal relative weakening of the horizontal semicircular canal on the affected side. Audiograms may demonstrate varying degrees of sensorineural hearing loss and discriminating loss. The literature on this test's specificity and sensitivity varies. In the acute stage, therapy includes symptom control and reassurance. Only use vestibular suppressants when necessary for really severe acute vertigo bouts. Patients should be warned against taking these drugs on a regular basis or as prophylaxis without symptoms because doing so can induce a delay in central compensatory mechanisms. High-dose steroids (oral and/or intratympanic) should be used to treat sudden single-sided sensorineural hearing loss as soon as feasible, ideally within two weeks. There is no conclusive evidence that steroids reduce vestibular problems. Vestibular rehabilitation has been proven to be a safe and effective treatment for unilateral peripheral vestibular impairment. It is the mainstay of treatment for chronic vertigo and dizziness. As soon as the initial phase passes and movement is bearable, usually within 2 to 3 days of onset, patients should start exercising. Appropriate antibiotics to remove infection for suppurative labyrinthitis. Depending on the degree of middle ear involvement, surgery may also be necessary, such as mastoidectomy or tympanostomy tubes. General Actions Postural control can be improved with vestibular exercises for chronic symptoms and unilateral vestibular loss. Medication The following medications should only be taken as needed. In addition, benzodiazepines can help with the anxiety brought on by vertigo. Because vestibular suppressants can prevent central compensation, no patient should take them on a long-term basis. Vestibular suppressants: Diazepam (Valium) or Lorazepam (Ativan) 0.5 to 2.0 mg SL/PO BID PRN Meclizine (Antivert, Bonine, Zentrip [dissolvable]): 2 to 5 mg QID PO PRN; Dimenhydrinate (Dramamine): 25 to 50 mg PO q4-6h PRN; Meclizine: 12.5 to 25.0 mg PO BID-TID. Antiemetics include meclizine (Antivert, Bonine), promethazine (Phenergan), 12.5 to 25.0 mg PO/PR QID PRN, and prochlorperazine (Compazine). Ondansetron (Zofran), 4 to 8 mg PO TID PRN, or granisetron (Kytril), 1 mg PO TID PRN, are antiemetics. Metoclopramide (Reglan) 25 mg PR BID PRN, 10 mg PO TID PRN Antivirals: 800 mg PO of acyclovir Herpes-related conditions can be treated with 5 doses each day for 7 days. Steroids: Methylprednisolone initially 100 mg PO daily and then tapered to 10 mg PO daily over 3 weeks; Prednisone 1 mg/kg/day up to a maximum of 60 mg daily for 1 week; Dexamethasone 0.4 to 0.8 mL of 24 mg/mL strength given via transtympanic injection for three to four sessions; can be used for salvage therapy. Given early in the course of bacterial meningitis, it may lessen the risk of developing otologic complications, particularly labyrinthitis ossificans. It is also used to treat labyrinthitis-related abrupt sensorineural hearing loss, ideally during the first two weeks. Aspects of Geriatrics Scopolamine, meclizine, and other vestibular suppressants should not be used excessively after the initial occurrence since this will postpone central compensation. Benzodiazepines are the primary method of treating vestibular suppression, however they do make older people more susceptible to falling. pregnant women's issues Pregnancy Category B drugs include dimenhydrinate, diphenhydramine, ondansetron, granisetron, and metoclopramide. Initial Line Benzodiazepines, which are superior vestibular suppressants to antihistamine/anticholinergics like meclizine, are favored. Sublingual benzodiazepines are an excellent first-line treatment for vertigo because of their high efficacy. Immediate steroid therapy in an emergency situation Referral For suspected central causes of vertigo or dizziness, consider referring to neurology. Consider referring someone to an otolaryngologist or neurotologist if you have vertigo, progressive hearing loss, or suppurative labyrinthitis that needs surgery. Admission It may be necessary to hospitalize patients for intravenous fluids and drugs if they have a systemic infection or uncontrollable nausea and vomiting. Patient Follow-Up Monitoring Audiograms should be used to monitor hearing loss until it stabilizes. The duration of acute vertigo symptoms can reach six weeks. It has been proven that residual symptoms might continue for years. Avoid drinking because it could make symptoms worse. Modification of Lifestyle Opening eyes while maintaining a visual fixation should lessen symptoms, however closing eyes can exacerbate them. Limit sudden head movements until symptoms go away. A long-term use of vestibular suppressants can prevent central compensation, therefore avoid it. Complications Permanent hearing loss, more frequently brought on by bacterial causes, and ongoing balance problems
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