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Vestibular Neuritis and Labyrinthitis
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
13 sections · 129 slides
Definitions and terminology
- Definition of vestibular neuritis
- Definition of labyrinthitis
- Separating the two acute vestibular syndromes
Vestibular neuritis: clinical features
- Presenting symptoms of vestibular neuritis
- Duration of the acute phase
- Residual symptoms after the acute phase
- Frequency of vestibular neuritis
- Incidence and demographics
Aetiology and pathophysiology
- Historical uncertainty about aetiology
- Vascular hypothesis
- Viral reactivation hypothesis
- Autoimmune hypothesis
- Evidence of acute inflammation
- Temporal bone histopathology
- Predilection for the superior division
- Divisions of the vestibular nerve and patterns of neuritis
- End organs of the superior vestibular nerve
- End organs of the inferior vestibular nerve
- Anatomical basis of superior division vulnerability
- Consequences of an atypical inferior presentation
- Membranous labyrinth and its nerve supply
Evaluation of vestibular neuritis
- Components of the clinical examination
- Spontaneous nystagmus in superior division disease
- Spontaneous nystagmus in inferior division disease
- Effect of visual fixation on nystagmus
- Bedside head impulse testing
- Video head impulse testing
- Role of diagnostic testing
- Videonystagmography and caloric testing
- Cervical vestibular evoked myogenic potentials
- Ocular vestibular evoked myogenic potentials
- Audiometry in vestibular neuritis
- Indications for computed tomography
- Indications for magnetic resonance imaging
- Serological testing
Diagnosis and subtypes
- Basis for the three subtypes
- Superior vestibular neuritis
- Inferior vestibular neuritis
- Complete vestibular neuritis
- Vestibular function test results for the subtypes of vestibular neuritis
- Peripheral differential diagnosis
- Central differential diagnosis
- Postural instability as the key discriminator
- Imaging when a central cause is suspected
Course and treatment of vestibular neuritis
- Natural course of the acute phase
- Mechanisms of recovery of balance
- Factors that block vestibular compensation
- Recurrence and later positional vertigo
- Supportive treatment in the acute phase
- Vestibular suppressant medication
- Corticosteroids and antiviral agents
- Vestibular rehabilitation
Labyrinthitis: clinical features
- Presentation of labyrinthitis
- Cochlear symptoms and hearing loss
- Epidemiology of labyrinthitis
Aetiology of labyrinthitis
- Categories of labyrinthine inflammation
- Viral labyrinthitis
- Viral pathogens implicated
- Congenital cytomegalovirus infection
- Bacterial pathogens in labyrinthitis
- Mechanisms of bacterial labyrinthine injury
- Autoimmune inner ear disease
Pathways of labyrinthine infection
- The two primary pathways into the labyrinth
- Routes of labyrinthine infection and inflammation
- Sources of tympanogenic labyrinthitis
- Causes of direct labyrinthine extension
- The round window as a route of spread
- Round window thickening after otitis media
- Other proposed mechanisms of tympanogenic spread
- The meningogenic route
- Hearing loss after bacterial meningitis
- Diffuse versus circumscribed disease
- Circumscribed labyrinthitis from lateral canal erosion
- Attic cholesteatoma seen on otoscopy
Evaluation of labyrinthitis
- Presentation of tympanogenic labyrinthitis
- Presentation of meningogenic labyrinthitis
- Otoscopic findings
- Chronic ear with keratin debris and perforation
- Audiometric patterns in labyrinthitis
- Spontaneous nystagmus in labyrinthitis
- Timing of vestibular testing
- Magnetic resonance imaging in labyrinthitis
- Computed tomography in labyrinthitis
Histopathologic subtypes and course
- Basis of the histopathologic subtypes
- Serous labyrinthitis
- Outer hair cell loss in serous labyrinthitis
- Suppurative labyrinthitis
- Serous compared with suppurative disease
- Differential diagnosis of labyrinthitis
- Course of labyrinthitis
- Labyrinthitis ossificans
- Stages of labyrinthitis ossificans
Treatment of labyrinthitis
- Treatment of viral labyrinthitis
- Management of tympanogenic disease from acute otitis media
- Indications for tympanomastoidectomy
- Steroids in tympanogenic labyrinthitis
- Treatment of meningogenic labyrinthitis
- Corticosteroids in bacterial meningitis
- Audiologic assessment after meningitis
- Timing of cochlear implantation
- External components of a cochlear implant system
Summary
- Key points on vestibular neuritis
- Key points on labyrinthitis
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- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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