To understand labyrinthitis, it helps to break down its name. It is the inflammation (-itis) of the labyrinth, the intricate, fluid-filled structure deep within the inner ear. The labyrinth is responsible for two of our most critical senses: balance and hearing. It is composed of two main parts:

1. The Vestibular System: This is our body’s primary organ of balance. It consists of the three semicircular canals and the otolith organs (the utricle and saccule). This system detects head motion and our orientation relative to gravity, sending constant signals to the brain to help us maintain our balance and stabilize our vision.
2. The Cochlea: This is the snail-shaped organ of hearing. It converts sound vibrations into electrical signals that are sent to the brain to be interpreted as sound.

These two systems are connected, and the information from both is transmitted to the brain via the vestibulocochlear nerve. In labyrinthitis, inflammation affects the entire labyrinth, disrupting the function of both the balance and hearing components.

A helpful analogy is to think of your inner ear as the sophisticated control panel of an airplane. The vestibular system is the gyroscope, constantly telling the pilot (your brain) which way is up and how the plane is moving. The cochlea is the airplane’s radio, receiving sound signals from the outside world.

• In labyrinthitis, it is as if a sudden electrical fire has broken out in this main control panel.
• The gyroscope goes haywire, sending chaotic and false signals of intense, continuous spinning (vertigo).
• At the same time, the radio goes fuzzy, staticky, or silent (tinnitus and hearing loss).
• The pilot (the brain) is receiving completely nonsensical and conflicting information, leading to severe disorientation, nausea, and an inability to “fly straight.”

Labyrinthitis vs. Vestibular Neuritis

It is important to distinguish labyrinthitis from a closely related condition, vestibular neuritis.

• Vestibular Neuritis is inflammation that affects only the vestibular portion of the nerve. It causes severe vertigo but does not affect hearing.
• Labyrinthitis affects both the vestibular and cochlear portions of the nerve and labyrinth, causing severe vertigo plus hearing loss and/or tinnitus.

Clinically, I’ve often seen patients with labyrinthitis arrive in the emergency room thinking they’re having a stroke because the dizziness, nausea, and unsteadiness can be that intense.

Labyrinthitis is caused by inflammation of the labyrinth or the vestibulocochlear nerve.

Viral Infections (The Most Common Cause)

In the vast majority of cases, labyrinthitis is caused by a viral infection. This can occur in one of two ways:

1. A virus can directly infect the inner ear itself.
2. More commonly, it is a post-viral inflammatory response. The immune system, while fighting off a recent or concurrent viral illness elsewhere in the body (like a cold or the flu), mistakenly launches an inflammatory attack on the inner ear structures. This autoimmune-like reaction is what causes the inflammation and swelling of the labyrinth and nerve.

In my experience, viral labyrinthitis often presents a week or two after a cold. Patients may feel fine for a few days and then suddenly wake up dizzy and nauseated, which can be disorienting and scary.

Labyrinthitis itself is not contagious. You cannot catch it from another person. However, the common viral illnesses that are known to trigger it are contagious. A person typically “gets” labyrinthitis as a rare complication following a routine viral infection.

The primary trigger for labyrinthitis is a recent or ongoing viral illness, most commonly an upper respiratory infection. Viruses that have been linked to labyrinthitis include:

• Influenza (the flu)
• The common cold viruses (rhinovirus, adenovirus)
• Herpes viruses (such as the ones that cause cold sores or chickenpox)
• Measles, mumps, and rubella (in unimmunized individuals)
• Enteroviruses

Bacterial Labyrinthitis

In very rare cases, labyrinthitis can be caused by a bacterial infection. This typically occurs when a severe, untreated middle ear infection (otitis media) or a case of bacterial meningitis spreads from the middle ear or the brain linings into the delicate structures of the inner ear. Bacterial labyrinthitis is much more serious than the viral form and carries a higher risk of permanent hearing loss.

Patients often tell me, “I felt like I was recovering from a cold, then everything started spinning.” That gap between the viral illness and the onset of vertigo is a signature pattern we see with labyrinthitis.

The onset of labyrinthitis is typically sudden and severe. A person can go to bed feeling well and wake up with debilitating symptoms.

The hallmark signs and symptoms include:

• Vertigo: This is the most dramatic and distressing symptom. It is a true rotational sensation, where the person feels that either they or the room around them is violently spinning. The vertigo is continuous, made worse by any head movement, and often renders the person unable to stand or walk.
• Hearing Loss: A noticeable decrease in hearing in the affected ear. This can range from a mild loss to complete deafness in that ear.
• Tinnitus: A ringing, buzzing, hissing, or roaring sound in the affected ear.
• Dizziness and Imbalance: A general feeling of being off-balance, unsteady, and disoriented.
• Nausea and Vomiting: This is a direct consequence of the intense vertigo, as the brain struggles to make sense of the conflicting signals it is receiving from the inner ear and the eyes.
• Nystagmus: Rapid, involuntary, and uncontrollable movements of the eyes, which a doctor will observe during an examination.

The most severe, acute phase of vertigo typically lasts for several days before it gradually begins to subside.

Clinically, patients often describe feeling like “the room is spinning” or “I can’t walk straight.” Unlike dizziness from low blood pressure, labyrinthitis causes persistent spinning and nausea that worsens with head movements.

Diagnosis is mainly based on medical history and physical examination, especially when a patient reports sudden vertigo after a recent cold. There’s no single test for labyrinthitis, but a combination of tools helps rule out more serious causes.

The diagnostic process involves:

1. A Thorough Clinical Examination: A doctor will take a detailed history of the symptoms and perform a comprehensive neurological exam. The exam will focus on eye movements, balance, and coordination. Doctors often use a specific set of bedside eye movement tests (known as the HINTS exam) which can be very effective at differentiating a peripheral inner ear problem like labyrinthitis from a central brain problem like a stroke.
2. Hearing Test (Audiogram): A formal hearing test will be performed to document the nature and severity of the hearing loss in the affected ear. This is key to differentiating labyrinthitis from vestibular neuritis.
3. Brain Imaging: An MRI of the brain is often performed, especially if the diagnosis is uncertain or if the patient has any other neurological signs or major stroke risk factors. This is to definitively rule out a stroke, a tumor, or other structural brain abnormalities.

I’ve found that the clinical pattern, sudden vertigo, hearing changes, and recent viral illness usually points clearly toward labyrinthitis. Imaging is typically reserved for cases where we’re ruling out more dangerous conditions.

There is no specific “cure” for viral labyrinthitis, as antibiotics are ineffective against viruses. Treatment is focused on managing the severe acute symptoms and then helping the brain to recover and recalibrate its sense of balance through a process of rehabilitation.

1. Acute Phase Treatment

The goal in the first few days is to control the debilitating vertigo and nausea.

• Corticosteroids: A course of oral steroids, such as prednisone, is often prescribed. It is believed that starting steroids early can help reduce inflammation of the inner ear and nerve.
• Vestibular Suppressants: Medications that suppress the vestibular system can be used to provide symptomatic relief from the intense spinning and nausea. Common medications include meclizine and benzodiazepines like diazepam. Importantly, these drugs are only used for a short period.
• Antiemetics: Medications to control severe vomiting.

2. The Recovery Process and Vestibular Rehabilitation

The intense, incapacitating vertigo usually begins to improve after several days to a week. However, this is often followed by a longer period, lasting several weeks to months, of residual dizziness, imbalance, and motion sensitivity.

The cornerstone of long-term recovery is Vestibular Rehabilitation Therapy (VRT).

• VRT is a specialized form of physical therapy designed to retrain the brain.
• A vestibular therapist will guide the patient through a customized program of specific head, eye, and body movement exercises.
• The goal of these exercises is to help the brain compensate for the damaged inner ear signals. It teaches the brain to recalibrate, to rely more on signals from the unaffected ear, the eyes, and the sensory receptors in the body (proprioception) to maintain balance and stability.

Prognosis

• Balance: For the vast majority of people, the prognosis for the vertigo and balance issues is excellent.
• Hearing: The prognosis for the hearing loss is more variable. Hearing may return completely, partially, or, in some cases, the hearing loss can be permanent.

In my experience, patients who start vestibular rehab early tend to recover balance faster and feel less fearful of moving around. It’s often underused, but incredibly effective for lingering symptoms.

Labyrinthitis is a sudden and terrifying inner ear disorder that plunges a person into a world of intense, spinning vertigo. Typically triggered by a common viral infection, it causes debilitating symptoms that can last for days. While the experience is alarming, the most critical first step is an urgent medical evaluation to rule out a stroke. Once a diagnosis of labyrinthitis is confirmed, the journey shifts to managing the acute symptoms and then embracing the recovery process. While the path can be long, it is a hopeful one. Clinically, I’ve noticed that what patients remember most isn’t the hearing loss, it’s the fear of movement. Reassurance, early rehab, and clear education go a long way in helping people regain confidence after labyrinthitis.

Vestibular Disorders Association (VeDA). (n.d.). Labyrinthitis and Vestibular Neuritis. Retrieved from https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/labyrinthitis-and-vestibular-neuritis/

National Institutes of Health, National Institute on Deafness and Other Communication Disorders (NIDCD). (2021). Balance Disorders. Retrieved from https://www.nidcd.nih.gov/health/balance-disorders

American Academy of Otolaryngology—Head and Neck Surgery. (n.d.). Dizziness and Motion Sickness. Retrieved from https://www.enthealth.org/conditions/dizziness-and-motion-sickness/