PANCE Blueprint EENT (7%)

Labyrinthitis (Lecture)

Patient will present as → a 23-year-old female PA student with hearing loss and tinnitus that began yesterday. She describes a sensation of the room "spinning" around her. She feels extremely nauseous and vomited already one time this morning. On physical exam, a horizontal nystagmus is observed. You excuse her from her histology exam later that afternoon.

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Acute onset, vertigo, hearing loss, and tinnitus of several days to a week. Often preceded by a viral respiratory illness There is an absence of neurologic deficits.

"Labyrinthitis is associated with CONITNUOUS vertigo along with hearing loss +/- tinnitus and is usually associated with an upper respiratory infection this differentiates it from Meniere’s syndrome which is EPISODIC and not typically associated with a viral infection"

The vertigo progressively improves over a few weeks, but the hearing loss may or may not resolve. Etiology is unknown.

Labyrinthitis is a clinical diagnosis in absence of neurologic deficits

  • May have a positive Romberg test - fall to the side of the affected ear
  • Rule out other etiologies with imaging, audiograms, TSH levels

Vestibular suppressants (Meclizine) are helpful during the initial acute symptoms, promethazine for nausea

  • Antibiotics are indicated with associated fever or signs of bacterial infection
Question 1
A 26-year-old woman comes to your office with a 6-day history of severe dizziness associated with ataxia and right-sided hearing loss. She had an upper respiratory tract infection 1 week ago. At that time, her right ear felt plugged. On examination, there is fluid behind the right eardrum. There is horizontal nystagmus present, with the slow component to the right and the quick component to the left. Ataxia is present. What is the most likely diagnosis in this patient?
A
vestibular neuronitis
Hint:
See B for explanation
B
acute labyrinthitis
C
positional vertigo
Hint:
See B for explanation
D
orthostatic hypotension
Hint:
See B for explanation
E
Meniere disease
Hint:
See B for explanation
Question 1 Explanation: 
This patient has acute labyrinthitis. Acute labyrinthitis usually follows otitis media or an upper respiratory tract infection. The disorder probably represents a chemical irritation of the canals of the inner ear. The features of acute labyrinthitis are similar to those of vestibular neuronitis, except it includes significant sensorineural hearing loss (with a conductive component if a middle ear effusion is present) and severe vertigo that lasts several days. Fever may accompany the illness.
Question 2
What is the treatment of choice for this patient?
A
avoidance of caffeine and alcohol
Hint:
See D for explanation
B
a thiazide diuretic
Hint:
See D for explanation
C
endolymphatic surgery
Hint:
See D for explanation
D
rest and antiemetics
E
none of the above
Hint:
See D for explanation
Question 2 Explanation: 
The treatment of choice for acute labyrinthitis includes rest, antiemetics, and, if the etiology is bacterial, antibiotics. Bacterial labyrinthitis may complicate serous labyrinthitis if antibiotics are not administered. Amoxicillin would be a good first-line agent for antibiotic prophylaxis. If symptoms do not improve, the addition of clavulanic acid to amoxicillin would be a reasonable second choice. If a patient appears very ill from presumed acute bacterial labyrinthitis, hospitalization and intravenous antibiotics are required. On occasion, surgical drainage may be necessary.
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