Labyrinthitis - Treating labyrinthitis

Labyrinthitis is usually treated using a combination of self-help techniques and medication. Chronic labyrinthitis may be treated with vestibular rehabilitation therapy (VRT).

Self-help

Drink plenty of liquid, particularly water, to avoid becoming dehydrated. You should drink little and often.

In its early stages, labyrinthitis can make you feel constantly dizzy and it can give you severe vertigo. You should rest in bed to avoid falling and injuring yourself. After a few days, the worst of these symptoms should have passed and you should no longer feel dizzy all the time.

You can do several things to minimise any remaining feelings of dizziness and vertigo. For example:

• during an attack, lie still in a comfortable position (on your side is often best)
• avoid chocolate, coffee and alcohol
• stop smoking
• avoid bright lights
• try to cut out noise and anything that causes stress from your surroundings

Medication

If your symptoms of dizziness, vertigo and loss of balance are particularly severe, your GP may prescribe a short course of medication such as benzodiazepine or antiemetics (vestibular sedatives).

Benzodiazepine

Benzodiazepines reduce activity inside your central nervous system. This means your brain is less likely to be affected by the abnormal signals coming from your vestibular system.

However, long-term use of benzodiazepines is not recommended because they can be highly addictive if used for long periods.

Antiemetics

A prescription medication known as an antiemetic may be prescribed if you are experiencing nausea and vomiting.

Prochlorperazine 5mg tablets are an antiemetic used to treat the symptoms of vertigo and dizziness. It may be considered as an alternative treatment to benzodiazepines.

Most people are able to tolerate prochlorperazine and side effects are uncommon, but can include tremors (shaking), abnormal or involuntary body and facial movements, and sleepiness.

Check the patient information leaflet that comes with your medicine for a full list of possible side effects.

If you are vomiting, there is a prochlorperazine 3mg tablet available which you place inside your mouth between your gums and cheek.

Corticosteroids

Corticosteroids such as prednisolone may be recommended if your symptoms are particularly severe. They are often effective at reducing inflammation.

Side effects of prednisolone include:

• an increase in appetite
• weight gain
• insomnia
• fluid retention
• mood changes, such as feeling irritable or anxious

Antibiotics

If your labyrinthitis is thought to be caused by a bacterial infection, you will be prescribed antibiotics. Depending on how serious the infection is, this could either be antibiotic tablets or capsules (oral antibiotics) or antibiotic injections (intravenous antibiotics).

A number of antiviral medications are also available, but these are usually less effective than antibiotics and may have a limited effect in speeding up your recovery time. Your GP may therefore feel there is little benefit in prescribing you this type of medication.

When to seek further advice

Contact your GP if you develop additional symptoms that suggest your condition may be getting worse. If this happens, you may be admitted to hospital. These symptoms include:

• mental confusion
• double vision 
• weakness or numbness in one part of your body
• a change in the way you usually walk

Also contact your GP if you do not notice any improvement in your symptoms after three weeks. You may need to be referred to an ear, nose and throat (ENT) specialist.

Chronic labyrinthitis

A small number of people experience symptoms of dizziness and vertigo that last for many months and, in some cases, years. This is sometimes known as chronic labyrinthitis. 

The symptoms of chronic labyrinthitis are not usually as severe as when you first get the condition, although even mild dizziness can have a considerable impact on your quality of life, employment and other daily activities.

Vestibular rehabilitation therapy (VRT)

Vestibular rehabilitation therapy (VRT) is an effective treatment for people with chronic labyrinthitis. VRT attempts to "retrain" your brain and nervous system to compensate for the abnormal signals that come from your vestibular system.

VRT is usually carried out under the supervision of a physiotherapist and involves a range of exercises designed to:

• co-ordinate your hand and eye movements
• stimulate sensations of dizziness so your brain starts to get used to disruptive signals sent by your vestibular system and then ignores them
• improve your balance and walking ability
• improve your strength and fitness

The Brain and Spine Foundation is a UK charity that has more information about vestibular rehabilitation on its website.

You can ask your GP to refer you to a physiotherapist or you can pay for private treatment. If you decide to see a private physiotherapist, make sure they are fully qualified and a member of a recognised body, such as the Chartered Society of Physiotherapy (CSP).

Physiotherapists who are members of the CSP will follow high standards of professional practice and have a good level of knowledge and skills. Go to the Physio First website, which lists qualified members, to find a private physio in your area.

Not all physiotherapists have training in VRT, so you need to make it clear you require this type of treatment before making an appointment.