Could your dizziness be caused by an inflammation of the inner ear?

Question:  

For more than 20 years, on and off, I have had labyrinthitis. The vomiting and dizziness caused by this disorder leave me bed-bound for three or four days at a time, and it can take another fortnight for me to recover.

Now, my neck hurts, it aches around my ear and I have tingling around my cheekbone and eyes. How can I get to the root of this?

Louise Pitts, via email.

Answer: 

Labyrinthitis is an inflammation of the inner ear, the maze-like system of tubes and passages that is fundamental to hearing and balance.

The inner ear consists of the snail-shell-shaped cochlea, the fluid-filled vestibular system and two nerves that gather information from these areas and send it to the brain.

A number of viruses — in 30 per cent of labyrinthitis cases there is history of a recent cold — and some bacterial infections can inflame this delicate structure, causing dizziness, nausea and, sometimes, hearing impairment along with tinnitus (noise or ringing in the ears).

Labyrinthitis is an inflammation of the inner ear, the maze-like system of tubes and passages that is fundamental to hearing and balance

Balance, concentration and confidence can all be affected, and to have experienced recurrent bouts for so many years must have caused you significant distress, as well as created great upheaval in your home and work life.

The dizziness, almost like severe motion sickness, tends to be the worst symptom and can be treated with anti-nausea medicines.

Cinnarizine and prochlorperazine, which are more typically used for travel sickness, can be taken as tablets or, in severe cases, injected, and will usually resolve an attack of labyrinthitis in one to three weeks.

They help by suppressing the nerve signals that are coming from the inner ear and can connect with the vomiting centre in the brain.

Your case is unusual because of the recurrent nature of your attacks and the facial numbness, ache around your ear and discomfort in the side of your neck that you are now experiencing.

The dizziness, almost like severe motion sickness, tends to be the worst symptom and can be treated with anti-nausea medicines

In your longer letter, you write that you are being woken during the night by the feeling the room is spinning and then vomiting when you get up.

The most common cause of such attacks of dizziness (known medically as vertigo) is benign paroxysmal positional vertigo.

However, with this, acute dizziness is triggered by head movements and lasts only a few seconds, and there is no associated discomfort, numbness, or tingling. A different disorder, called Meniere’s disease, also causes dizziness and may lead to a sense of fullness and pain in one ear, as well as tinnitus and hearing loss.

While this can be recurrent, bouts most commonly last two to three hours, not the days and weeks you describe.

A third condition, vestibular migraine, causes dizziness and nausea — and not necessarily a headache — but rarely lasts longer than a few hours, although it may be recurrent.

Given the severity of your symptoms, the fact they clear up fully only to return later, and the tingling and numbness that you are experiencing, I believe that labyrinthitis is the correct diagnosis and that it may be caused by the herpes simplex virus (HSV) attacking the inner ear.

This common virus, which more usually causes cold sores, can lie dormant in the body, reactivating periodically to cause pain, tingling and numbness.

If the infection is in the inner ear, balance and hearing may also be affected.

Whether or not HSV is involved can be hard to prove and I urge you to ask your GP to refer you to the expert hands of a neurotologist (an ear, nose and throat specialist).

They may prescribe preventive anti-viral medication (400mg of acyclovir twice a day), which, if HSV is indeed at the root of your problems, could minimise the attacks or stop them altogether.

IN MY VIEW … Poetry could extend your life 

We’ve all heard of the importance of a balanced diet, plenty of sleep and regular exercise if you want to live a long and healthy life.

But wouldn’t it be great if visits to the theatre or art galleries were part of the recipe for longevity? Well, it seems this could be the case, with research published in the British Medical Journal last month revealing that the more people engage with the arts, the lower their risk of an early death.

The effects were substantial. Men and women aged 50-plus who saw a play, attended the opera or went to a museum, gallery or concert every few months were almost a third less likely to die early than those who never engaged with such activities. Even dabbling in the arts once or twice a year cut the risk of dying early by 14 per cent.

Wouldn’t it be great if visits to the theatre or art galleries were part of the recipe for longevity? (file image) 

These results can’t be explained away by virtue of culture vultures being wealthier. Rather, it seems the outcome is at least partly due to them being more likely to heed health advice. The outings may also provide exercise, combat loneliness and stimulate the brain.

Another fun and more budget-friendly way to exercise the mind is to learn a piece of poetry.

In broadcaster Gyles Brandreth’s book Dancing By The Light Of The Moon, he encourages us to go back to learning poetry as we did at school. Most of us will feel that we no longer have the memory to do so, but Brandreth, who took the time to interview neuroscience experts at Cambridge University, informs us that the issue isn’t the actual memorising, it’s the recall that is needed afterwards, and recall will improve with practice.

Learning a new poem every week, even just a rude limerick, won’t only exercise the relevant neurological muscles, it will also lift your heart.

What better way of engaging in the arts and extending your life?

Source: Martin Scurr