Labyrinthitis

Labyrinthitis

1. LABYRINTHITIS

2. 2 Labyrinthitis I nflammation of the labyrinth of the inner ear.

3. Etiology Viral or bacterial infections Cholesteatoma Drug toxicity Head injury Tumour Vasculitis

4. 4 Clinical manifestations Vestibular manifestations (vertigo) Cochlear manifestations (hearing loss) Nausea and vomiting

5. 5 Pathology Infection usually occurs by one of three routes: From the meninges From the middle ear space Hematogenous spread

6. 6 Pathology Meningogenic : through the IAC, cochlear aqueduct, both (bilateral ) Tympanogenic : extension of infection from the middle ear, mastoid cells or petrous apex-most common through the round or oval window (unilateral ) Hematogenous : through blood, least common

7. 7 Bacterial Infections Two types of labyrinthitis associated with bacterial infections: Toxic Labyrinthitis Suppurative Labyrinthitis

8. 8 Toxic Labyrinthitis : results from a sterile inflammation of the inner ear following an acute or chronic otitis media or early bacteria meningitis. Toxins penetrate the round window, IAC, or cochlear aqueduct and cause an inflammatory reaction in the perilymph space. Toxic Labyrinthitis

9. 9 Bacterial Infection Toxic Labyrinthitis produces mild high frequency hearing loss or mild vestibular dysfunction Treatment: Antibiotics for precipitating otitis, possible myringotomy.

10. 10 Suppurative Labyrinthitis Suppurative Labyrinthitis : direct invasion of the inner ear by bacteria. From otitis or meningitis

11. 11 Suppurative Labyrinthitis : 4 stages Serous or irritative : production of Ig rich exudates in the perilymph Acute or purulent: bacterial and leukocyte invasion of the perilymphatic scala -end organ necrosis Fibrous or latent: proliferation of fibroblasts and granulation tissue in the perilymph Osseous or sclerotic: new bone deposition throughout the involved labyrinth

12. 12 Diagnosis History: severe vertigo from any movement of the head. Nausea and vomiting U/L or B/L hearing loss Recent URTI Loss of balance and falling in the direction of the affected ear.

13. Diagnosis Physical findings: Spontaneous nystagmus Jerking movements of eyes toward unaffected ear Purulent discharge Lab: Culture and sensitivity test Audiometry A flat tympanogram Electronystagmography

14. Management Meclizine to relieve vertigo Antiemetics Antibiotics Oral fluids IV fluids for severe dehydration

15. Surgery Surgical excision of cholesteatoma Incision and drainage Labyrinthectomy

16. Complications Meningitis Permanent balance disability Permanent hearing loss

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