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262: VESTIBULAR LABYRINTHITIS

Eric Shamus, PhD, DPT, PT, CSCS; Jennifer Shamus, PhD, DPT, COMT, CSCS

CONDITION/DISORDER SYNONYMS

  • Serous labyrinthitis

  • Circumscribed labyrinthitis

  • Suppurative labyrinthitis

  • Toxic labyrinthitis

  • Viral labyrinthitis

ICD-9-CM CODES1

  • 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

ICD-10-CM CODES2

  • 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

PREFERRED PRACTICE PATTERNS3

  • 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling

  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury

PATIENT PRESENTATION

A 31-year-old man decided to begin swimming for exercise at his local fitness club. At the end of the first week he noticed that his ear was very red and itched terribly. His doctor diagnosed him with an ear infection and gave him antibiotics. The man noticed increasingly frequent episodes where he felt like the room was spinning. These episodes lasted for a few days then would lessen. He also noticed he struggled to hear accurately in the ear that had been afflicted with the infection. He had no loss of strength or range of motion (ROM) and his reflexes were normal; however, he struggled to keep his balance particularly when he had the sensation of spinning. On testing, he was unable to keep his balance with his eyes closed and he demonstrated nystagmus with head movements.

FIGURE 262-1

Coronal section of the temporal bone showing the hearing apparatus. (From Henderson MC, Tierney LM, Smetana GW. The Patient History: An Evidence-Based Approach to Differential Diagnosis. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 262-2

Labyrinthitis ossificans. (A) Axial CT scan viewed in bone window demonstrates ossification and therefore poor visualization of the middle and apical turns of the cochlea (arrowhead) as well as narrowing and subtle sclerosis of the base turn of the cochlea (arrow). (B) Axial T2-weighted image in the same patient shows absence of expected fluid signal in the middle and apical turns of the cochlea (expected position indicated by arrowhead), consistent with ossification. The base turn is narrowed, but still has some fluid signal within it (arrow). The information about patency of fluid spaces that is obtained on MRI can be useful to determine if a patient is a candidate for cochlear implantation. (From Lalwani AK. Current Diagnosis & Treatment in Otolaryngology—Head and Neck Surgery. 3rd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

Description

  • Disorder of the peripheral vestibular and auditory systems (inner ...

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