Labyrinthitis and vestibular neuritis

If the patient has no serious neurological sequelae, the prognosis is generally good. Patients with labyrinthitis with other neurological complications from bacterial meningitis such as hydrocephalus or stroke may require additional therapy such as a ventriculoperitoneal shunt or physiotherapy and occupational therapy. Patients with cerebral infarcts in critical areas are often left with significant disabilities. The recovery rate of peripheral vestibular function in vestibular neuritis ranges from 40% to 63%.[100]Brandt T, Huppert T, Hüfner K, et al. Long-term course and relapses of vestibular and balance disorders. Restor Neurol Neurosci. 2010;28(1):69-82. http://www.ncbi.nlm.nih.gov/pubmed/20086284?tool=bestpractice.com ​ About 2% of patients may experience a relapse, but that may not be in the same ear.[100]Brandt T, Huppert T, Hüfner K, et al. Long-term course and relapses of vestibular and balance disorders. Restor Neurol Neurosci. 2010;28(1):69-82. http://www.ncbi.nlm.nih.gov/pubmed/20086284?tool=bestpractice.com [101]Huppert D, Strupp M, Theil D, et al. Low recurrence rate of vestibular neuritis: a long-term follow-up. Neurology. 2006 Nov 28;67(10):1870-1. http://www.ncbi.nlm.nih.gov/pubmed/17130428?tool=bestpractice.com

Incomplete vestibular compensation

After injury to the inner ear, the brain undergoes a complex set of changes that allow it to adapt to the altered sensory input and abolish the perception of vertigo. This process is called vestibular compensation. Some patients may experience problems with incomplete vestibular compensation and so continue to experience vertigo. This can often be alleviated by a course of vestibular rehabilitation therapy, eliminating the vestibular suppressants, and increasing daily activities.[88]McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015 Jan 13;(1):CD005397. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005397.pub4/full http://www.ncbi.nlm.nih.gov/pubmed/25581507?tool=bestpractice.com

Hearing loss

The hearing loss that occurs with suppurative labyrinthitis is typically irreversible.[2]Kitsko DJ, Dohar JE. Inner ear and facial nerve complications of acute otitis media, including vertigo. Curr Allergy Asthma Rep. 2007 Nov;7(6):444-50. http://www.ncbi.nlm.nih.gov/pubmed/17986375?tool=bestpractice.com This would not be expected in vestibular neuritis. Treatment with corticosteroids may decrease inflammation and potentially preserve some hearing. Corticosteroids also decrease the inflammatory response within the cochlea, thus decreasing fibrosis and ossification, which can make cochlear implantation more challenging in the setting of bilateral suppurative labyrinthitis. Patients with serous labyrinthitis often recover their hearing. Hearing loss can be permanent in up to 20% of children with meningitis.

Tinnitus

Tinnitus that is associated with sensorineural hearing loss in labyrinthitis typically gets less noticeable with time. However, patients with persistent tinnitus can develop a reactive depression. These patients may benefit from antidepressant therapy (selective serotonin-reuptake inhibitors), tinnitus re-training, biofeedback, tinnitus maskers, and amplification with a hearing aid.