Merck Manual

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Purulent Labyrinthitis


Lawrence R. Lustig

, MD, Columbia University Medical Center and New York Presbyterian Hospital

Last full review/revision Jun 2020| Content last modified Jun 2020
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Purulent (suppurative) labyrinthitis is a bacterial infection of the inner ear that often causes deafness and loss of balance.

The labyrinth is the bony cavity that contains the inner ear. The inner ear contains the organs of hearing (the cochlea) and of balance (see also Overview of the Inner Ear). 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, or as a complication of a fracture of the temporal bone of the skull. It also may develop as a complication of a chronically perforated eardrum (as may occur in people who have repeated episodes of otitis media), particularly when people have a cholesteatoma (skinlike material that grows in the perforated eardrum).


Symptoms of purulent labyrinthitis 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 or ringing in the ear)

  • Varying degrees of hearing loss

People also commonly have pain and fever.


  • Computed tomography (CT) and/or magnetic resonance imaging (MRI)

  • Sometimes a spinal tap

Doctors suspect purulent labyrinthitis if people have vertigo, nystagmus, hearing loss, or a combination during an episode of acute otitis media. Doctors do a CT scan of the skull to look for abnormalities of the bone (temporal bone) that contains the inner and middle ear, the bones in the inner ear, and the bone behind the ear. Doctors may also do an MRI to see if the infection extends into the brain.

If people have symptoms of meningitis, such as confusion, stiff neck, or high fever, doctors do a lumbar puncture (spinal tap) and send samples of spinal fluid to the laboratory for culturing.


  • Intravenous antibiotics

  • Drainage of fluid from the middle ear

Purulent labyrinthitis is treated with antibiotics 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 (see Myringotomy: Treating Recurring Ear Infections). Some people may need a more extensive surgical procedure to remove all or part of the bone behind the ear (mastoidectomy).

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