Labyrinthitis vs Vestibular Neuritis

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Woman thats dizzy with labyrinthitis

Disorders of the inner ear can be difficult to fully understand; after all, it is a small space with numerous components. Labyrinthitis and vestibular neuritis are two conditions involving the inner ear, where labyrinthitis affects the labyrinth, and vestibular neuritis affects the vestibulocochlear nerve.

However, the areas they impact will differ. Below, we’ll take a closer look at the differences between labyrinthitis and vestibular neuritis.

The inner ear houses the organs and cranial nerve responsible for maintaining hearing and balance function, both of which can be affected as a result of the inflammation during these conditions. However, the areas of the inner ear impacted and the reason for disruption to daily hearing and balance functions will differ. Below, we’ll take a closer look at the differences between labyrinthitis and vestibular neuritis, including how they are treated and how individuals can address potential hearing loss.

Hearing Pathway Anatomy

Understanding the anatomy of the hearing pathway, particularly the inner ear, will help improve understanding of balance disorders such as vestibular neuritis, labyrinthitis, and other conditions affecting the inner ear and hearing. This, in turn, helps with treatment.

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The auditory pathway involves the outer, middle, and inner ear, and if any of these parts of the ear are damaged, inflamed, or ill, hearing loss can occur. The outer ear is the beginning of the hearing pathway and is made up of the pinna or auricle, which is the circular portion of the ear that is visible from the outside of the body. The design of the pinna allows it to send sound waves into the ear canal and ear drum (or tympanic membrane), the mechanism separating the outer and middle ear.

From the outer ear, sound moves into the middle ear, a system comprised of the smallest bones in the body, the ossicles. These bones are responsible for further amplifying sounds before they enter the inner ear. The inner ear is made up of structures for both hearing and vestibular (balance) functions. As a whole, these systems are described as the labyrinth, which houses the cochlear and cochlear nerve, the semicircular canals, and otolith organs.

The cochlea contains the sensory organs of hearing, meanwhile, the semicircular canals and otolith organs regulate balance control systems. Sound that has passed through the ear canal and into the inner ear then passes through a snail-shaped, fluid-filled structure called the cochlea. Hair cells within the cochlea transmit hearing information through nerves to the brain, where sound is processed and understood.

The balance and hearing systems are complicated and deeply involved. Under normal circumstances, the brain combines messages from these systems for normal hearing and vestibular function. Any changes or damages to the vestibular nerve or labyrinth of the ear, as happens in labyrinthitis and vestibular neuritis (or vestibular neuronitis), can result in changes to hearing or vestibular disorders. Inner ear infection, inflammation, and other conditions can all contribute to sudden onset hearing loss, and severe vertigo, among other symptoms.

Vestibular Organs

Model of the inner ear

Our vestibular organs are responsible for helping us maintain balance while moving or in certain positions. The two main organs regulating this function are the semicircular canals, responsible for rotational movement (e.g. turning your head), and otolith organs, responsible for linear movement (e.g. moving forward and backward).

When movement occurs, the hair cells found within the inner ear (called the crista in the semicircular ducts and the maculae in the otolith organs) produce an afferent movement that helps compress and deliver information through the VIII cranial nerve to the brain. This helps the body and brain orient themselves in space and stops you from feeling dizzy or off-kilter.

Activation of these hair cells – i.e. the movement of these hair cells – occurs when the body moves, which is why it is difficult to avoid feelings of unease and dizziness when sitting still. If the hair cells are not functioning or are impaired by illness or infection, balance disorders are the result.

VIII Cranial Nerve

The VIII cranial nerve, also called the vestibulocochlear nerve, is an important part of the vestibular system. This vestibular nerve contains nerve fibers supporting the functions of both the auditory system and the vestibular system. The auditory nerve and vestibular nerve both rely on this network to carry appropriate signals to the brain, to hear and orient yourself in space.

This particular nerve connecting the body and brain cannot function properly when a condition like vestibular neuritis, labyrinthitis, and other inner ear infections or maladies arise. This may eventually lead to difficulties in both hearing and balance. Labyrinthitis and vestibular neuritis treatment will typically soothe the issue, and restore proper communication.

Labyrinthitis

Labyrinthitis is an infection of the labyrinth within the inner ear. The infection can come from viral infections, or bacterial infections (bacterial labyrinthitis). When either type of labyrinthitis develops, the structures responsible for hearing and balance function are impacted.

Someone with labyrinthitis may experience a variety of symptoms, including dizziness, vertigo, sudden hearing loss, and tinnitus. Labyrinthitis is typically addressed using medication (e.g. antibiotics, antivirals, and steroids), and the brain will often compensate for labyrinthitis-induced damage, leading symptoms to become less severe within a few weeks.

Because both bacterial and viral infections can negatively impact the inner ear hearing apparatus, it is important to treat the root cause of the condition before addressing any loss of hearing, tinnitus, or vertigo that has developed. In some cases, anti-nausea medications can be helpful, to ease dizziness and vertigo while the underlying cause is resolved.

Vestibular Neuritis

Man with migraine holding his head

Benign paroxysmal positional vertigo and Ménière disease are the most common vestibular disorders, followed by vestibular neuritis, a condition where an infection of the ear or another area within the body affects the vestibular system. Vestibular neuritis, sometimes referred to as acute unilateral vestibulopathy and vestibular neuronitis, is characterized by the onset of an intense spinning sensation, nausea, balance issues, and even difficulty walking and concentrating.

Symptoms of vestibular neuritis can persist over a few days, or a few weeks, and can even become chronic, though these debilitating symptoms do not typically last for prolonged periods. Acute vestibular neuritis impacts the vestibular organs, and symptoms can mimic symptoms of labyrinthitis.

In vestibular neuritis, the vestibular portion of the VIII cranial nerve becomes inflamed. Dizziness, vertigo, and other vestibular symptoms result, but decreased hearing is rarely present during the acute phase of vestibular neuritis, nor is tinnitus.

Like labyrinthitis, vestibular neuritis is usually treated with medication. While vestibular neuritis symptoms can mimic labyrinthitis, the precise medication used to address the root cause differs unless both are caused by an ear infection, in which case treatment may mirror each other.

Labyrinthitis vs Vestibular Neuritis: What’s the difference?

Labyrinthitis and vestibular neuritis affect different parts of the inner ear and often have the same symptoms: balance issues such as vertigo and dizziness which sometimes resolve themselves within a few weeks. There is one important distinction between the two, however, as labyrinthitis symptoms include hearing impairment while vestibular neuritis symptoms do not.

Both can result from a bacterial or viral infection, but the involvement of the auditory system is not a likelihood for both conditions. Vestibular neuritis and labyrinthitis come from ear infections, but they can also be caused by a respiratory issue, stomach virus, as well as a systemic virus like the herpes virus (shingles, cold sores, chicken pox), and influenza.

Interestingly, however, hearing-related issues can come about as a result of vestibular neuritis, including tinnitus. Usually, this is when symptoms persist. The resulting hearing issues occur when the brain fails to adequately compensate as the inner ear is permanently damaged.

An otolaryngologist (ENT doctor) or audiologist will perform a physical exam and thorough examination of your medical history. Imaging tests can be used to rule out other potential causes of losing hearing and dizziness, along with hearing tests and vestibular testing to develop a differential diagnosis.

A thorough case history, including information about the timing and initial onset of the issues, can also help a practitioner develop the best treatment regimen to fully address symptoms. Be as detailed as possible when relaying your symptoms to your healthcare professional. Simply expressing the presence of or lack of hearing problems can accelerate your diagnosis of labyrinthitis, vestibular neuritis, or another hearing or balance disorder.

Treating Tinnitus, Dizziness, and Loss of Hearing

Man with vertigo holding his head

Inner ear infections can be at the root of both labyrinthitis and vestibular neuritis, but changes to hearing are not typical of vestibular neuritis; instead, the ear balance apparatus leads to specific symptoms involving dizziness and confusion.

Treating tinnitus, dizziness, and hearing changes typically begins with addressing the underlying cause of the issue via medications like antiviral medications, antibiotics, and steroids. When these do not fully resolve the issue, as might be the case in instances of a chronic phase of vestibular neuritis or labyrinthitis, other interventions like vestibular rehabilitation therapy can help ease more severe symptoms.

Anti-nausea medications can be used to reduce nausea and help ease the discomfort of dizziness and vertigo. Lingering symptoms of vestibular neuritis may involve physical therapy and vestibular rehabilitation exercises at home. Hearing changes, including tinnitus, can be addressed using the following:

Hearing Aids

Hearing aids are used to treat varying degrees of hearing impairment, the most obvious of which is through the amplification of sound. Amplifying sound is the most commonly recognized way that hearing aids help people with hearing difficulties, but hearing aids can also deliver certain types of therapy like sound therapy, to also help address tinnitus treatment.

Cognitive Behavioral Therapy (CBT)

CBT is a therapy modality designed to improve coping skills and adapt responses to experiences to reduce suffering. Usually, we hear of CBT for dealing with major life changes like grief or relationships, however, some use CBT for tinnitus. The purpose of this treatment is to reduce a patient’s reaction to the condition for peace of mind.

Tinnitus Retraining Therapy (TRT)

TRT is a form of therapy that uses both sound therapy and educational counseling (usually CBT) to help reduce responses to tinnitus. Although it is not used specifically for hearing changes, tinnitus often includes changes to hearing and can be a common companion for the other interventions listed here.

Having a healthy balance system often means having a healthy body overall, and making sure that the central nervous system is healthy and in balance can similarly improve general health. When these systems are thrown into imbalance, as is the case with labyrinthitis and vestibular neuritis, dizziness, nausea, and other similar symptoms must be addressed, along with the underlying cause for relief.

Treating Vestibular Disorders With Treble Health

Managing Vestibular Disorders With Treble Health

Our Treble Health audiologists have decades of experience working in top practices around the country, and are equipped to help patients manage a variety of conditions. Regardless of what you’re experiencing, our team of audiologists is here to help, offering expert guidance and support tailored to your specific condition. If you have any questions about how we can help your personal situation, we encourage you to schedule a complimentary telehealth consultation with our team.

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