Antibiotics for labyrinthitis: when are they needed?

A clinician should distinguish inner-ear inflammation from other causes of sudden vertigo before choosing treatment. Antibiotics cannot clear a viral infection and can cause side effects when used unnecessarily.

Labyrinthitis is inflammation of the inner ear, where the systems for balance and hearing sit close together. It can present with spinning vertigo, unsteadiness, nausea, hearing change, or ringing in an ear. A similar condition called vestibular neuritis mainly affects balance and generally does not cause hearing loss.

Symptoms may follow a respiratory viral illness. Less commonly, bacterial infection can spread from a middle-ear infection or another nearby infection; that situation needs prompt medical assessment rather than leftover antibiotics.

Arrange a GP assessment for new persistent vertigo, especially when hearing has changed. The clinician may examine your ears, check eye movements, assess balance and hearing, and review medicines and recent infections. Treatment can include short-term medicine for severe nausea or vertigo, followed by gradual movement and balance exercises as symptoms settle.

Until you are steady, avoid driving, climbing, swimming alone, and operating machinery. Rise slowly, keep walkways clear, and ask for help if you are at risk of falling. If an antibiotic is prescribed for a suspected bacterial infection, take it exactly as directed and do not share it.

Seek emergency help for vertigo with facial droop, new weakness or numbness, trouble speaking, severe difficulty walking, fainting, a sudden severe headache, chest pain, or double vision. These features can occur with problems affecting the brain or circulation and should not be assumed to come from the inner ear.

Get prompt medical care for sudden hearing loss, discharge from the ear, swelling or redness behind the ear, high fever, repeated vomiting that prevents fluids staying down, or rapidly worsening symptoms.

Ask whether your hearing should be tested, whether your symptoms fit labyrinthitis or vestibular neuritis, and how long to use any medicine for nausea or vertigo. If an antibiotic is recommended, ask which finding suggests a bacterial infection and what side effects should prompt advice.