Labyrinthitis vs vestibular neuritis: the role of hearing

Both conditions cause a sudden onset of vertigo, the sensation that everything around you is spinning, along with feeling unsteady, sick and sometimes being sick. What separates them is what happens to hearing. If your hearing is affected, with hearing loss or tinnitus, that points to labyrinthitis. If balance is affected but hearing is not, it is called vestibular neuritis. The NHS combines the two on a single page and says the symptoms are very similar.

In practice, the distinction is often less important for treatment than for monitoring. Management is much the same for both, but sudden hearing loss in one ear is something the NHS wants assessed urgently, so noticing whether your hearing has changed is the single most useful thing you can tell a clinician.

The NHS describes both as types of inner ear infection that affect your balance. The two parts of the inner ear involved are different. The labyrinth is a maze of fluid-filled channels, and NHS inform explains it contains the cochlea, which sends sounds to the brain, and the vestibular system, a set of fluid-filled tubes that affect balance. Labyrinthitis is inflammation of this structure, and so can affect both hearing and balance.

Vestibular neuritis is inflammation of the vestibular nerve, the nerve that sends messages from the balance organ to the brain. Because it involves the balance nerve and not the hearing part of the inner ear, hearing is not affected. NHS inform says most cases of viral labyrinthitis occur in adults aged 30 to 60, that bacterial labyrinthitis is much less common and that children under 2 are more vulnerable to the bacterial form.

The table is based on the NHS and NHS inform descriptions.

NHS inform says a GP may ask about your symptoms, check your medical history, examine you and ask you to move your head or body, check your ears for signs of inflammation and infection, test your hearing and check your eyes. Labyrinthitis is more likely if you have hearing loss. Eyes that flicker uncontrollably can suggest the balance system is not working properly.

This means that the hearing test and your own account of any change in hearing are what do most of the work. NHS inform also notes that certain things can make dizziness worse, such as colds or feeling generally unwell, the dark, tiredness or jet lag and being on your period.

Both usually get better on their own. The NHS suggests lying still in a dark room if you feel very dizzy, drinking plenty of water little and often if you are being sick, avoiding noise and bright lights, getting enough sleep and starting to go for walks outside as soon as possible, with someone to steady you, keeping your eyes on a fixed object. It says not to drive, cycle or use tools or machinery if you feel dizzy and not to drink alcohol.

A GP may prescribe antihistamines, motion sickness tablets or anti-sickness medicines for up to 3 days. The NHS says not to take them for longer because they can slow your recovery. NHS inform adds that for severe symptoms a GP may prescribe prochlorperazine, an anti-sickness medicine or corticosteroids to reduce inflammation. Antibiotics only help if the infection is bacterial.

If balance problems last for months or even years, the NHS says vestibular rehabilitation, a series of exercises supervised by a specialist such as a physiotherapist or audiologist, can help restore balance and reduce dizziness, nausea and anxiety. You can ask a GP to refer you, or it may be possible to refer yourself directly.

The NHS says to see a GP if symptoms have not got better after a few days or are getting worse, or if you have been diagnosed and your symptoms have not improved within a week of starting treatment. Ask for an urgent GP appointment or get help from NHS 111 if you have sudden hearing loss in one ear, as you may need referral to a specialist for tests and possibly treatment.

Sudden dizziness can also be a feature of other conditions. The NHS stroke advice lists feeling dizzy or falling over, blurred vision, weakness or numbness down one side, difficulty speaking and a severe headache among the other signs of stroke, and says to call 999 if you think you or someone else is having a stroke. If vertigo comes with any of those, treat it as an emergency rather than as an ear problem.