Labyrinthnitis/vestibular

neuritis
Dr. Simranjeet Kaur
● INFLAMMATIONS OF LABYRINTH is called
labyrinthnitis.or Inflammation of the inner ear or
the nerves that connect the inner ear to the brain.
● Anatomy:The ear can be divided into three parts:
the outer ear, middle ear and inner ear.
● The inner ear is the innermost part of the ear, and
houses the vestibulocochlear organs. It has two
main functions:
■ To convert mechanical signals from the
middle ear into electrical signals, which can
transfer information to the auditory pathway
in the brain.
● To maintain balance by detecting position and
motion.
● Inner ear has two components :
○ Bony labyrinth – consists of a series of bony
cavities within the petrous part of the temporal
bone. It is composed of the cochlea, vestibule
and three semi-circular canals. All these
structures are lined internally with periosteum and
contain a fluid called perilymph
● Membranous labyrinth – lies within the bony
labyrinth. It consists of the cochlear duct,
semi-circular ducts, utricle and the saccule.
The membranous labyrinth is filled with fluid
called endolymph.
● Innervation:
● The inner ear is innervated by the
vestibulocochlear nerve (CN VIII).
 Viral labyrinthitis
Viruses usually reach the inner ear by blood stream
affecting stria vascularis and then the endolymph
and organ of Corti. Measles, mumps and
cytomegaloviruses are well-documented to cause
labyrinthitis. Several other viruses, e.g. rubella,
herpes zoster, herpes simplex,
influenzaandEpstein–Barrareclinicallyknowntocause
deafness but direct proof of their invasion of labyrinth
is lacking.
 Syphilitic
Sensorineural hearing loss is caused both by
congenital and acquired syphilis. Congenital syphilis
is of two types: the early form, manifesting at the
age of 2 or the late form, manifesting at the age of
8–20 years. Syphilitic involvement of the inner ear
can cause
● Sudden sensorineural hearing loss, which may
be unilateral or bilateral.
 Physiotherapy assessment:
1. Vertigo
2. Pain- vas scale, dizziness handicap inventory
scale, functional disability scale
3. Eye examination
4. Positional test
5. Examination of gait
6. Reference -vestibular disorder chapter, Sullivan
book
 Physiotherapy
● Combinations of head and eye
movements:keeping eyes fixated on a specific
target while moving the head, moving the head
right to left at two targets at a significant distance
apart.
● Postural changes, and walking exercises.:keeping
eyes fixated on a specific target, and walking
while keeping eyes fixated on a specific target
while also turning the head in different directions.
 Vestibular rehabilitation
VRT is a highly effective way to substantially reduce
or eliminate residual dizziness from labyrinthitis.
● Gaze stability exercises – moving the head from
side to side while fixated on a stationary object
(aimed at assisting the eye to fixate during head
rotation without the input from the lost canal
vestibulo–ocular reflex). An advanced progression
of this exercise would be walking in a straight line
while looking side to side by turning the head.
● Functional retraining – including postural control,
relaxation, and balance training.
● What is labyrinthitis?
Medically reviewed by Gerhard Whitworth, RN on
November 7, 2018 — Written by Jamie Eske
● Labyrinthitis
● Physiotherapy works: Vestibular rehabilitation
● Vestibular rehabilitation exercises
 In bed or sitting
A. Eye movements

Up and down
From side to side
Focusing on finger moving from three feet to one
foot away from face
B. Head movements

Bending forwards and backwards

Turning from side to side
 Sitting
A. Eye and head movements, as 1

B. Shrug and circle shoulders

C. Bend forward and pick up objects from the ground

D. Bend side to side and pick up objects from the

ground
 Standing
A. Eye, head and shoulder movements, as 1 and 2

B. Change from a sitting to a standing position with

eyes open, then closed (please note this is not advised
for the elderly with postural hypertension)

C. Throw a ball from hand to hand above eye level

D. Throw a ball from hand to hand under the knee

E. Change from a sitting to a standing position, turning

 Moving about
A. Walk up and down a slope

B. Walk up and down steps

C. Throw and catch a ball

D. Any game involving stooping, stretching and

aiming (for example, bowling)
 Risk Factor
● Upper respiratory infections, such as the common
cold and the flu
● Middle ear infections
● Meningitis
● Head injuries
● Respiratory illnesses, such as bronchitis viral
infections, including herpes and measles
autoimmune conditions.
● Smoking
● Heavy alcohol consumption
● Ahistory of allergies
● Stress
● Use of specific medications