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Purulent Labyrinthitis

by Lawrence R. Lustig, MD

Purulent (suppurative) labyrinthitis is bacterial infection of the inner ear, often causing deafness and loss of vestibular function.

Purulent labyrinthitis usually occurs when bacteria spread to the inner ear during the course of severe acute otitis media, purulent meningitis, or an enlarging cholesteatoma.

Symptoms include severe vertigo and nystagmus, nausea and vomiting, tinnitus, and varying degrees of hearing loss. Pain and fever are common.

Purulent labyrinthitis is suspected if vertigo, nystagmus, sensorineural hearing loss, or a combination occurs during an episode of acute otitis media. CT of the temporal bone is done to identify erosion of the otic capsule bone or other complications of acute otitis media, such as coalescent mastoiditis. MRI may be indicated if symptoms of meningitis or brain abscess, such as altered mental status, meningismus, or high fever, are present; in such cases, a lumbar puncture and blood cultures also are done.

Treatment is with IV antibiotics appropriate for meningitis (eg, ceftriaxone 50 to 100 mg/kg IV once/day to maximum 2 g) adjusted according to results of culture and sensitivity testing. A myringotomy (and sometimes tympanostomy tube placement) is done to drain the middle ear. Mastoidectomy may be required.

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