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 (the cochlea and vestibular structures) as a complication of severe acute otitis media or chronic suppurative otitis media, purulent meningitis, trauma causing a labyrinthine fracture with a subsequent infection, or an enlarging cholesteatoma. Chronic suppurative otitis media leads to suppurative labyrinthitis in approximately 9% of cases with complications (1). In a retrospective analysis of 20 patients who experienced inner ear complications and/or facial palsy following acute otitis media over a 14-year period, 2 individuals (10%) developed suppurative labyrinthitis (2). Viruses can also cause labyrinthitis; however, the resulting infection is not usually suppurative.
The pathophysiology of purulent labyrinthitis involves the invasion of bacteria into the perilymphatic spaces through the cochlear aqueduct, leading to a breakdown of the blood-labyrinth barrier and suppurative changes in the labyrinth; hair cell damage and neuronal death in the spiral ganglion ensue, which can result in sensorineural hearing loss (3).
References
1. Yorgancılar E, Yildirim M, Gun R, et al. Complications of chronic suppurative otitis media: a retrospective review. Eur Arch Otorhinolaryngol. 2013;270(1):69-76. doi:10.1007/s00405-012-1924-8
2. Hydén D, Akerlind B, Peebo M. Inner ear and facial nerve complications of acute otitis media with focus on bacteriology and virology. Acta Otolaryngol. 2006;126(5):460-466. doi:10.1080/00016480500401043
3. Klein M, Koedel U, Kastenbauer S, Pfister HW. Nitrogen and oxygen molecules in meningitis-associated labyrinthitis and hearing impairment. Infection. 2008;36(1):2-14. doi:10.1007/s15010-007-7153-1
Symptoms and Signs of Purulent Labyrinthitis
Because purulent labyrinthitis affects both the vestibular and cochlear regions of the inner ear, symptoms of purulent labyrinthitis include the following:
Severe vertigo and nystagmus
Nausea and vomiting
Tinnitus
Varying degrees of hearing loss
Otic pain and fever are common. Gait impairment due to dysequilibrium may be present.
Diagnosis of Purulent Labyrinthitis
Temporal bone CT
Possibly MRI
Sometimes lumbar puncture
Audiogram
Purulent labyrinthitis is suspected if vertigo, nystagmus, sensorineural hearing loss, or a combination occurs during an episode of acute otitis media, trauma, or spread of chronic infection (eg, complicating a cholesteatoma). 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 are also done. Audiograms may also be performed to detect sensorineural hearing loss.
Treatment of Purulent Labyrinthitis
Intravenous (IV) antibiotics
Myringotomy
Sometimes tympanostomy
The treatment of purulent labyrinthitis is with IV antibiotics appropriate for meningitis (eg, ceftriaxone IV once a day). Ceftazidime is often substituted for ceftriaxone in nosocomial infections to cover (eg, ceftriaxone IV once a day). Ceftazidime is often substituted for ceftriaxone in nosocomial infections to coverPseudomonas aeruginosa. The antibiotics are later adjusted according to the 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
