Labyrinthitis

Dr. Rajal Sukhiyaji (M.PT. in Sports Science)

Labyrinth (Inner Ear) :-Definition :- It is the inner most part of the ear. Lying within the petrous part of the temporal bone.Parts :-1. Bony labyrinth2. Membranous labyrinth

1) Bony labyrinth :-• Consists of series of bony cavities connected with one another.

• It is filled with a fluid called “ Perilymph “.• It consists of the following :

1. Semicircular canals2. Vestibule3. Cochlea

2) Membranous labyrinth :-• It lies in the perilymph of the bony part.• It consists of sacs and tubes connected with each other and contains a fluid called “ Endolymph “.

• It consists of the following :1. Semicircular ducts2. Utricle and Saccule3. Cochlear duct

• ..\Structure of the Inner Ear.mp4• ..\Model- Inner Ear and the Bony Labyrinth.mp4

Labyrinthitis :-• The infection may affected the labyrinth in 3 stages. 1. Fistula formation (Para labyrinthitis) :- o Without active clinical features.o At this stage the infection does not reach the membranous labyrinth.

2. Serous labyrinthitis (Reversible condition)3. Purulent labyrinthitis :-o With permanent deafness and loss of vestibular function.

Causes :-• Infections• Secondary to acute otitis media, dangerous chronic otitis media.

• TB• Syphilitic otitis media• Secondary to meningitis• Viral ( due to mumps, measles, herpes zoster )• Vascular causes ( thrombosis, embolism )• Acoustic neuroma of internal auditory meatus• Ototoxic drugs (like streptomysin)• Meniere’s syndrome/disease (vertigo, deafness, tinnitus)

Clinical features :-• Sensory – neural deafness• Tinnitus• Giddiness• Vomiting• Nystagmus• Loss of balance• Hearing is not markedly affected in serous labyrinthitis.• Fistula test positive• Purulent labyrinthitis (dead ear) leads to permanent total sensory

neural deafness. While the giddiness usually settles down in 3 to 4 weeks, as the labyrinth of the other side takes over its function.

Treatment :-

• Mastoidectomy ( For first 2 stages )• Labyrinthectomy ( For 3rd stage to drain pus )• Antibiotics in full dose

• ..\How labyrinthitis develops.mp4

Mastoidectomy

• Surgical removal of some or all of the mastoid process.• Classification :-1. Simple mastoidectomy2. Radical mastoidectomy3. Modified radical mastoidectomy

1) Simple mastoidectomy ( Conservative or Schwartze mastoidectomy ) :-• This operation aims at draining the mastoid air cells by postaural

approach.• It does not disturb the structure of the middle ear, hence the

hearing is unaffected.Indication :-1. Acute coalescent mastoiditis2. Complications of mastoiditis3. Tympanoplasty as a part of surgery4. Decompression of the facial nerve5. Decompression of the endolymphatic sac6. Excision of an acoustic neuroma

• Complication :-Immediate :-1. Haemorrhage : primary2. Injury to surrounding structures

Sigmoid sinus Tegmen plate Facial nerve Labyrinth Incus : dislocation

Late :-1. Haemorrhage : secondary2. Infection3. Mastoid fistula 4. Persistence of otorrhoea5. Stenosis of external auditory canalDelayed :-6. Thrombophlebitis7. Meningitis8. Facial nerve paralysis9. Labyrinthitis :giddiness, sensorineural deafness10. Conductive deafness

2)Radical mastoidectomy :-

• It is an operation in which the mastoid, middle ear and the external auditory canal are converted into a single cavity by lowering the wall between the mastoid and the external ear, and removal of the remnants of the ear drum, malleus and incus.

• The stapes is not removed as the labyrinth gets exposed and may be damaged.

• Conductive deafness may be a sequelae of this operation.

Indication :-1. Cholesteatoma 2. Chronic osteitis of the mastoid3. Chronic osteomyelitis of the mastoid4. Tumors of the middle ear :benign5. Labyrinthectomy Complication :-• Same as above , except conductive deafness is a sure sequelae.

• Reoccurrence of the condition

3)Modified Radical Mastoidectomy :-• Which is similar to radical mastoidectomy, with the following differences.

1) The following structures are not removed.a) Tympanic membraneb) Lower portion of malleus and incus.2) There is no disease in the middle ear, and hence there is no need for removal of any structures from there.

Indication :-1. Cholesteatoma2. As an adjunt to fenestration operation for

otosclerosis.Complication :-• No deafness

• ..\Start of mastoidectomy.mp4• ..\mastoidectomy.mp4• ..\modified radical mastoidectomy3gp.mp4• ..\Ear Surgery for Chronic Ear Infection-About Mastoid and

Tympanoplasty-DrKOPaulose FRCS.mp4

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