Labyrinthitis: symptoms, treatment and how long it lasts

The NHS lists the most common symptoms as dizziness or a spinning sensation (vertigo), feeling unsteady and off balance so that it is hard to stay upright or walk straight, nausea or vomiting, hearing loss and ringing in the ears (tinnitus). Symptoms can start suddenly and may be there on waking, getting worse as the day goes on. NHS inform adds a feeling of pressure inside the ear and mild headaches, and describes hearing loss ranging from mild to total.

NHS inform says dizziness can be made worse by colds or feeling generally unwell, darkness, tiredness or jet lag, and, for some people, being on their period. Because the onset can be frightening, it recommends seeking medical advice straight away rather than waiting.

• Vertigo, the feeling that you or the room is spinning or moving

• Unsteadiness and difficulty walking in a straight line

• Nausea or vomiting

• Hearing loss in labyrinthitis, from mild to total

• Tinnitus or a feeling of pressure in the ear

• Mild headaches

NHS inform says a GP may ask about your symptoms, check your medical history and carry out a physical examination. You may be asked to move your head or body, and the GP can check your ears for signs of inflammation and infection. They may test your hearing, because labyrinthitis is more likely if you have hearing loss, and check your eyes: if they flicker uncontrollably, your balancing system may not be working properly.

The NHS says the GP may refer you to a hospital specialist if symptoms do not improve.

The NHS suggests lying still in a dark room if you feel very dizzy, drinking little and often if you are being sick, avoiding noise and bright lights, and getting enough sleep because tiredness can make symptoms worse. It recommends starting to go for walks outside as soon as possible, ideally with someone to steady you until you feel confident, and keeping your eyes on a fixed object when out and about instead of looking around all the time.

The NHS says not to drive, cycle or use tools or machinery if you feel dizzy and not to drink alcohol, which can make symptoms worse. NHS inform adds that you should avoid working at heights while dizzy.

The NHS says a GP may prescribe antihistamines, motion sickness tablets or anti-sickness medicines for up to 3 days, and that they should not be taken for any longer because they can slow recovery. NHS inform lists prochlorperazine for dizziness and sickness, other anti-sickness medicines, and corticosteroids to reduce inflammation, for particularly severe symptoms. Only a prescriber can decide whether any of these is suitable.

Because the condition is usually caused by a virus such as a cold or flu, the NHS says antibiotics will not help, although a GP may prescribe them if they think the infection is bacterial. NHS inform notes that bacterial labyrinthitis is much less common and that children under 2 are more vulnerable to it.

The NHS says labyrinthitis and vestibular neuritis usually get better on their own within a few weeks. The symptoms often ease after a few days, and you will usually get your balance back over 2 to 6 weeks, although it can take longer.

For some people balance problems last much longer. The NHS says this can be for many months or even years, and NHS inform calls dizziness and vertigo lasting months or years chronic labyrinthitis. For these cases it recommends vestibular rehabilitation (see the recovery section).

The NHS says to see a GP if symptoms do not get 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.

NHS inform describes the labyrinth as the innermost part of the ear, with two parts: the cochlea, which sends sound to the brain, and the vestibular system, a set of fluid-filled tubes that affect balance. When the labyrinth becomes inflamed, both hearing and balance can be disturbed. It says this is usually due to a viral infection such as a cold or flu, and much less commonly a bacterial infection.

The NHS explains the related condition, vestibular neuritis, affects a different structure: the vestibular nerve, which carries balance messages from the inner ear to the brain. Because the symptoms are so similar, the key difference is hearing. NHS inform adds that many people diagnosed with labyrinthitis have only balance symptoms without hearing loss, which is then called vestibular neuronitis, and that both names are often used for the same diagnosis.

NHS inform says the labyrinth, the innermost part of the ear, usually becomes inflamed because of a viral infection such as a cold or flu (viral labyrinthitis), or less commonly a bacterial infection (bacterial labyrinthitis). Most cases of viral labyrinthitis occur in adults aged 30 to 60, and are quite common. Children under 2 are more vulnerable to bacterial labyrinthitis.

NHS inform lists things that can make dizziness worse: colds or illness, anything that makes you feel generally unwell, the dark, tiredness or jet lag, and being on your period. The NHS says alcohol can make symptoms worse.

Labyrinthitis is inflammation of the inner ear, and the NHS and NHS inform do not describe it as something you can catch from another person. NHS inform says the inflammation is usually due to a viral infection such as a cold or flu.

The cold or flu itself is a different matter. The NHS says colds are caused by viruses and spread easily through germs from coughs and sneezes, and that a person with a cold is infectious from a few days before symptoms begin until they have finished. Washing your hands often and using tissues reduces the risk of passing a cold on. If you are unsure, ask a GP or pharmacist.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have sudden hearing loss in one ear, because you may need to be referred to a specialist for tests and possibly treatment. NHS inform advises contacting your GP practice urgently if you have symptoms of labyrinthitis and they are getting worse.

Dizziness can also have other causes. The NHS lists these among the signs of a stroke: weakness or numbness down one side of the body or face drooping on one side, slurred speech, blurred vision or loss of sight, confusion, feeling dizzy or falling over, and a severe headache. The NHS says to call 999 straight away if you think you or someone else is having a stroke, even if the symptoms have stopped, and not to drive yourself to A&E.

Most people recover well, but the NHS says balance problems can sometimes last for many months or even years. Vestibular rehabilitation is a series of exercises that can restore balance and help with dizziness, nausea and anxiety, and the NHS says they should only be done under the supervision of a specialist such as a physiotherapist or audiologist. A GP can refer you, or you may be able to refer yourself.

NHS inform calls dizziness lasting months or years chronic labyrinthitis and says it requires vestibular rehabilitation therapy, usually supervised by a physiotherapist. It warns that not all physiotherapists are trained in it, so tell them you need this treatment and check they are qualified and belong to a recognised body such as the Chartered Society of Physiotherapy. The NHS notes NHS physiotherapy waiting lists can be long and that some people prefer to pay privately.

Labyrinthitis is usually first assessed by a GP, who may prescribe short-term medicines and refer you to a hospital specialist if symptoms do not improve. For long-lasting balance problems, the NHS says a GP can refer you to a physiotherapist, or you may be able to refer yourself directly.

The NHS notes that waiting lists for NHS physiotherapy can be long, that you may prefer to pay for private treatment, and that most private physiotherapists accept direct self-referrals. NHS inform advises making sure any private physiotherapist is fully qualified, belongs to a recognised body such as the Chartered Society of Physiotherapy, and has training in vestibular rehabilitation.