Inner ear infection (or labyrinthitis)

What is an inner ear infection?

An inner ear infection is inflammation affecting the inner ear, the part of your ear responsible for hearing and balance.

There are two main types: labyrinthitis, which affects the labyrinth (a maze of fluid-filled channels controlling both hearing and balance), and vestibular neuritis, which affects only the vestibular nerve, so it disrupts balance without affecting your hearing.

Both usually get better on their own within a few weeks.

What are the symptoms of an inner ear infection?

The most common symptoms of labyrinthitis are:

• dizziness, or a spinning sensation (vertigo)
• feeling unsteady or off balance, which can make it hard to stay upright or walk in a straight line
• feeling or being sick
• hearing loss
• ringing in your ears (tinnitus)

Vestibular neuritis causes very similar symptoms, but without the hearing loss or tinnitus, since it's the balance nerve rather than the hearing and balance organ itself that's affected.

Symptoms often start suddenly, sometimes on waking, and can get worse as the day goes on. They're usually at their most intense in the first few days, then start to ease, though it can take 2 to 6 weeks, occasionally longer, for your balance to fully return.

Some people also notice a feeling of fullness in the ear, earache, headaches, or their eyes moving involuntarily, making it hard to focus.

What are the causes of an inner ear infection and who is at risk?

Most inner ear infections are caused by a virus, often one linked to a cold or flu, and are more common in adults aged 30 to 60. Bacterial infections are much less common but can be more serious – they're more likely to follow a middle ear infection or meningitis, and young children under two are particularly vulnerable to this type.

Other things that can raise your risk include:

• a recent respiratory infection, cold or flu
• a middle ear infection
• a head injury
• smoking, stress, fatigue or drinking large amounts of alcohol
• a history of allergies, or an autoimmune condition
• taking certain medicines, including aspirin, that can affect the inner ear.

Are there different types of inner ear infection?

Yes. The two main types are labyrinthitis and vestibular neuritis, and the key difference is hearing:

• Labyrinthitis: This affects the labyrinth, which handles both hearing and balance, so it causes hearing loss and tinnitus alongside balance problems.
• Vestibular neuritis: This only affects the vestibular nerve, which handles balance, so hearing isn't affected.

Both types can be caused by a virus or, less often, by bacteria, and viral cases are far more common than bacterial ones.

Occasionally, balance problems continue for months rather than weeks – this longer-lasting pattern is usually described as chronic, and it's treated differently from a typical short episode.

How is an inner ear infection diagnosed?

Unlike other ear infections, an inner ear infection can't be diagnosed just by looking in the ear, since the affected structures sit too deep to see with an otoscope.

Instead, a doctor will carry out a balance examination and often a wider neurological assessment, checking things like your eye movements, reflexes and coordination.

Because conditions such as migraine, stroke and Meniere's disease can cause similar symptoms, part of the assessment involves ruling these out.

Depending on your symptoms, you may also be offered a hearing test, or tests that check your eye reflexes by using warm or cool air or water in the ear canal (caloric testing), along with a CT or MRI scan if needed.

How is an inner ear infection treated?

There's no surgical treatment for a typical inner ear infection. Most cases are viral and get better on their own, so treatment focuses on easing symptoms while your body recovers.

Simple self-care measures can help in the first few days:

• lie still in a dark room if you feel very dizzy, and avoid sudden movements or changes in position
• if you're being sick, sip water little and often
• avoid bright lights, loud noise and reading
• get enough rest, since tiredness can make symptoms worse
• once you feel able to, start going for short walks, ideally with someone alongside you until you feel steady, keeping your eyes on a fixed point rather than looking around
• avoid alcohol, and don't drive, cycle, or use tools or machinery while you feel dizzy.

A doctor may prescribe antihistamines, motion sickness tablets or anti-sickness medicine, usually for no more than three days, since taking them for longer can slow your recovery.

Antibiotics won't help a viral infection, but may be prescribed if a bacterial cause is suspected. Occasionally, steroids are used to reduce inflammation.

If balance problems last for months rather than weeks, a structured programme of exercises called vestibular rehabilitation can help retrain your brain to compensate. This is usually supervised by a physiotherapist or audiologist, and a GP can refer you, or you can arrange this privately with a suitably qualified practitioner.

When should I see a doctor?

See a GP if your symptoms haven't improved after a few days, are getting worse, or haven't improved within a week of starting treatment for a diagnosed inner ear infection.

Get an urgent GP appointment or call 111 if you suddenly lose your hearing in one ear.

Call 999 or go to A&E if vertigo or dizziness comes with:

• convulsions, fainting, or slurred speech
• double vision
• vomiting that won't stop
• weakness or paralysis anywhere in the body
• a fever above 38.3°C

These can be signs of a more serious underlying condition rather than a straightforward inner ear infection.