The Pathophysiology of Labyrinthitis

Labyrinthitis generally defined as an inflammatory response within the membranous inner

ear structures in response
 to infections, an inner ear infection. The causes of infection may be
attributable to bacterial, viral, protozoal or fungal insult from localized or systemic origin. Both
viral and bacterial causes of labyrinthitis are relatively common in comparison to fungal infection.
The mechanisms of viral and bacterial labyrinthitis are distinct, so this student project will discuss
them.[1]

Figure 1. The labyrinth (or inner ear) houses

the delicate membranous structures
necessary for hearing and balance.

Bacterial Labyrinthitis

Bacterial aetiology of labyrinthitis is normally secondary to a previously acquired infection

such as sinusitis or meningitis, bacterial otitis media (middle ear infection/ inflammation) as a
significantly influential factor in the development of labyrinthitis pathophysiology.

Primarily, a build-up of infective discharge reaches a small chamber that is in direct contact
with the round window. This precipitate consists of toxins, enzymes and inflammatory chemicals
that form exudate/pus, and will eventually leave the ear as suppurative otorrhoea. Within this small
chamber is a potential space: the perilymphatic space, containing the fluid perilymph. Proliferation
of the discharge subsequently extends to the potassium rich endolymph within the membranous
labyrinth.

The interference of the homeostatic environment of the perilymphatic and endolymphatic

fluids within the labyrinth by bacterial toxins and inflammatory mediators causes irritation, and
also triggers an inflammatory response. This produces an inflammatory response within the
cochlea and has the ability to cause morphological alteration and dysfunction of sensory cells,
resulting in an irreversible hearing loss. [1]

Viral Infection

Viral insult, on the other hand, is the most common pathogenic factor of human
labyrinthitis. It is frequently associated as a complication of influenza, colds, upper
respiratory tract infections or viral otitis media.

Replication of viruses (protein-coated nucleic acids) occurs by the hijacking of

host cells and stimulating ribosomal protein synthesis. Pathogenically, it is still not
known exactly how the causal relationship between the virus and labyrinthitis occurs,
however, there is evidence to support congenital transmission in utero from rubella and
cytomegalovirus or transmission as
 a characteristic of systemic viral illness such as
influenza, human immunodeficiency virus or mumps, for example.[1]

1. Mildenhall J. The pathophysiology of labyrinthitis. Journal of Paramedic Practice. 2010;2(7):297-303.