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Health condition · Clinically reviewed

Labyrinthitis, vertigo with hearing loss - and how UK inner-ear care works.

Not just a bad case of dizziness - inflammation of the inner ear needs a proper specialist assessment, and rehabilitation, not just tablets.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BAO-HNS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK ENT and audiology practice, including HINTS assessment and vestibular rehabilitation.

Key facts

Labyrinthitis at a glance.

The essentials, in plain English - what it is, how it differs from vestibular neuritis, and how UK ENT and audiology approach it.

  • What it is

    Inflammation of the inner-ear labyrinth - the semicircular canals and cochlea - causing vertigo, hearing loss and tinnitus.

  • Not the same as

    Vestibular neuritis affects the vestibular nerve only, without hearing loss. Labyrinthitis involves the cochlea, so hearing is affected.

  • Most common cause

    Viral, usually after an upper respiratory infection - self-limiting but often intensely disabling for days.

  • Serious causes

    Bacterial labyrinthitis from middle-ear infection or meningitis is an emergency needing specialist ENT input.

  • Assessment

    History plus a HINTS examination (head-impulse, nystagmus, test of skew) to separate peripheral from central causes.

  • Recovery

    Vestibular rehabilitation from specialist audiology drives most of the long-term recovery, not tablets.

Why this guide matters

Vertigo is a symptom, not a diagnosis.

The three points below shape everything else on this page - and explain why a proper assessment matters more than another packet of tablets.

  • Hearing loss changes the label

    Vertigo with hearing loss is labyrinthitis. Vertigo without hearing loss is vestibular neuritis. See our /conditions/dizziness/ guide for the wider picture.

  • Bacterial forms are emergencies

    Middle-ear infection, meningitis or a labyrinthine fistula can seed the labyrinth - hospital-based specialist ENT care is needed.

  • Rehabilitation drives recovery

    Vestibular exercises with a specialist audiologist do far more for long-term recovery than any medication.

How the diagnosis is made

From acute vertigo to a clear plan.

The steps a UK GP, ENT surgeon or acute physician normally follows, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and red flags

    Sudden vertigo, nausea, hearing loss and tinnitus - with a careful check for headache, neurology or recent ear infection.

  2. 02

    Assessing

    Hearing screen at the bedside

    A simple whispered-voice or tuning-fork check - the presence of hearing loss is what separates labyrinthitis from pure vestibular neuritis.

  3. 03

    Assessing

    HINTS examination

    Head-impulse test, nystagmus pattern and test of skew - a specialist ENT or neurology bedside test that helps rule out stroke.

  4. 04

    Confirming

    Formal audiometry

    Pure-tone audiometry with a specialist audiologist quantifies any sensorineural hearing loss and guides follow-up.

  5. 05

    Confirming

    ENT and neurology review

    Specialist ENT for the ear, specialist neurology if central features are suspected - MDT input where the picture is mixed.

  6. 06

    Preparing

    MRI internal auditory meatus

    Specialist-commissioned MRI IAM if hearing loss persists or the picture is atypical - to exclude retrocochlear pathology.

  7. 07

    Preparing

    DVLA and return-to-work plan

    Specialist advice on driving, work and vestibular rehabilitation - most people can plan a graded return within weeks.

Typical timeline: a specialist assessment in days, a rehabilitation plan in weeks.

Symptoms

What labyrinthitis actually looks like.

The classic mix of vertigo, hearing loss and tinnitus - and the features that mean it isn\'t just labyrinthitis.

  • Acute vertigo

    A sudden spinning sensation lasting days - worse with head movement and usually settling into unsteadiness.

  • Nausea and vomiting

    Often the most disabling early feature - short-course anti-sickness medication helps in the first days.

  • Hearing loss

    Sensorineural hearing loss on the affected side - the feature that distinguishes labyrinthitis from vestibular neuritis.

  • Tinnitus

    Ringing, buzzing or hissing on the affected side - may persist after the vertigo settles.

  • Unsteady gait

    Difficulty walking straight, veering to one side - improves with vestibular rehabilitation.

  • Spontaneous nystagmus

    Involuntary eye movement, usually beating away from the affected ear - a peripheral sign your clinician will look for.

  • Aural fullness

    A blocked or pressured feeling in the ear - common but not universal.

  • Red flag - focal neurology or headache

    Severe headache, weakness, double vision or slurred speech means urgent assessment for stroke, not labyrinthitis.

Treatment

How labyrinthitis is treated in the UK.

Short-course symptom relief first, specialist ENT input where needed, and vestibular rehabilitation to drive recovery.

  • Short-course antihistamine

    Cinnarizine, cyclizine or prochlorperazine for a few days - eases vertigo and nausea, then stopped so recovery can start.

  • Anti-emetic support

    Prochlorperazine tablets, buccal or injection where oral intake is poor - short-course only.

  • Oral corticosteroids

    Specialist ENT selective use in sudden sensorineural hearing loss - evidence is mixed but early treatment matters.

  • Antivirals

    Occasionally added by specialist ENT where a specific viral cause is suspected - not routine.

  • IV antibiotics

    Bacterial labyrinthitis from otitis media or meningitis - an emergency needing hospital admission and specialist ENT.

  • Surgical drainage

    Specialist-commissioned mastoid or middle-ear surgery where infection or a labyrinthine fistula is the driver.

  • Vestibular rehabilitation

    The mainstay of recovery - specialist audiology-led exercises that retrain balance over weeks. See our /treatments/vestibular-rehabilitation/ guide.

  • Hearing-loss management

    Formal audiology follow-up, hearing aids where needed, and onward specialist input if loss is severe. See /conditions/hearing-loss/.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, ENT surgeon or audiologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE Clinical Knowledge Summary. Vestibular neuronitis and labyrinthitis.

  • British Association of Otorhinolaryngology - Head and Neck Surgery (BAO-HNS). Vestibular guidance.

  • ENT UK. Vertigo and dizziness patient information.

  • DVLA. Assessing fitness to drive - vestibular disorders.

Red flags

When vertigo needs urgent attention.

Most labyrinthitis settles with time and rehabilitation. These are the situations where it doesn\'t - and where a specialist opinion is needed quickly.

  • Sudden hearing loss

    Sudden sensorineural hearing loss is a same-week emergency - urgent specialist ENT review and audiology within days.

  • Meningitis features

    Headache, neck stiffness, photophobia or non-blanching rash with ear symptoms - call 999 or attend A&E.

  • Discharging ear plus vertigo

    Suspect bacterial labyrinthitis or a labyrinthine fistula - urgent specialist ENT assessment.

  • Focal neurology

    Weakness, numbness, double vision, slurred speech or a severe headache means stroke until proven otherwise - HINTS by a specialist and urgent imaging.

  • Persistent vertical or direction-changing nystagmus

    A pattern that suggests a central cause - needs specialist neurology and imaging.

  • Symptoms lasting beyond three weeks

    Ongoing vertigo, hearing loss or tinnitus needs specialist ENT and audiology review, plus consideration of vestibular rehabilitation.

  • Recurrent episodes

    Repeated attacks suggest Meniere disease, migraine or BPPV rather than a single labyrinthitis - see /conditions/dizziness/.

  • Immunocompromised patients

    Lower threshold for hospital assessment - infections can progress quickly.

  • Autoimmune features

    Fluctuating bilateral hearing loss, eye inflammation or systemic symptoms may point to Cogan syndrome - specialist review needed.

Living with it

A recoverable condition, with a clear plan.

Four things that make the biggest difference: dose gently in the first days, move early, respect driving rules, and ask for rehabilitation rather than more tablets.

A quiet reminder

Compensation happens through movement.

The brain rewires around a damaged labyrinth by using it. Prolonged rest slows recovery; graded exercise speeds it.

  1. 01 Days 1-3

    Rest, hydrate, dose gently

    Short-course antihistamines and anti-sickness medication in the first days - then stop, so the brain can start compensating.

  2. 02 Weeks 1-4

    Move, don't hide

    Gentle activity and vestibular exercises drive recovery. Prolonged bed rest slows compensation.

  3. 03 Driving

    Stop until advised otherwise

    Don't drive while symptoms are acute. Your specialist and DVLA guidance decide when it is safe to restart.

  4. 04 Escalate

    Ask for rehab and audiology

    If vertigo, tinnitus or hearing loss persist beyond a few weeks, ask for a specialist audiology and ENT plan - not another course of tablets.

Frequently asked

Everything we get asked about labyrinthitis.

Quick answers on vertigo, hearing loss, HINTS, recovery timelines and driving.

  • What is labyrinthitis?

    Labyrinthitis is inflammation of the inner-ear labyrinth - the semicircular canals and the cochlea. It causes vertigo, nausea, hearing loss and tinnitus, usually on one side. Most cases are viral and self-limiting, but bacterial and autoimmune forms exist and need specialist ENT care.

  • How is it different from vestibular neuritis?

    Vestibular neuritis inflames the vestibular nerve alone - so it causes vertigo and imbalance without hearing loss. Labyrinthitis also involves the cochlea, so hearing loss or tinnitus is present. The distinction matters because hearing loss triggers earlier audiology involvement.

  • Could this be a stroke?

    A small proportion of acute vertigo presentations are actually strokes affecting the brainstem or cerebellum. Red flags include severe headache, focal neurology, double vision or a nystagmus pattern that changes direction. A specialist HINTS examination and urgent imaging are used when these are present.

  • What actually treats it?

    Short-course antihistamines and anti-sickness medication ease the first few days. Antivirals and steroids are used selectively by specialist ENT. Bacterial labyrinthitis needs hospital-based IV antibiotics. Long-term recovery is driven by vestibular rehabilitation with a specialist audiologist, not tablets.

  • How long does it take to recover?

    Acute vertigo usually settles over days to a couple of weeks. Residual unsteadiness, tinnitus or hearing loss can persist longer. With vestibular rehabilitation most people are substantially better within six to twelve weeks, though a minority need longer specialist audiology input.

  • When can I drive again?

    Not while vertigo is active or unpredictable. UK DVLA guidance restricts driving during acute vestibular symptoms; your specialist will advise on timing based on how settled and predictable your balance has become. Some people need to notify the DVLA formally - your clinician will guide you.

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