Ep 202 – Labyrinthitis

In this episode of the GPnotebook Podcast, Dr. Roger Henderson provides a comprehensive deep dive into labyrinthitis, emphasizing that it is a diagnosis of exclusion requiring careful clinical reasoning. He clarifies that true labyrinthitis involves inflammation of the membranous labyrinth affecting both vestibular and cochlear functions, leading to vertigo, hearing loss, tinnitus, and nausea—distinguishing it from vestibular neuritis, where hearing remains intact. The episode reviews the anatomy of the inner ear, common causes including viral triggers (such as CMV, mumps, measles, and Ramsay-Hunt syndrome), bacterial origins (especially in meningitis or otitis media), and rare autoimmune or systemic causes. Dr. Henderson stresses the critical importance of excluding serious mimics like posterior circulation stroke, acoustic neuroma, and Meniere’s disease through thorough neurological exams, audiometry, and imaging such as MRI. Management is largely supportive, with emphasis on early mobilization, short-term use of vestibular suppressants, and urgent referral for sudden sensorineural hearing loss. He highlights that prolonged use of suppressants can impair compensation, and vestibular rehabilitation is key for long-term recovery. The episode concludes with a strong call to avoid using 'labyrinthitis' as a catch-all for dizziness and to always consider the broader differential before confirming the diagnosis.