Yes, it is possible that inner ear infections can cause vertigo. In this blog, we will discuss how inner ear infections can be a cause of vertigo along with the most common treatments that may help.
Inner Ear Infection Detected
During the initial exam, I assess all my patients for an inner ear infection. I check the eye movements by performing an oculomotor exam. I compare the oculomotor test results under normal lighting conditions with the same tests performed in the dark using infrared oculography video goggles (IVOG).
I check for the presence of spontaneous nystagmus and gaze-evoked nystagmus. This means I check all my patients for “jittery eyes” looking straight ahead and gazing to either side while they are sitting upright in the chair.
By comparing and contrasting the results of these oculomotor tests in room light versus in the dark, I can assess for the presence of an inner ear infection.
*This cause of vertigo is commonly missed by providers who do not use infrared oculography video goggles for a vestibular exam, so it can be missed at the emergency room.*
There are generally two types of inner ear infections, vestibular neuritis and vestibular labyrinthitis.
Vestibular Neuritis
If your hearing has NOT been affected, then the medical diagnosis for your inner ear infection is called vestibular neuritis. Some doctors also call this vestibular neuronitis.
Vestibular neuritis is thought to be caused by inflammation or a virus.
Common medications prescribed for vestibular neuritis include short-term corticosteroids to reduce inflammation, such as a medrol dose pack.
Antivirals are often prescribed for an acute onset of vestibular neuritis, along with steroids.
Types of Viruses that May Cause Vestibular Neuritis
Traditional thinking about vertigo from a virus is typically preceded by a G.I. infection or upper respiratory infection.
Viral vertigo may also be preceded by cold sore or fever blisters caused by the herpes virus. In that case, the herpes virus active within the face has affected the vestibular nerve.
In more recent years, patients with long Covid or post vaccination syndrome often have waxing and waning viral activity with vertigo that comes and goes. For example, these patients may show really high levels of Epstein-Barr virus or cytomegalovirus in their bloodwork due to immune system insufficiency.
Vestibular Labyrinthitis
If your hearing has been affected, then the medical diagnosis for this condition is called vestibular labyrinthitis.
Vestibular labyrinthitis is more often thought to be a bacterial infection, but could also be caused by inflammation or a virus.
Patients may be prescribed any of the medications listed above as well as possibly antibiotics.
What to Do About an Inner Ear Infection
The first step is to notify your doctor. Typically your primary care provider needs to know, but you can also seek medical management at urgent care or with a specialist.
Medications to Address the Root Cause
Your medical doctor, nurse practitioner, or physician assistant can prescribe any medication necessary for medical management.
If you know that you’ve had some kind of infection preceding your vertigo, you should report that to your healthcare provider. The type of infection you had prior to the onset of vertigo – viral or bacterial – may help them determine which medication may help.
If you don’t have a primary care provider, you can go urgent care to request medication.
Take all your medication as prescribed and talk to your doctor if you have any questions about your medication.
Medications for CNS Suppression to Mask Symptoms
While you are recovering, your healthcare provider may prescribe medication such as meclizine or a benzodiazepine to suppress your vertigo symptoms.
While those medications are very helpful for the first 2 to 3 days of a new inner ear infection and may help by masking your symptoms overall, those medications may slow down your recovery if you take them for more than three days.
Current research supports using vestibular suppressant medications only for the first few days of a new inner ear infection.
After that, it’s ideal to use these medications only as needed so you can recover as quickly as possible.
Take all your medication as prescribed and talk to your doctor if you have any questions about your medication.
Medication for Nausea
Please note that ondansetron for nausea is very helpful for as needed use and this medication will not slow down your recovery. Talk to your doctor if you need medication for nausea.
Medical Specialists
Your primary care provider may decide to refer you to a specialist. A specialist referral may or may not be necessary on a case-by-case basis.
If your hearing has been affected by the inner ear infection, you should get a hearing exam. Your primary care provider can make that referral for you.
Lifestyle Recommendations for Immune Support
To support your body in fighting the inner ear infection, you may need extra sleep and stress management. Lack of sleep and heightened stress can interfere with a normal immune response.
Cut out alcohol and cut way back on white sugar if possible during your recovery. Alcohol and sugar can interfere with your immune system.
You may also choose to take supplements for immune system support. Immune support typically includes vitamin C, vitamin D, and zinc.
Talk to your doctor to determine if you need any supplements for immune support.
Visit the Store at VertigoDetective.com for products I recommend for immune support.
How to Assess for Immune Deficiency
If you have noticed an increase in viral or bacterial infections in your body lately or you have unexplained recurrent viral vertigo, you can get a CBC blood draw test to assess your immune response.
Your doctor can order a CBC blood draw through your insurance or you can pay out of pocket at a lab.
If you decide to get this test to assess your immune response to the inner ear infection detected by your vestibular provider, it’s important to get the bloodwork done before starting any steroids.
White blood cells should be elevated on CBC results when you are fighting an active infection. If the white blood cells are “normal” on your CBC, then your immune response may be deficient.
In that case, you may benefit from additional medical care for your suspected immune deficiency.
Click here for more detailed information on Immune Deficiency
Super-Imposed BPPV in Addition to an Inner Ear Infection
Some patients with an inner ear infection also get a new onset of BPPV at the same time. You may or may not also have a new onset of BPPV crystals in the affected ear.
It’s always possible that anyone can have BPPV crystals displaced prior to the onset of a new inner ear infection.
If you have super-imposed BPPV in addition to an inner ear infection, you may need to follow up with your vestibular provider for BPPV assessment and treatment.
You can seek vestibular physical therapy if symptoms linger after an inner ear infection. Some patients need vestibular exercises for a full recovery.
Disclaimer
This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
