Dr. Koralla Raja Meghanadh
- Sep 23, 2023
- 7 min read

Inner Ear Infection-Causes, Symptoms, and Treatment

Updated: Sep 29, 2023

Inner ear

The inner ear is a complex organ that converts sound vibrations and position signals into electrical signals, which are then interpreted by the brain. Doing so allows us to perceive and understand sounds and words. Additionally, it helps in maintaining a sense of balance.

It is the innermost part of the ear located within the skull's temporal bone.

Any infection or problem in the inner ear can lead to hearing loss, dizziness, or balance problems.

Inner ear infection

An inner ear infection is always a secondary infection that mostly spreads from middle ear infections. In rare cases, ear infection originates from brain infections such as meningitis or encephalitis.

When an infection enters the inner ear, it spreads faster than infections in another part of the ear, as the inner ear lacks an immune system.

With no means to restrain the condition, the functions of the inner ear become compromised, resulting in hearing loss, tinnitus, and giddiness.

If the inner ear infection is left untreated, it can cause permanent hearing loss and can even lead to brain infection.

So, it is essential to promptly address inner ear issues and seek appropriate medical care to minimize the risk of complications. This article will delve into their causes, symptoms, and available treatments.

Types of inner ear infections

An inner ear infection can be classified into two types:

Labyrinthitis
Vestibular neuritis

Labyrinthitis

Labyrinthitis is an infection that affects the labyrinth, a crucial part of the inner ear responsible for both hearing and balance. The labyrinth encompasses the cochlea (responsible for hearing) and the vestibular system (responsible for maintaining balance). Consequently, an infection within the labyrinth disrupts both hearing and balance, leading to symptoms such as:

Vomiting
Tinnitus
Giddiness
Nausea
Severe Hearing loss

Vestibular neuritis

Vestibular neuritis is an infection in the vestibular nerve, a part of the labyrinth responsible for maintaining balance. Vestibular neuritis can cause symptoms like:

Nausea
Vomiting
Giddiness, loss of balance in the body

What causes inner ear infections?

As mentioned earlier, an inner ear infection is a secondary infection that two situations can cause.

Middle ear infection or Otitis Media
Brain infections like Encephalitis and Meningitis

Middle ear infections

The most common cause of inner ear infection is the middle ear infection. When the disease in the middle ear is left untreated or not adequately managed, the condition can progress and extend into the inner ear, leading to an inner ear infection.

Middle ear infections are the most common type of ear infection that is also a secondary infection. It is mainly caused due to common cold, and other infections that can be responsible for it are chronic sinusitis and Otitis external, i.e., outer ear infection.

Infection from the brain

The second cause, although rare, involves infections spreading from the brain to the inner ear. The disease in the brain can either be encephalitis or meningitis.

How can ear infections be triggered?

Ear infection can spread from one part of the ear to another. So, here is a list of causes that can trigger an ear infection.

Untreated Common Cold
Blowing nose very hard
Chronic Sinusitis
Allergy
Bacteria
Virus
Fungus
Extra growth or tumor in the back of the nose where the eustachian tube opens
Adenoids - Most common ear infection cause in children
Oil in ear
Water in ear
Using external objects like cotton buds to clear the ear canal
Humid climates
Infection in brain
Low immunity
Going to a hilly area at a high speed
high-speed elevator over 20 floors
diving into the water
Traveling in flight
Smoking - active and passive

To know more about these causes, please refer to our article "What are the causes of an ear infection?".

Symptoms of inner ear infection

Most patients with an inner ear infection will experience a progression of symptoms, starting with middle ear symptoms and eventually developing into inner ear symptoms. These symptoms include

Hearing loss: A decrease in the ability to hear sounds.
Ear blockage or clogged sensation: Feeling fullness or obstruction in the ear.
Tinnitus: Ringing, buzzing, or other noises in the ear.
Giddiness and loss of balance: Feeling dizzy or unsteady, experiencing difficulty maintaining balance.
Vomiting: Nausea and vomiting may occur in some cases.

Signs of Inner Ear Infection: Involuntary Eyeball Movement (Nystagmus)

One of the signs that may indicate an inner ear infection is involuntary eyeball movement, known as Nystagmus.

When the right inner ear is irritated, it triggers rapid eyeball movement toward the affected ear. If both eyeballs rapidly move towards the right side, indicating possible active damage in the right ear.

Eyeballs moving towards the affected ear suggests that irritation and damage are still occurring.

Shift in Eye Movements

Once the damage becomes total and there is no further potential for damage, the eye movement direction shifts to the opposite side. This shift helps determine whether the condition is salvageable (potential for recovery) or non-salvageable (complete damage has already occurred).

By observing the eye movement pattern, healthcare professionals can gain insights into the severity and progress of the inner ear infection.

Understanding the components of the inner ear and their role in the symptoms

Front end (responsible for hearing): Damage to the front end can lead to symptoms like hearing loss, tinnitus, sudden ear blockage, or a sensation of water or obstruction in the ear.
Back end (crucial for balance): Damage to the back end can result in giddiness, dizziness, loss of balance, instability, and a lack of confidence in walking or standing

Who are at risk of getting inner ear infections?

Not everyone has an equal risk of developing inner ear infections. Certain factors can increase or decrease the likelihood of experiencing these infections. Here are the critical risk factors to consider.

Sudden severe bacterial infection in the middle ear: If a person with no middle ear infection suddenly experiences a severe bacterial infection in that area, the middle ear may not be prepared to handle the condition. This can result in the rapid spread of infection to the inner ear.
Compromised immunity: Individuals with compromised immune systems, such as those taking immunosuppressant medications, undergoing anticancer treatments, and having uncontrolled diabetes for a long time, have the risk of developing inner ear infections.
Viral infections: Viral infections, including COVID-19, can weaken the immune system, making individuals more susceptible to inner ear infections.
Children: Their developing immune systems and lower immunity levels make them more prone to inner ear infections.
Accidents or injuries: Individuals who have had middle ear infections for a few weeks and experience accidents or injuries may have a more severe and fast-spreading infection.

It's important to note that individuals with long-standing middle ear infections lasting more than ten years may not be at significantly higher risk, even if they experience an accident or injury. The middle ear can manage the condition even when the balance between immunity and infection is shifted.

Understanding these risk factors can help identify individuals who may be more susceptible to inner ear infections, enabling them to seek timely medical treatment.

Diagnosis

Doctors diagnose an inner ear infection using various methods.

Nystagmus observation: Nystagmus refers to the rapid involuntary movement of the eyes. The presence of Nystagmus, along with the patient's complaints and symptoms, can indicate an inner ear infection.
Audiometry test: This test assesses the patient's hearing levels. If there is a middle or outer ear defect, the resulting hearing loss will be less than 60% of the overall hearing ability. However, if the fault lies within the inner ear, the hearing loss will exceed 60% of the total hearing capacity. This indicates that the infection affects the inner ear, specifically the part responsible for hearing.

By evaluating these, doctors can diagnose an inner ear infection and determine how much the inner ear is affected.

Treatment of inner ear infections

The treatment of inner ear infections requires a proactive and aggressive approach. Here's how it is typically carried out

High-dose antibiotics: High doses of antibiotics are administered to quickly suppress the infection and limit its spread and potential damage. These doses are typically double the dosage for middle ear or other body infections.
High-dose steroids: In the initial stages, high doses of steroids are given to protect the remaining function of the ear and prevent further damage. The objective is to mitigate the potential harm caused by the body's immune response. It's important to note that steroids should only be given after the infection is under control through the use of high-dose antibiotics.

Approach

The treatment approach involves administering antibiotics first to control the infection. Once the infection is suppressed, high-dose steroids are used to mitigate the potential damage caused by the body's immune response.

The rationale behind this treatment strategy is that the body produces antibodies to fight the bacteria during an infection. However, these antibodies can also affect the surrounding areas, leading to a double-edged effect. The use of high-dose steroids helps minimize damage caused by the immune response.

In summary, treating inner ear infections requires a proactive approach with high-dose antibiotics to control the infection, followed by high-dose steroids to prevent damage caused by the body's immune response. This treatment strategy aims to safeguard overall health while addressing the specific condition in the ear.

Treatment decision based on hearing loss severity

Cochlear implant for significant hearing loss: For hearing loss exceeding 80%, a cochlear implant is usually the preferred option.
Hearing aid for mild to moderate hearing loss: A hearing aid may be considered an alternative for hearing loss below 75%.
Immediate cochlear implant for bone formation: Even if the hearing loss is as low as 20% and new bone formation is discovered, a cochlear implant is the only way to restore hearing even after a completely new bone formation. Immediate implantation is recommended to ensure the best outcome, as a fully formed bone makes cochlear implant insertion ineffective.

Preservar la audición existente durante la formación de hueso nuevo

In cases of severe hearing loss, around 90%, a CT scan of the inner ear is recommended to assess bone formation. This defensive mechanism occurs when our body forms a protective bone around the inner ear to contain the infection. Once the bone is fully formed, the ear becomes non-functional, resulting in complete hearing loss that cannot be restored.

Allowing bone formation to progress can result in complete hearing loss and subsequent balance problems. While balance may gradually recover, the hearing loss is irreversible. Therefore, it is crucial to take prompt action to prevent irreversible damage, preserve hearing, and ensure the best possible outcome for individuals with inner ear infections and associated hearing loss.

Immediate cochlear implant surgery is necessary in such cases. Delaying the procedure makes it challenging to implant a cochlear device effectively. A complete bone formation will make the ear unfit for this surgery. Controlling the infection and proceeding with a cochlear implant as early as possible is crucial in cases where bone formation started.

Home remedies for inner ear infection

Unfortunately, there are no home remedies available for inner ear infections.

It would be best if you didn't wait and immediately seek the assistance of the best available ENT doctor in your area. There should be no consideration of home remedies or any delays.

Even if it's midnight, it is imperative to urgently visit the doctor and commence treatment as early as possible. Because inner ear infections can result in severe complications if not promptly, these complications may include permanent hearing loss, balance issues, or the infection spreading to nearby structures like the brain.

Written by

Dr. K. R. Meghanadh