Labyrinthis

1. LABYRINTHITIS
INTRODUCTION:
The human ear is not only an organ of hearing but also provides the sense of
balance or equilibrium to the body. Labyrinth is a fluid-filled structure inside the
ear and appears like a maze of channels and canals. Half of this structure is called
cochlea and it appears like snail’s shell. The sound that we hear is transmitted by
ears to the brain by the cochlea. The cochlea converts the sound waves into
electrochemical impulses. The remaining half of the labyrinth is called vestibule
and it appears like a gyroscope with three semi-circular canals. Vestibules send the
information about position and movement of the head to brain and provide the
balancing to the body.
In case of labyrinthitis, cochlea and vestibule become inflamed and therefore
patient experiences hearing problems, tinnitus (constant high or low pitched
ringing sound in ear) and dizziness
DEFINITION
Labyrinthitis is an inflammation of the inner ear or labyrinth.
CLASSIFICATION
1. Viral labyrinthitis: also known as vestibular neuritis. This often results
from viral infections. Symptoms are gradual onset of vertigo with vomiting
and nausea.
2. Bacteriallabyrinthitis: There are 3 types of bacterial inner ear infection.
A.Syphilitic Labyrinthitis: Bacterial infections of this type can be present
at time of birth or it may be acquired.
B.Toxic Labyrinthitis: Infection of this type occurs when bacterial agents
in middle ear pass to inner ear resulting in loss of balance as well as
hearing loss.
C.Acute Suppurative Labyrinthitis: Infection of this type is quite rare.
Symptoms are sudden vertigo.

2. ETIOLOGY
1. Viral infection: Such as common cold and flu.
2. Trauma or injury to the head or ear.
3. Bacterial infections in the nearby structures like middle ear.
4. Allergies.
5. Alcohol abuse.
6. A benign tumor of the middle ear.
7. Some medications taken in high doses like furosemide (Lasix), aspirin
etc.
8. Benign paroxysmal positionalvertigo:
9. Some serious causes of vertigo produce symptoms like labyrinthitis such
as tumors at the base of the brain or strokes.
PATHOPHYSIOLOGY
Human ears have a labyrinth in each of inner ears, which are covered in
dense bone near the base of the skull. As the name indicates, the labyrinth is
a network of interconnected fluid-filled channels. About half of the labyrinth
(the cochlea) is formed like a snail's shell. It is responsible for sending
information regarding various sounds to the brain. The other half comprises
of 3 semicircular canals connected to an open cavity or vestibule. The
vestibule portion of the labyrinth is responsible for sending information to
the brain regarding the movement and position of the head. Any irritation of
the vestibule causes defective information going to the brain. Eyes are also
one of the sense organs that help in sending positioning information to the
brain and if the information from the labyrinth and the eyes don't
correspond, then the brain has trouble translating what is actually occurring.
This misinterpretation makes the patient feel as if he is spinning. This
sensation is termed as vertigo. It can be followed by feelings of nausea and
vomiting. Some patients may also experience hearing loss or abnormal
sounds (tinnitus).

3. CLINICAL MENIFESTATIONS
1. Extreme vertigo or dizziness.
2. Aural fullness.
3. Tinnitus.
4. Nausea, vomiting.
5. Headache.
6. Fever.
7. Double vision.
8. Facial weakness or paralysis.
9. Neck pain/stiffness
10.Depression/anxiety.
DIAGNOSTIC EVALUATION
1. History collection: Past medical history and medication.
2. Physical examination.
3. Imaging tests; CT scan and MRI of the head.
4. Neurological examination: Complete cranial nerve examination.
5. Laboratory: CBC and blood culture.
6. Hearing test.
7. Dix hallpike test: It is a diagnostic maneuver used to identify
Vertigo.
MANAGEMENT
1. Vertigo can be treated with meclizine or scopolamine.
2. Viral labyrinthitis cured with Acyclovir, velocyclovir.
3. Bacterial labyrinthitis treated with broad spectrum antibiotics.
4. I.V. fluids and antiemetic medications.
5. Corticosteroids.
6. Vestibular rehabilitation therapy: It is an exercise based
programme designed by a specialized physical therapist to improve
balance and reduce dizziness problems.
7. Antihistamine: Diphenhydramine.
8. Surgery: Myringotomy is a surgical procedurein which a tiny
incision is created in the eardrum to relieve pressure caused by
excessive buildup of fluid, to drain the pus from the middle ear.

4. CONSERVATIVE TREATMENT
1. Resting in a comfortable position.
2. Reduce salt and sugar intake.
3. Drinking a lot of water.
4. Avoid alcohol and quit smoking.
5. Remain stress free.
COMPLICATIONS
1. Falls.
2. Benign Paroxysmal Positional Vertigo: BPPV is the most
common vestibular disorder. It is the most common cause of
vertigo.
3. Unilateral hearing loss.
NURSING MANAGEMENT
NURSING DIAGNOSIS:
1. Risk for falls
2. Impaired transfer ability related to perceptual impairment.
NURSING INTERVENTIONS:
RISK FOR FALLS
1. Assess conditions that can increase the patient’s level of fall
risk such as change in mental status, medications etc.
2. Keep the patient’s bedside free from anything that can hit his
head on.
3. Make sure that the patient’s bed is at lowest position. Keep it as
adjacent to the floor as possible.
4. Use side rails on the bed whenever needed and avoid using
restraints.
5. Move the patient to a room that is near the nurse’s station.
6. Teach the patient to move slowly.
7. Encourage family members and relatives to remain with the
patient at all times.

5. FOR IMPAIRED TRANSFER ABILITY:
1. Assess degree of impairment using the 0-4 functional level
classification.
2. Provide a safe environment by keeping bed rails up,
maintaining bed in low position.
3. Allow the patient to perform tasks at his or her own pace.
4. Encourage patient to move slowly.
5. Give medications as ordered.