Have you ever wondered that how do we remain standing without falling down despite the continuous pull of gravity? How can we whirl or spin around suddenly without falling down? If till today, never given a thought about such wonders of nature, then it’s time to think now. We would have heard about sense of vision, sense of touch, sense of taste and other senses, but very little is thought about the sense of balance, it usually goes unnoticed. Not many people know that we have something called the sense of balance, which helps us to stand erect while walking or standing without falling on either side. The sense of balance is the most amazing thing that nature has gifted us. The organ in our body that maintains our balance is the ears. Apart from helping us hear sounds, the ear also balances us while walking and standing. The balancing act is taken care exactly by the inner ear called the labyrinth.
More about labyrinth & labyrinthitis
Labyrinth or the inner ear consists of group of organs called as vestibular organs, which includes three membranous semi-circular canals called vestibular canals, and two large sacs – the utricle and the saccule. All these vestibular organs consist of a receptor cell (receiver cells) called the hair cells. These vestibular organs or vestibular apparatus helps to maintain the equilibrium by sending information about the movement and position of head to the brain. The sensory impulse of the movement of head is carried to the brain by the vestibular nerve. In some people infection or as an allergic reaction cause their inner ear to swell and irritate, a condition called as labyrinthitis. The infection inflames the labyrinth (labyrinthitis) or the vestibule-cochlear (vestibular neuritis) nerve that connects the inner ear to the brain, which interrupts the balance signal to the brain. Labyrinthitis can make a person feel like he/she is spinning even if they are not.
Causes
The many causes of labyrinthitis are
- Bacterial or viral infection
- Ear infection (otitis media)
- Upper respiratory tract infection
- Allergy or previous allergies
- Side-reactions of drugs, especially aspirin
- Trauma
- Might arise as complications of influenza (flu virus)
- Fatigue
- Consuming large amount of alcohol
- Smoking
- Stress
Symptoms
Symptoms of labyrinthitis may vary from mild to severe. A person may experience the symptoms either in the morning after waking up or suddenly in any time of the day. The person may be unable to sit, stand or walk, and have abnormal sense of movement (vertigo) or spinning of head. Labyrinthitis may cause a blocked feeling or feeling of fluid in both the ears. There may be involuntary eye movement resulting in difficulty in focusing, and impaired concentration. The person may feel dizzy and faint, and feels like the ground is moving. The person may fall on one side due to loss of balance. Loss of hearing in one ear may be present. Other symptoms include nausea and vomiting, tinnitus (ringing voices in the ear), increased night blindness, and low stamina.
Diagnosis
Diagnosis of labyrinthitis or balance disorder is quite difficult as there are many potential causes including other medical conditions and drugs. To evaluate the condition the person may be referred to an otolaryngologist (Ear, nose, and throat expert/ ENT). An ENT may be able to evaluate the situation based on the symptoms experienced by the patient. A simple ear examination may not show any problems. Electronystagmography, is considered the gold standard test for diagnosing ear disorder. This helps to find out the cause of dizziness as sometime dizziness is not caused by vestibular reasons but by other causes. Magnetic resonance imaging (MRI) is done to check if something is wrong with the inner ear. Audiometry/hearing test is done to check if there is something wrong with the hearing capability of the person. This test also differentiates a labyrinthitis (hearing loss is noticed) from vestibular neuritis (no hearing loss). Tympanometry helps to find fluid in the middle ear, middle ear pressure and other middle ear problems. Brainstem auditory evoked response test is done to see how fast the brain responds to a click sound near the ear. Rotator chair test is done to determine whether dizziness is due to disorder in the inner ear or in the brain
Treatment
Labyrinthitis actually goes away after few weeks without any medical intervention. But medical assistance or treatment is provided to ease the patients from the symptoms of labyrinthitis, such as spinning sensation. In case of severe symptoms, corticosteroids such as prednisone is prescribed. Antihistamines and non-steroid anti-inflammatory drugs are prescribed to reduce swelling. For nausea and vomiting, compazine is prescribed. Meclizine or scopolamine are given to relieve dizziness. Antibiotic and antiviral drugs may be given if middle ear infection is present.
Physical therapy can improve balance disorder. Even severe labyrinthitis gets better after first week of treatment and many are completely well after 2-3 months of treatment. But the major problem, which many patients continue to suffer with, is sensitivity to motion especially in older adults. In very few cases people might have permanent hearing loss.
Thing to do to feel better
During labyrinthitis episode the person can try the following tips to bring the situation under control
- Keep still and do not move
- Take rest
- Do not change the position suddenly
- Do not read anything when the symptom occurs
- Avoid bright light
- Resume the activity gradually
- Do not drive or run
- Avoid climbing stairs
- Avoid operating or standing near heavy machines
Outlook
Sense of balance is a great gift to us by nature. Labyrinthitis is not a severe disease but of course during labyrinthitis episodes people loss their balance and behave like they are drunk. The hardest thing about the disease is that is an invisible illness that only the patient can feel and experience. It is particularly hard for the physician to diagnose a hidden disease. The person might look perfectly well for an out-looker but what the patient feels inside is not known. Therefore many people do not get the support they need. People with labyrinthitis often feel that they are going mad; they experience frustration, depression, and anxiety. But this is not the same for everyone, knowing and educating themselves about the disease helps them to deal with it more effectively.
