Inner Ear Infection

An infection of the inner ear will occasionally cause vertigo. It is believed that a herpes virus causes these infections.

The herpes virus is neurotropic, which means that it lives within nerves. When the infection is active, it causes inflammation. This inflammation leads to swelling, which may cause the blood flow to the inner ear (or the nerve itself) to be disrupted, which may lead to permanent damage. This vertigo is quite severe and typically lasts 1-2 days. It may be associated with hearing loss. If the attack causes vertigo alone, it is called vestibular neuritis. If it is associated with hearing loss, it is called labyrinthitis. Either way, it is a self-limiting illness.

The acute vertigo resolves by itself. Vestibular suppressants, especially benzodiazepines (valium and xanax) and anti-nausea medications are the mainstay of medical therapy, and their purpose is only to help with the vertigo. Often times the infection will leave the person with a partial loss of hearing and balance function on the affected side. The loss of balance function may cause a persistent dizziness due to the asymmetric input from the inner ear balance system to the brain (one “engine” normal, the other “engine” at partial power). The hearing loss often does not improve and varies in severity. Occasionally anti-viral medications and the anti-inflammatory steroid are prescribed, but these have not been shown to make a significant difference in recovery or outcome. Long-term treatment may require hearing rehabilitation with a hearing device and/or vestibular therapy. Vestibular therapy is a type of physical therapy specifically for balance.