Acute Labyrinthitis — Practical OPD Prescription
A practical prescription for acute viral/serous labyrinthitis with vertigo, vomiting, and right-sided sensorineural hearing loss — built around symptom control, urgent hearing protection, early ENT referral, and central-danger exclusion.
Why This Prescription Matters
In acute labyrinthitis, vertigo and vomiting demand rapid symptom control, but the hearing loss is the time-critical part. Acute unilateral sensorineural hearing loss must be confirmed with tuning fork tests and urgent pure tone audiometry, because early steroid decisions within the first 48–72 hours may protect hearing.
This prescription therefore does two things at once: it treats acute labyrinthitis symptomatically while keeping the clinician alert to sudden sensorineural hearing loss, AICA stroke mimic, dehydration, steroid safety, and same-day/early ENT referral.
What You’ll Learn
- Working diagnosis — acute viral/serous labyrinthitis presenting with vertigo, vomiting, and right-sided sensorineural hearing loss.
- Critical caveat — acute unilateral SNHL cannot be treated casually; confirm now and refer early to ENT.
- Acute symptom control — short-course prochlorperazine, ondansetron support, and betahistine continuation.
- Steroid window — why prednisolone is strongly considered when SNHL overlaps with sudden hearing-loss management.
- Rehydration — ORS or IV fluids when vomiting and dehydration threaten recovery.
- Supportive advice — quiet room, avoiding sudden head movements, early gentle mobilisation, and driving restrictions.
- Red flags — severe headache, neck stiffness, diplopia, weakness, slurred speech, inability to walk, visual loss, uncontrolled vomiting, and dehydration.
- Follow-up strategy — review at 48–72 hours, audiometry report review, ENT escalation, intratympanic steroid consideration, MRI IAM, and vestibular rehabilitation if persistent.
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This prescription is for clinical learning. Acute vertigo with unilateral hearing loss requires active exclusion of sudden sensorineural hearing loss and posterior circulation stroke before settling on labyrinthitis. Individualise treatment according to vitals, neurological signs, hydration, diabetes/BP, pregnancy status, drug contraindications, local protocols, and referral availability.