Merck Manual

Please confirm that you are a health care professional

honeypot link

Purulent Labyrinthitis

(Suppurative Labyrinthitis)


Mickie Hamiter

, MD, New York Presbyterian Columbia

Reviewed/Revised May 2023

Purulent 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, trauma causing a labyrinthine fracture with a subsequent infection, or an enlarging cholesteatoma.

Symptoms and Signs of Purulent Labyrinthitis

Symptoms of purulent labyrinthitis include

  • Severe vertigo and nystagmus

  • Nausea and vomiting

  • Tinnitus

  • Varying degrees of hearing loss

Pain and fever are common.

Diagnosis of Purulent Labyrinthitis

  • Temporal bone CT

  • Possibly MRI

Purulent labyrinthitis is suspected if vertigo Dizziness and Vertigo Dizziness is an imprecise term patients often use to describe various related sensations, including Faintness (a feeling of impending syncope) Light-headedness Feeling of imbalance or unsteadiness... read more , nystagmus Nystagmus Nystagmus is a rhythmic movement of the eyes that can have various causes. Vestibular disorders can result in nystagmus because the vestibular system and the oculomotor nuclei are interconnected... read more , sensorineural hearing loss Pathophysiology Pathophysiology , or a combination occurs during an episode of acute otitis media Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear, usually accompanying an upper respiratory infection. Symptoms include otalgia, often with systemic symptoms (eg, fever... read more Otitis Media (Acute) , trauma, or spread of chronic infection (eg, complicating a cholesteatoma Otitis Media (Chronic Suppurative) Otitis Media (Chronic Suppurative) ). 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 Symptoms and Signs Meningitis is inflammation of the meninges and subarachnoid space. It may result from infections, other disorders, or reactions to drugs. Severity and acuity vary. Findings typically include... read more or brain abscess Symptoms and Signs A brain abscess is an intracerebral collection of pus. Symptoms may include headache, lethargy, fever, and focal neurologic deficits. Diagnosis is by contrast-enhanced MRI or CT. Treatment is... read more Symptoms and Signs , such as altered mental status, meningismus, or high fever, are present; in such cases, a lumbar puncture and blood cultures are also done.

Treatment of Purulent Labyrinthitis

  • IV antibiotics

  • Myringotomy

  • Sometimes tympanostomy

Treatment of purulent labyrinthitis is with IV antibiotics appropriate for meningitis Antibiotics Acute bacterial meningitis is rapidly progressive bacterial infection of the meninges and subarachnoid space. Findings typically include headache, fever, and nuchal rigidity. Diagnosis is by... read more (eg, ceftriaxone 50 to 100 mg/kg IV once a day to a maximum of 2 g). Ceftazidime is often substituted for ceftriaxone in nosocomial infections to cover Pseudomonas  aeruginosa. The antibiotics are later 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.

Drugs Mentioned In This Article

Drug Name Select Trade
Ceftrisol Plus, Rocephin
Ceptaz, Fortaz, Tazicef, Tazidime
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
quiz link

Test your knowledge

Take a Quiz!