Labyrinthitis, vestibular

• 386.3 Labyrinthitis
• 386.30 Labyrinthitis unspecified
• 386.31 Serous labyrinthitis
• 386.32 Circumscribed labyrinthitis
• 386.33 Suppurative labyrinthitis
• 386.34 Toxic labyrinthitis
• 386.35 Viral labyrinthitis
• 386.53 Hypoactive labyrinth, unilateral

• H83.09 Labyrinthitis, unspecified ear
• H83.2X1 Labyrinthine dysfunction, right ear
• H83.2X2 Labyrinthine dysfunction, left ear
• H83.2X3 Labyrinthine dysfunction, bilateral
• H83.2X9 Labyrinthine dysfunction, unspecified ear

• Pattern 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling
• Pattern 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury

Description

• Disorder of the peripheral vestibular and auditory systems (inner ear)
• These systems consist of a complex series of interconnected tubes that are fluid filled (fluid called endolymph) and form a labyrinth.
• The peripheral vestibular sensory organs of each ear detect head position and head motion to provide input for gaze stability, orientation, and balance.
• The peripheral auditory sensory organs of each ear convert sound vibration into a neural impulse to provide input for hearing.
• Each system sends its respective sensory information, via the vestibulocochlear nerve (eighth cranial nerve), to the central nervous system for processing.
• Reduction or loss of function of one of the labyrinths due to an infection, which causes an imbalance of neural activity between the two inner ears
• Results in a spontaneous, severe attack of rotary vertigo (illusion of spinning motion of the room or self) that lasts from 48 to 72 hours as well as sudden hearing loss that can be permanent

Essentials of Diagnosis

• Physical exam normal
• Audiogram abnormal
• Neurotologic exam abnormal
• Thorough and detailed history is essential to distinguish vestibular labyrinthitis from other vestibular disorders and central pathology.

General Considerations

• Similar in presentation to vestibular neuritis, however with labyrinthitis, patients also have hearing loss and/or tinnitus (ringing or noises in the ear), which can be permanent
• Initially, patients report persistent, severe feeling of rotary vertigo that occurs spontaneously but worsens with head movement.
  • Patients complain of nausea and vomiting, difficulty standing and walking without assistance, and blurred vision due to oscillopsia (apparent movement of the environment).
  • Initial symptoms improve over a period of a few days.
• After initial episode, patients typically continue to present with a general feeling of dizziness (disorientation, wooziness, off balance, etc.) and imbalance that mostly occurs with quick head movements and may continue to have difficulty reading.
  • This phase may manifest for up to 6 weeks or longer, until recovery and compensation occur.

Demographics

• More likely to occur after trauma or middle ear infections

Signs and Symptoms

• Acute presentation:
  • Report of persistent, prolonged episode of severe rotary vertigo, nausea and vomiting, unsteadiness, and/or jumping, bouncing vision
  • Imbalance manifested by inability to stand and walk without assistance.
  • Increased risk of falling
  • Sudden hearing loss and audiological exam abnormal
  • Observe nystagmus in room light and with fixation removed
  • Abnormal ...