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Labyrinthitis Case

Timothy C. Hain, MD   Page last modified: October 6, 2013

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A middle aged woman presented to the clinic with a 1 month history of dizziness, imbalance, and a hearing disturbance. After some physical exertion, the room started spinning. This was preceded by a flu-like illness for about a week prior. She was given Augmentin (for uncertain reasons) and later on, prednisone and diazepam. When seen in the clinic, she had jumping vision, lightheadedness, positional vertigo, and left-sided hearing symptoms including a hissing locust-like sound (tinnitus), sensitivity to noise on both sides (hyperacusis), fullness on the left, and decreased hearing.

The patient was unable to stand in eyes-closed tandem Romberg (indicating imbalance). Under video Frenzel’s goggles, there is right-beating nystagmus in the dark. There was also strong right-beating nystagmus on vibration. There was no BPPV.

 

Audiometry showed a high frequency sensorineural reduction on the left side.

Audiometry is asymmetrical in persons with labyrinthitis.

The VEMP test was reduced on the left.

VEMP's are variable in labyrintitis. In severe cases, VEMP's are reduced. One would think that the lack of a VEMP would predict lack of posterior canal BPPV, as seen in this case.

There was a weak right-beating nystagmus in the light, not much stronger in the dark. This pattern should make one suspect a technical error, as spontaneous nystagmus should increase in the dark.

 

Vibration greatly increased the amplitude of the spontaneous nystagmus

Vibration usually increases spontaneous nystagmus in the dark.

Caloric testing was reduced on the left in this case of labyrinthitis.

 

This is a classic presentation of labyrinthitis. As time goes on, the spontaneous nystagmus will resolve but the other findings will remain.

Click here to return to the main Labyrintitis/Vestibular Neuritis Page.

 

For more information:

Understanding your dizziness and balance disorder DVD (has segment on Labyrintitis/vestibular neuritis).

Copyright March 24, 2014 , Timothy C. Hain, M.D. All rights reserved. Last saved on March 24, 2014