Tinnitus As A Symptom Of Labyrinthitis: Insights And Solutions

Labyrinthitis is one of the many conditions of the inner ear that can eventually result in hearing loss or a rise in tinnitus symptoms. Unlike a standard ear infection, labyrinthitis affects a specific part of the ear and can either be a viral infection or bacterial labyrinthitis, an inner ear infection spurred by exposure to and subsequent infection from bacteria. Regardless of the exact cause of this type of ear infection, labyrinthitis symptoms can lead to other issues of the inner ear. Is tinnitus among those possible comorbidities? First, let’s take a closer look at symptoms of labyrinthitis, how they affect hearing function, the vestibular system, and other symptoms involving ear infections and the auditory system.

Anatomy Of The Ear

To fully understand how doctors diagnose labyrinthitis, and how these types of viral infections affect the ear, take a closer look at the outer ear, middle ear and inner ear, and how they relate to the symptoms of labyrinthitis:

Image Source

• Outer Ear
  • The outer ear contains the pinna, ear canal, and eardrum, or tympanic membrane. The outer ear is often the source of both bacterial infection and viral infection, and when someone complains of a viral or bacterial infection, they are likely talking about an infection of the outer ear.

• Middle Ear
  • The middle ear contains the middle ear bones (called ossicles), the eardrum or tympanic membrane, and the eustachian tube. The middle ear is also a common site of infection, and is the one we most commonly think about when the word “ear infection” comes to mind. 
• Inner Ear (Cochlea/Labyrinth)
  • The inner ear is made up of the cochlea (the hearing and balance organ which contains thousands of tiny hair cells which allow us to hear), auditory nerve endings, and semicircular canals, which are responsible for hosting the vestibular nerve and maintaining the vestibular system and balance.

What Is Labyrinthitis

Labyrinthitis is the term used to describe inflammation of the labyrinth, or inner ear, and the vestibulocochlear nerve, which can lead to the development of vertigo and hearing loss. Because this portion of the ear is, in part, responsible for transmitting information from the rest of the ear to the vestibular nerve to the brain, inflammation can result in hearing loss and balance dysfunction, as it interrupts the vestibular system’s ability to communicate between the ear and the brain. Chronic labyrinthitis can lead to chronic vertigo, damages to hearing, and issues regarding balance and movement.

Symptoms Of Labyrinthitis

The symptoms of labyrinthitis primarily affect the inner ear, but the systems of the inner ear involve the vestibular system and more, which means that symptoms of labyrinthitis can extend well past that part of the ear. Resulting in a sudden onset of the following symptoms can last from days to weeks, and typically only affect one ear:

• Changes in hearing
• Sudden hearing loss
• Vertigo or dizziness
• Changes in balance
• Vomiting or nausea
• Blurry vision
• Tinnitus

These symptoms are caused by the inflammation occurring within the inner ear, the pressure of which is causing damage to the inner ear structures. Sudden changes in hearing result in sudden disruption in information from the ear to the brain, oftentimes causing the person to experience sudden onset of tinnitus, as well. Whether from bacterial infection or viral infection, the symptoms of labyrinthitis can be intense, and can cause severe hearing loss for a few weeks, severe vertigo, and even a great deal of nausea and general discomfort.

Who Is Affected By Labyrinthitis?

People of all ages are affected by labyrinthitis, but the condition is most common in adults who are between the ages of 30 and 60. Women are also more likely to develop labyrinthitis, and people who smoke, experience a lot of stress, are chronically tired, or prone to drinking large quantities of alcohol are all at higher risk of both acute and chronic labyrinthitis. People who have repeated contact with herpes viruses, head injury, and an underlying autoimmune condition may also be more apt for developing labyrinthitis, and may also find tinnitus a more common diagnosis.

Vestibular Neuritis vs. Labyrinthitis

Vestibular neuronitis or neuritis is another type of labyrinth disorder. The symptoms of both conditions are similar, but there is a distinct difference: the portion of the inner ear involved. In vestibular neuronitis, only the vestibular portion of the vestibulocochlear nerve is affected, resulting in symptoms that are primarily balance and vertigo related. In labyrinthitis, symptoms involve both branches of the nerve, and patients therefore can experience both hearing problems and other common symptoms, as well as balance dysfunction.

What Causes Labyrinthitis?

Most cases of labyrinthitis diagnosed in adults are the result of viral infections, including the herpes zoster oticus virus and respiratory illnesses. Diagnosing labyrinthitis is also possible when bacterial infection is at the root, or idiopathic causes are to blame. In idiopathic cases, the cause is unknown but still results in inner ear inflammation, which puts pressure on the surrounding structures, leading to hearing loss, vertigo, and tinnitus.

Some medications can also lead to labyrinthitis symptoms, or make symptoms persist, as can a medical history of allergies. There is also the possibility of developing autoimmune labyrinthitis, or a type of the condition involving autoimmunity (the body essentially attacking itself).

What Do I Do If I Suspect I Have Labyrinthitis?

Untreated labyrinthitis can cause anything from mild dizziness to severe vomiting, with rare cases leading to permanent hearing loss and damage to the vestibulocochlear nerve. It is important to seek help as soon as possible from an Otolaryngologist (ENT doctor) for medical diagnosis and treatment. Labyrinthitis treated within 72 hours to 1 week typically responds well to treatment, reducing the likelihood to need further intervention and experiencing long-term nerve inflammation or damage to the affected ear. 

When calling an ENT or other hearing specialist, make sure to mention any nervous system changes, sudden hearing loss, tinnitus, or vertigo, and press the need to be seen as soon as possible. Vestibular imbalance can be dangerous, and damage to the vestibular organs on a permanent basis can result in neurological symptoms and other long-term issues. While vestibular rehabilitation is possible, it is best to prevent any issues from arising to begin with.

Labyrinthitis Treatment Options

Treating labyrinthitis typically involves one of two forms of intervention: medical intervention or symptom intervention. Vestibular rehabilitation exercises do exist, but it is best to avoid them by turning to the following:

• Medicinal interventions. There are several different approaches to treating labyrinthitis medicinally, but the most common routes include the following:
  • Antiviral medications
  • Antibiotics
  • Steroid Treatments (both oral and intratympanic injections)

• Symptom treatment. Treating symptoms help ease the pain, discomfort, and vestibular issues associated with inflammation of the inner ear, both when vestibular neuritis and labyrinthitis are the cause of the symptoms. Symptom mitigation efforts may include:
  • Anti Nausea Medication/Meclizine
  • Vestibular Rehabilitation Therapy (VRT)
  • Hearing Aids
  • Tinnitus Retraining Therapy (TRT)

Any of the interventions identified above can be used to prevent permanent hearing loss as much as possible, control nausea, and soothe the discomfort of an acute infection or inflammation for the duration of illness.

What Happens If Labyrinthitis Is Left Untreated?

Left untreated, the results of bacterial labyrinthitis and viral labyrinthitis differ somewhat, though bacterial infections that go untreated often have a higher risk of developing serious complications. In both, if left untreated, it is possible to experience changes in hearing, blurred vision, vertigo, and tinnitus as permanent fixtures in daily life.

Symptom therapies that include hearing aids, TRT, and VRT can help alleviate the severity of symptoms, but are not to be misunderstood as permanent fixes for complications of the illness. Instead, early diagnosis and treatment remains the ideal means of intervention.

If tinnitus should develop in the absence of effective treatment, such as oral antibiotics, there are various therapies that can help alleviate symptoms of tinnitus specifically. Interventions for the ear called Tinnitus Retraining Therapy (TRT) and hearing aids can both be beneficial for tinnitus treatment, regardless of cause, soothing the discomfort and irritation that can occur as a result of tinnitus symptoms.

Labyrinthitis And Tinnitus

Although tinnitus and labyrinthitis symptoms are not always intertwined, the nature of labyrinthitis means that symptoms often intersect, and the presence of the condition can lead to the onset of other symptoms of the central nervous system, and the vestibular system, including tinnitus. The goal of treatment for each condition may vary; in labyrinthitis, it is essential to reduce nerve inflammation to lessen or altogether eradicate symptoms.

In tinnitus, the primary goal is to lessen the effects of ringing or buzzing, whether by using a hearing aid, or specific therapies designed to target the sounds of ringing, such as sound therapy, Cognitive Behavioral Therapy (CBT), and Tinnitus Retraining Therapy. In both conditions, treatment with a professional is key, in order to achieve the best results, and target the conditions at their root.