Otolaryngology-Head and Neck Surgery: Clinical Reference Guide, Sixth Edition by Raza Pasha;Justin S. Golub;

Author:Raza Pasha;Justin S. Golub;
Language: eng
Format: epub
Publisher: Plural Publishing Inc.
Published: 2021-02-15T00:00:00+00:00

Serous (Non-Suppurative) Labyrinthitis

• toxin containing serous inflammation of labyrinth resulting in hearing loss and vertigo

• Pathophysiology: presumed diffusion of toxic inflammatory products into labyrinth, typically from the middle ear; can be result of acute or chronic otitis media, trauma, or surgery

• SSx: vertigo, hearing loss, tinnitus, irritative nystagmus toward affected ear

• Dx: H&P, audiogram (SNHL)

• Rx: same as viral labyrinthitis

Suppurative Labyrinthitis

• bacterial invasion into labyrinth, usually associated with permanent hearing loss and vestibular dysfunction, can cause labyrinthine ossificans and ascending meningitis

• Pathophysiology: bacterial invasion from middle ear space through round window membrane, oval window niche or bone erosion with spread though otic capsule (may occur secondarily from meningitis from invasion through cochlear aqueduct)

• SSx: sudden vertigo and hearing loss, typically in presence of middle ear infection, tinnitus, nystagmus with fast phase away from affected ear (hypoactive lesion)

• Dx: H&P, audiogram (SNHL), VNG

• Rx: high-dose parenteral antibiotics, limited course of vestibular suppressants, surgical management of middle ear infection (if indicated); if not contraindicated, consider oral or transtympanic steroid administration if audiogram confirms SNHL

Vestibular Neuritis (Neuronitis)

• vestibular dysfunction only (versus labyrinthitis, which also includes hearing loss)

• Pathophysiology: presumed viral infection (HSV or varicella) of vestibular nerve

• SSx: vertigo lasting several hours to days, no hearing loss, may be associated with prodromal URI, recovery from acute phase may require weeks, chronic imbalance possible, may later develop benign paroxysmal positional vertigo (BPPV)

• Dx: H&P, unilateral vestibular weakness (decreased caloric response) on VNG, no associated hearing loss on audiogram, nystagmus with fast phase away from affected ear

• Rx: hospitalization with parenteral hydration if severe, high-dose corticosteroids, vestibular suppressants and antiemetics (long-term antivertiginous medications decrease central compensation, limit to <72 hours), vestibular rehabilitation

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