Circumscribed labyrinthitis may be seen in patients with expanding middle ear and mastoid lesions. It is produced by localized erosion of bone into the labyrinth, without invasion of the endolymphatic portion. The usual cause is a cholesteatoma eating away at the lateral semicircular canal in the mastoid antrum, but any other expanding tumor, such as glo-mus jugulare, can be a cause.
The symptom is mild vertigo, which may be aggravated by pushing on the ear or getting water in it. Positional vertigo may also be present. Complaints of hearing loss or drainage, referable to the middle ear lesion, are often present. Ear examination will uncover a middle ear abnormality. If the primary physician encounters true vertigo with evidence of middle ear disease, the ENT physician should be called immediately.
A positive fistula test (see "Spontaneous Perilymph Fistula" in Chapter 5) is often present. There may be further erosion of the cholesteatoma or tumor into the membranous portion of the vestibule, with ensuing fulminant suppurative labyrinthitis. If this occurs, there will be extreme vertigo, with subsequent total loss of hearing and vestibular function.
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