By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

ACUTE LABYRINTHITIS -- A COMMON DISORDER WITH AN UNCOMMON NAME

Question: A few weeks ago my wife woke up very dizzy. When she tried to get out of bed, she was so dizzy she almost fell down. She went to the doctor and was told she had an inner ear infection. He gave her some medicine and told her to stay quiet until she felt better. She is better but still dizzy. How long will this last? What caused this? Are there other things she can do to make the dizziness go away?

Answer: It sounds like your wife had what doctors call acute labyrinthitis. This disorder gets its name from a part of the inner ear called the vestibular labyrinth. A brief description of a healthy vestibular labyrinth and how it works will help you better understand what can cause the type of dizziness you describe.

The vestibular labyrinth -- located behind the eardrum -- contains three interconnected semicircular canals or tubes. The three canals are hollow and contain a fluid that moves in response to head movement. On the inside surface of these canals are special hair-like nerve fibers and tiny calcium stones. When you move your head or stand up, the hair cells are bent by the weight of the stones or the movement of the fluid. This movement of the hair cells transmits a signal to the brain that it can interpret as the movement and position of the head. With this information your brain is able to maintain proper balance.

In acute labyrinthitis something goes temporarily wrong with this complex system. The exact cause is not understood, but it is a relatively common medical problem. This disorder usually follows an upper respiratory infection, such as a cold, and is significantly more common in women. While it can occur at any age, the incidence increases in the 40s and beyond.

Generally this illness has a sudden onset, such as you describe with your wife. You wake up one morning and the normal movement of getting out of bed causes severe dizziness. Acute labyrinthitis is usually self-limiting, but many people continue to suffer through periods of dizziness for weeks to months after the acute episode has subsided. In some people, the acute illness may have nausea and vomiting associated with the dizziness.

Diagnosis is usually made by a thorough physical exam. This may include some head moving maneuvers to see what positions or types of movement bring on the dizziness. Many times the doctor will order a head CT scan or MRI, especially if there has been recent head trauma, if there are extreme symptoms, or the illness is prolonged.

If everything points to acute labyrinthitis, then medications to calm the dizziness and help with the nausea are usually prescribed. A few days of bedrest will help the dizziness to resolve. Avoiding alcohol and smoking are usually advised as well. Some people need to be hospitalized if the vomiting is severe.

In the event that the dizziness lasts for several weeks following the acute phase, or if the dizziness is severe, your doctor may recommend vestibular therapy. This consists of home exercises to strengthen the vestibular system and thus lessen the dizziness. Most people make a full recovery from acute labyrinthitis. The most common complication of this illness is bone fracture from falls due to the dizziness.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.