Educational information, not medical advice. This article is written to help you understand common ear and hearing issues. It is not a substitute for professional diagnosis or treatment. If your symptoms are severe, sudden, or persistent, please consult a qualified doctor or audiologist. For urgent symptoms (sudden hearing loss, bleeding from the ear, severe pain with dizziness, or a head injury), seek medical care the same day.

Both cause sudden, severe spinning vertigo, often after a cold or viral illness. In vestibular neuritis only the balance nerve is affected, so hearing is normal. In labyrinthitis the hearing part of the inner ear is also involved, so there is hearing loss or ringing. A hearing test tells them apart.

The direct answer

Labyrinthitis and vestibular neuritis are inflammations of the inner-ear balance system, usually following a viral illness. Both cause sudden, intense vertigo with nausea and unsteadiness. The difference is hearing: in vestibular neuritis hearing stays normal, while in labyrinthitis there is also hearing loss and/or tinnitus. A hearing test is the simplest way to tell them apart.

Comparison at a glance

Vestibular neuritis: inflammation of the vestibular (balance) nerve. Vertigo and imbalance, no hearing loss.
Labyrinthitis: inflammation of the inner-ear labyrinth, which includes both balance and hearing structures. Vertigo plus hearing loss, ringing or a full feeling in the ear.

Typical symptoms

Sudden, severe spinning vertigo lasting hours to days.
Nausea, vomiting and difficulty walking straight.
Rapid, jerking eye movements during attacks.
In labyrinthitis: reduced hearing and ringing in the affected ear.
Often follows a cold, flu or other viral illness.

Red flags: get emergency care

Sudden vertigo can, rarely, be caused by a stroke or another serious condition. Seek emergency care straight away if vertigo comes with double vision, slurred speech, facial droop, weakness or numbness, difficulty walking that is severe, or a very severe headache. Any sudden loss of hearing is itself an emergency. See sudden hearing loss: a medical emergency.

How doctors tell them apart

Clinical examination of eye movements and balance by an ENT or physician.
Audiogram: normal hearing points to neuritis, reduced hearing points to labyrinthitis. See balance test near me.
Balance tests such as videonystagmography, and in some cases scans.

Treatment

Short-term medicines to reduce vertigo and nausea, used only for a few days, as prescribed.
Sometimes steroids, at a doctor's discretion.
Vestibular rehabilitation: guided exercises that help the brain compensate, and are the key to full recovery. Early gentle activity is better than long bed rest.
Treating bacterial causes, in the rare case of infection spreading from the middle ear.

Recovery and hearing

Vertigo usually settles over days to weeks, though some unsteadiness can last longer. In labyrinthitis, hearing may recover partly or fully, or may be permanently reduced, which is why a hearing test soon after onset is important. If it stays reduced, hearing aids can help. See vertigo and your ears and Meniere's disease for other causes.

If you have had a bout of vertigo, book a free hearing test so any hearing change is recorded. This article is general information and does not replace medical advice.

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