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.
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 of purulent labyrinthitis is with IV antibiotics appropriate for meningitis (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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