Don't underestimate the flu

Dr. Barnaby Young, 33, started the day with a mild sore throat and runny nose – akin to a flu-like illness. The symptoms lasted for a few days, but he had no fever or headache. However, by the evening of the third day, he began to feel dizzy, which developed into severe dizziness when he woke up the next morning. He felt as if his room was spinning.

"For the first two days after the vertigo started, I couldn't eat, drink, turn my head or even roll my eyes from side to side without vomiting or feeling lightheaded," he said. Dr. Young, an infectious disease specialist from the UK who works at a local hospital, decided to self-medicate with vestibular and anti-nausea medications, prescription medications used to relieve dizziness and nausea. "But the drugs had little effect. The problem is still recovery time and I'm trying every day to rest my mind."

From the third day (after the dizziness), the upper respiratory infection symptoms gradually improved. "I was able to open my eyes and stagger to the sofa to watch TV. By the fourth day, I was slowly walking to the clinic, although I moved slower and less well than my toddler!"

Dr. Young has fully recovered from his flu, but it took about two weeks for the symptoms to go away. He joked, "I spent a week at work staggering like a drunkard, sometimes unable to stand when turning my head!"

What disease did he have?

Dr Barrie Tan, Senior Consultant and working at Gleneagles Hospital Singapore, analyzed that: it turned out that Dr Young had Labyrinthitis – a disease that causes inflammation of the inner ear leading to disorder.

Dr Tan said labyrinthitis is relatively rare in Singapore, but he has treated a number of patients with the condition, most of whom are young, healthy people aged between 20 and 50.

The doctor continued to explain: The inner ear is the inner part of the ear that includes the vestibular organ that regulates the body's balance (senses the body's position in space) and the cochlea, an important hearing organ.

"When the labyrinth is inflamed, the patient may experience hearing loss and loss of balance. The head will feel dizzy and lightheaded as if the world is spinning constantly. The dizziness is often very intense, causing constant nausea/vomiting. The condition is so severe that the patient cannot move because the dizziness will increase when trying to move.

Because the disease has a sudden and acute onset, it can be quite frightening for the patient. It also increases the risk of falls and head injuries due to dizziness, and dehydration due to persistent vomiting.

Dr. Tan shared: "Acute vertigo usually lasts for a few days or two weeks. When the disease subsides, the patient only has a slight dizziness or unsteadiness when walking. The recovery period can last from 1-2 months. Hearing function after the disease can be completely restored or affected a little. The fastest recovery time is in the first month, but many patients still have to rest for about 6 months after the disease develops."

In positive cases, the patient will fully recover hearing and balance within two weeks.

In extreme cases, patients risk becoming deaf in one ear and experiencing persistent vertigo for weeks, followed by loss of balance and difficulty walking for months. But Dr. Tan said most patients usually regain their balance within two weeks.

What causes the disease?

Labyrinthitis is often spontaneous and idiopathic, but can occur after a cold or upper respiratory tract infection (URTI). "These infections do not usually affect the inner ear. More commonly, an upper respiratory infection affects the middle ear when bacteria and secretions from the nose travel through the Eustachian tube to the ear, causing fluid to build up. Severe middle ear infections can lead to infection spreading to the brain or, in rare cases, labyrinthitis," says Dr. Tan.

Although an MRI (magnetic resonance imaging) scan can reveal inflammation, diagnosis is usually made after a thorough medical history and physical examination. Hearing loss is diagnosed through a “pure tone audiometry”. The doctor can also detect signs of the disease such as rapid eye movements, or abnormal eye movements when moving the head.

Treatment includes:

Vestibular inhibitors:Helps relieve dizziness. Taken as a pill or as a patch behind the ear.

Oral steroids: Relieves inflammation of the inner ear, which causes labyrinthitis.

Some literature also recommends the use of antiviral medications.

Rest and recuperate:Avoid irritating the ear's balance mechanism. Many cases of labyrinthitis clear up with a few days or weeks of bed rest.

After the disease and how to prevent it

Long-term effects can occur if the inner ear does not fully recover.

The patient may experience loss of balance, especially with sudden changes in body position, and is at risk of permanent hearing loss.

“These cases are very unpredictable and have their own characteristics, so there is no sure way to say who will have permanent hearing loss.”

Labyrinthitis rarely affects the same patient more than once. "There is currently little information about the risk factors for repeated episodes.

However, the disease does not tend to get worse in cases of subsequent recurrence."

Labyrinthitis is not preventable. "However, upper respiratory infections are a risk factor, so we need to be careful to limit contact with people who have this disease," says Dr. Tan.