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Purulent Labyrinthitis

by Lawrence R. Lustig, MD

Purulent (suppurative) labyrinthitis is a bacterial infection of the inner ear that often causes deafness and loss of balance.

Purulent labyrinthitis usually occurs when bacteria enter the inner ear during the course of a severe infection of the middle ear (acute otitis media) or some forms of meningitis. It also may develop as a complication of a chronically perforated eardrum (as may occur in people who have repeated episodes of otitis media).

Symptoms include severe vertigo (a false sensation of moving or spinning) and nystagmus (a rapid jerking movement of the eyes in one direction alternating with a slower drift back to the original position), nausea and vomiting, tinnitus (noise in the ear), and varying degrees of hearing loss. People also commonly have pain and fever.

Doctors suspect purulent labyrinthitis if people have vertigo, nystagmus, hearing loss, or a combination during an episode of acute otitis media. Doctors do a computed tomography (CT) scan of the skull to look for abnormalities of the bone that contains the inner and middle ears, the bones in the inner ear, and the bone behind the ear. Doctors may also do magnetic resonance imaging (MRI). If people have symptoms of meningitis, such as confusion, stiff neck, or high fever, doctors do a lumbar puncture (spinal tap).

Purulent labyrinthitis is treated with antibiotics (such as ceftriaxone) given by vein (intravenously). Doctors also do a myringotomy, in which an opening is made through the eardrum to allow fluid to drain from the middle ear. Some people may need a surgical procedure to remove all or part of the bone behind the ear (mastoidectomy).

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