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
Varying degrees of hearing loss
Pain and fever are common.
Diagnosis of Purulent Labyrinthitis
Temporal bone CT
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 , 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 . 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 , such as altered mental status, meningismus, or high fever, are present; in such cases, a lumbar puncture and blood cultures also are done.
Treatment of Purulent Labyrinthitis
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/day to maximum 2 g). Ceftazidime is often substituted for ceftriaxone in nosocomial infections to cover P. 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.
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