Labyrinthitis in Children

What is Labyrinthitis in Children?

Labyrinthitis is an inflammatory disease of the inner ear. The development of the disease occurs due to the effects of infection, pathogenic microorganisms on the inner ear. With labyrinthitis, the peripheral receptors of the auditory and vestibular analyzer respond to damage, the functions of the organs of hearing and balance are impaired. With labyrinthitis, not only the inner ear, but also the middle one is often affected.

Causes of Labyrinthitis in Children

The cause of the disease is a viral or bacterial pathogenic flora, the effect of toxins on the body, as well as various types of ear injuries. Labyrinthitis is divided into non-specific and specific (tuberculous, syphilitic). The causes of the development of the disease include:

• The introduction and spread of viruses in the inner ear, which provoke labyrinthitis, with the help of blood flow (streptococcus, tuberculosis, syphilis, etc.).
• The location of the meningitis focus near the inner ear.
• The penetration of infection through the meninges, the internal auditory canal and the water supply of the cochlea.

Pathogenesis during Labyrinthitis in Children

For pathological indicators, labyrinthitis is divided into: serous, purulent and necrotic.

Serous labyrinthitis is characterized by the development of endolymphatic edema, accompanied by purulent inflammation of the membranes of the inner ear, while nerve elements are damaged. There is a swelling, vacuolization and decay of the neuroepithelium. Serous labyrinthitis can be a complication of chronic suppurative otitis media.

During necrotic labyrinthitis, soft tissue necrosis occurs, capsules of the labyrinth with inflamed areas, and the bony walls of the labyrinth. Such a process goes into labyrinth sclerosis. Inflammation extends partially or completely to the labyrinth.

If the patient is diagnosed with purulent labyrinthitis, the development of the disease occurs in the following way: polymorphonuclear leukocytes and bacteria accumulate in the perilymphatic space, while the vessels expand, after which the edema increases in volume and passes into necrosis of the membranous and bone walls of the labyrinth tissue. Such a process destroys all receptors and nerve elements.

Depending on the route of infection into the inner ear, labyrinthitis is divided into:

• Tympanogenic is the most common form of this disease. It penetrates the body from the cavities of the middle ear, destroying the bony walls of the labyrinth, or through the window of the cochlea and vestibule.
• Meningogenic – develops in children with epidemic meningitis. It is caused by an infection that penetrates from the subarachnoid space along preformed pathways through the internal auditory canal and perilymphatic duct. This form of labyrinthitis can occur in people who suffer from tuberculosis, flu, scarlet fever, measles and typhoid. The pathogens also include: pneumococcus, pale triponema, meningococcus, mumps, etc. This type of labyrinthitis is often purulent or serous. As a rule, both ears are susceptible to damage.
• Hematogenous – the infection penetrates the hematogenous route (blood flow). This can occur in patients with common infectious diseases of predominantly viral origin, for example, influenza, mumps.
• Traumatic – appears in violation of the bone and membranous labyrinth.

The inflammatory process can affect the entire maze or only certain sections. Based on this, the labyrinthitis is divided into diffuse and limited. The first type is observed in children with chronic purulent epithympanitis, which is complicated by caries and cholesteatoma. A fistula often appears in the bone capsule of the labyrinth, which by its size reaches the inner wall of the capsule. At this point, in response to inflammation, a granulation shaft appears, which prevents the further penetration of the infection. Such a labyrinthitis has a chronic course and with its progression of the inflammatory process can go into diffuse.

With labyrinthitis, various morphological changes occur in the body: for example, labyrinthitis can manifest itself in the form of temporal bone osteitis. The patient has a depletion of epithelial cells of the inner ear, the walls of the maze swell. Maze edema is caused by accumulated pathogenic bacteria and white blood cells, for which timely treatment has not been carried out. Such a process causes severe swelling and tissue necrosis.

With labyrinthitis, the patient has atrophy of soft tissues and focal localization of the infection, which can spread widely.

Symptoms of Labyrinthitis in Children

Regardless of the form of labyrinthitis, all patients have common signs, which include: noise in the ear, imbalance, a sharp decrease in hearing, nausea during head movements, discoloration of the face, dizziness. These signs can be observed in the patient for 2-3 weeks, after which they turn into a chronic form of the maze.

The course of the labyrinthitis can be acute and chronic. In acute labyrinthitis (serous or purulent), symptoms of dysfunctions of the inner ear develop: dizziness, nausea and vomiting, imbalance, noise in the ear, hearing impairment. With serous labyrinthitis, the symptoms gradually (within 14-21 days) disappear, and the functions of the inner ear are partially or completely restored. With purulent labyrinthitis, a permanent violation of the functions of the lesion occurs. Chronic labyrinthitis gradually develops with a violation of the functions of the inner ear, a fistular symptom appears.

In patients with chronic labyrinthitis, periodic dizziness, nausea and vomiting, imbalance, the appearance of spontaneous nystagmus from the patient’s ear are manifested. One of the important signs of limited labyrinthitis is a fistular symptom or pressor nystagmus. If there is a fistula in the lateral semicircular canal due to thickening or rarefaction of air in the external auditory canal, nystagmus appears. With a fistal symptom, the patient feels pain while cleaning the ear. During pressor nystagmus, dizziness, nausea, swaying or falling of the patient are observed. In this case, the hearing may persist, but worsen due to the inflammatory process in the middle ear. It is very important to remove the purulent focus in time and prevent the transition of the labyrinthitis from limited to diffuse.

In acute diffuse serous labyrinthitis, auditory and vestibular function disorders occur. In this case, hearing is sharply worsened, nystagmus, dizziness, nausea, and imbalance appear.

With serous labyrinthitis, the functions of the inner ear are restored fully or partially only after complete removal of the inflammatory process.

Acute diffuse purulent labyrinthitis is characterized by a severe course and consequences, which leads to a complete loss of hearing and vestibular function on the injured side. With this form, intracranial complications may occur in the form of meningitis and cerebellar abscess.

The onset and course of purulent labyrinthitis is turbulent, accompanied by dizziness, nausea, vomiting, imbalances, spontaneous nystagmus. Auditory and vestibular functions are quickly lost. At the beginning of the disease, spontaneous nystagmus appears from the affected ear.

Necrotic labyrinthitis is characteristic of patients with scarlet fever and tuberculous otitis media, measles. Necrosis affects the bone labyrinth, spreads as a result of thrombosis of one of the branches of the labyrinth artery. Sequestries may appear.

For meningococcal labyrinthitis, the following disorders are characteristic: mild disorders of the vestibular apparatus. Both labyrinths give in to defeat, which leads to a sharp hearing impairment.

With tuberculous labyrinthitis, a gradual and progressive hearing loss occurs. This type of labyrinthitis can develop in a latent form, which leads to significant deterioration and complicates treatment.

Syphilitic labyrinthitis is manifested by a decrease in hearing and the appearance of regular dizziness (this is due to accumulated fluid in the labyrinth). Syphilitic labyrinthitis is characterized by damage to the facial nerve and loss of labyrinth function. In some cases, hearing loss can occur imperceptibly and gradually. A diagnosis can only be made by conducting additional studies. There is also a category of patients in whom the hearing decreases sharply, and accordingly, vestibular apparatus disorders also abruptly occur.

Diagnosis of Labyrinthitis in Children

When diagnosing, doctors take into account etiological factors, pathogenesis, clinical symptoms, and the duration of the inflammatory process. Depending on the etiology of the occurrence of the disease, the examination is carried out not only by the otolaryngologist, but they also give their advice – a neurologist, otoneurologist, traumatologist, venereologist, infectious disease specialist.
The diagnosis of labyrinthitis is based on an analysis of the above factors and a number of studies:

• Otoscopy and microotoscopy – reveal changes occurring changes in the structure of the eardrum.
• Vestibulometry – checking the condition of the vestibular apparatus (caloric, rotational and index tests).
• Audiometry is a measurement of the tonality of hearing.
• Computed tomography – examine the temporal region (with a traumatic cause of the disease).
• X-ray – shows the visible pathology of the brain.
• Magnetic resonance imaging – examine the brain for infection in the cranial brain.
• Lumbar puncture.
• RIF, IVA and PTsZ-diagnosis – carried out to determine the specific pathogen.
• Bacteriological examination – is prescribed for purulent discharge from the auricle.
• Differential diagnosis – allows you to distinguish labyrinthitis from Meniere’s pathology, ataxia, cochlear neuritis, otosclerosis, auditory nerve neuroma.
• Electistagmography is the recording of eyeball movements with electrodes. For dizziness, the cause of which is a disease of the inner ear, certain types of movements are characteristic.
• Test answer study – shows the functioning or malfunction of a nerve going from the inner ear to the brain.

Treatment of Labyrinthitis in Сhildren

Treatment of any type of labyrinthitis is carried out in an ENT hospital, under the close supervision of doctors. The patient is prescribed bed rest and drug therapy, consisting of:

• Antibacterial – broad-spectrum antibiotics are prescribed (penicillin and cephalosporin series, fluoroquinolones). Ototoccic antibiotics are not recommended.
• Dehydration – consists of a diet, diuretics, glucocorticoids, hypertonic drugs (solutions of glucose, urotropine, calcium chloride, magnesium sulfate).
• Antiseptic and anti-inflammatory drugs. They eliminate inflammation in the inner ear.
• In therapy, drugs that improve blood circulatаion are used, they affect the resumption of hearing function after a labyrinthitis. Such drugs normalize the functions of the vestibular apparatus.
• Drugs that normalize trophic disorders in the tissues of the ear (preductal, vitamins C, K, P, group B, cocarboxylases).

The neglected forms of labyrinthitis are treated surgically. Operations are performed in order to remove fluid from the cavity of the inner ear.

In the case when there is acute diffuse serous labyrinthitis, developing as a result of acute purulent otitis media, conservative treatment is indicated. In the case of a prolonged course of the disease with symptoms of mastoiditis, an antromastoidotomy is prescribed. The purpose of the operation is the elimination of the purulent focus. Before it, the patient undergoes a 5-7 day drug therapy.

If the labyrinthitis develops in chronic suppurative otitis media, as a rule, a sanitizing operation is performed on the middle ear. Labyrinthitis with a necrotic form is treated surgically with intervention in the labyrinth.

With intracranial complications, the operation is performed as soon as possible in order to eliminate the inflammatory process in the ear.

Prevention of Labyrinthitis in Children

Prevention of labyrinthitis is the prevention of common infectious diseases (tuberculosis, meningitis, flu, etc.) that can trigger labyrinthitis.

Timely referral to a doctor for ear diseases also applies to prevention. If you do not provide timely assistance, then inflammatory processes can spread to all the components of the inner ear, resulting in various complications.

It is worth remembering that any ear disease is easier to cure in the initial stages than when it becomes chronic or neglected.