Clinical Presentation and Diagnosis of Labyrinthitis

Characterization of Labyrinthitis

Labyrinthitis is characterized by sudden severe vertigo with profound hearing loss and prolonged vertigo (lasting >24 hours), distinguishing it from other vestibular disorders 1
The vertigo in labyrinthitis is typically accompanied by nausea and hearing loss, and is not episodic or fluctuating like in Ménière's disease 1
Severe rotational vertigo in vestibular neuritis (a related condition) typically lasts 12 to 36 hours with decreasing disequilibrium for the next 4 to 5 days 1

Unlike Benign Paroxysmal Positional Vertigo (BPPV), which causes positional vertigo lasting less than a minute, labyrinthitis causes prolonged vertigo not primarily triggered by position changes 1, 2
Unlike Ménière's disease, which presents with episodic vertigo attacks and fluctuating hearing loss, labyrinthitis typically causes a single prolonged vertigo attack with more persistent hearing loss 1
Unlike vestibular neuritis, which affects only the vestibular portion of the inner ear (causing vertigo without hearing loss), labyrinthitis affects both the vestibular and cochlear portions, resulting in both vertigo and hearing symptoms 1

Vertigo accompanied by speech difficulties, dysphagia, visual disturbances, or motor/sensory deficits requires urgent evaluation for possible central causes 3
Severe imbalance disproportionate to the vertigo or symptoms lasting more than 24 hours without improvement are red flags requiring immediate attention 3
New-onset severe headache, particularly occipital headache with vertigo, is a red flag for central vertigo 3