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Inner ear infection symptoms: What are the early signs of an inner ear infection?

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician
Updated Oct. 27, 2023  •  Published Aug. 11, 2023
Fact Checked
Inner ear infection symptoms: What are the early signs of an inner ear infection?

Overview: What does an inner ear infection feel like?

An inner ear infection can involve one of two structures: the labyrinth or the vestibular nerve that connects the ear to the brain. These ear structures help us hear and tell the brain how the head is oriented in space. Our sense of position, balance, stability, and motion comes from the inner ear. As a result, the first sign of an inner ear infection is vertigo, a dizzying sense that the room is spinning around. Other common symptoms accompanying vertigo are nausea, vomiting, balance problems, and eyes that rapidly move from side to side. Other symptoms include extreme sensitivity to motion or difficulty with concentration. Hearing problems or ringing in their ears are also common if the infection is in the labyrinth. Symptoms tend to linger even after the infection resolves, sometimes for months. Some people never fully recover their hearing or balance.

RELATED: What is an inner ear infection?

Key takeaways:

  • Inner ear infections are a common health condition affecting anyone regardless of age, sex, race, or ethnicity. 

  • Early signs of inner ear infections include vertigo, loss of balance, and nausea.

  • Serious symptoms of inner ear infections, such as severe vertigo, severe balance problems, ear pain, or loss of hearing, may require immediate medical attention.

  • Bacterial or viral infections cause inner ear infections. You may be at risk for developing inner ear infection symptoms if you have an upper respiratory infection like flu, the common cold, COVID, a bacterial infection (particularly of the middle ear), or a previous viral infection such as herpes.

  • Inner ear infections usually require a medical diagnosis.

  • Inner ear infections generally require treatment. Inner ear infection symptoms typically resolve with treatment within weeks but can linger for weeks or months. Viral ear infections will resolve spontaneously, and antibiotics do not work on them. 

  • Treatment of bacterial inner ear infections may include antibiotics. Symptomatic treatment of dizziness may help decrease discomfort. 

  • Untreated bacterial inner ear infections could result in complications like hearing loss, permanent ear ringing, complete deafness, and reduced vestibular nerve function. 

  • Use coupons for inner ear infection treatments like Valium (diazepam), promethazine, and Benadryl (diphenhydramine) to save up to 80%.

What are the early signs of an inner ear infection?

The early signs of an inner infection are:

  • Vertigo (a sense of being spun around)

  • Nystagmus (rapid, uncontrollable back-and-forth movement of the eyes)

  • Nausea

  • Vomiting

  • Balance problems

  • Hearing loss

  • Tinnitus (ringing in the ears)

Other inner ear infection symptoms

The most common symptoms of an infection of the labyrinth (labyrinthitis) are:

  • Vertigo

  • Balance problems

  • Nausea

  • Vomiting

  • Nystagmus

  • Loss of hearing

  • Tinnitus

The most common symptoms of a vestibular nerve infection (vestibular neuritis) are:

  • Vertigo

  • Balance problems

  • Dizziness

  • Nausea

  • Vomiting

  • Nystagmus

  • Sensitivity to motion

  • Problems concentrating

  • Anxiety (in chronic cases)

RELATED: Vertigo symptoms: what are the early signs of vertigo?

Inner ear infection vs. other ear infection symptoms

Inner ear infections are only one type of ear infection. The outer ear, consisting of the front part of the ear and the ear canal up to the eardrum, can also get infected, a condition called acute otitis externa or “swimmer’s ear.” So can the middle ear, the chamber of the ear that lies between the eardrum and the cochlea, a condition called acute otitis media. This is the most common location of ear infections and is most common in children. Viruses mainly cause inner ear infections, while bacterial infections commonly cause outer and middle ear infections. Inner ear infections can also be caused by viruses or fungi. Symptoms are very different:

Inner ear infection Outer and middle ear infections
Shared symptoms
  • Hearing problems
  • Tinnitus (middle ear and inner ear infections)
Unique symptoms
  • Vertigo
  • Nystagmus
  • Nausea
  • Vomiting
  • Balance problems
  • Earache (mild to severe pain)
  • Redness
  • Swelling
  • Fullness in the ear
  • Pressure
  • Fever
  • Drainage
  • Lymph node swelling
  • Itchiness and irritation in the ear canal (outer ear infection)
  • Scaly skin (outer ear infection)
  • Fluid buildup (middle ear infection)

RELATED: Ear infection treatments and medications

Types of inner ear infections: How can I tell which one I have?

Healthcare professionals distinguish between three types of inner ear infections depending on the location of the infection:

  • Suppurative labyrinthitis is an infection of the labyrinth structure in the inner ear

  • Serous labyrinthitis is an infection of the middle ear (otitis media) in which bacterial toxins or inflammatory substances pass into the inner ear and cause labyrinthitis symptoms—it is the most common form of inner ear infection

  • Vestibular neuritis (or neuronitis) is an infection or inflammation of the vestibular nerve which runs from the inner ear to the brain

Symptoms will vary, but all three conditions cause vertigo, loss of balance, dizziness, and related problems. Serous labyrinthitis will also have the typical symptoms of a middle ear infection, such as earache, fever, ringing in the ears, and a slight loss of hearing. Suppurative labyrinthitis does not have most of the symptoms of a middle ear infection except for loss of hearing and tinnitus. Vestibular neuritis will only cause vertigo and related symptoms like balance problems, nausea, and vomiting.

All three types of ear infections can happen to anyone, but vestibular neuritis is less common in young children. Young children most commonly have middle-ear bacterial ear infections, which are treated with antibiotics. 

When to see a doctor for inner ear infection symptoms

See a doctor with any symptoms of an inner ear infection. Some infections can be treated to prevent complications such as permanent hearing loss. Other infections, such as vestibular neuritis, can only be treated symptomatically. However, symptoms like persistent vertigo or dizziness may be due to other conditions, and an evaluation by a healthcare professional is needed for diagnosis.

A doctor will usually diagnose the problem clinically, that is, based on the symptoms, medical history, risk factors, and a physical. Lab and imaging will only be obtained if the diagnosis is unclear. Most patients start with their family doctor, but a referral to an otolaryngologist specializing in ear disorders may be needed.

Be prepared to describe your symptoms and recent medical history when you talk to a healthcare provider. The clinician may ask questions such as:

  • When did the symptoms start?

  • Do you feel off-balance? If so, does the spinning come and go, or is it continuous?

  • Have you recently had a viral infection like the flu, COVID, mono, or cold sores?

  • Do you have an active ear or sinus infection?

  • Do you have other symptoms like numbness, tingling, vision changes, problems walking, or weakness?

  • Has this happened before?

The clinician or specialist will perform a routine physical exam. Although the problem is with the inner ear, the clinician will look in the ear to check for a middle ear infection or other possible problems. 

Afterward, the clinician may perform a few tests on the head, called a HINTs exam, to rule out other causes of vertigo. The clinician will also administer a hearing test.

If other causes are suspected, such as stroke, cancer, or meningitis, the clinician may refer you to a neurologist or order other tests, such as an MRI or CT scan of the head or a spinal tap.

Complications of inner ear infection

Complications of an untreated inner ear infection include:

  • Permanent hearing loss

  • Permanent ringing in the ears

  • Deafness

  • Permanent problems with vertigo 

  • Permanent problems with the vestibular nerve

How to treat inner ear infection symptoms

Treatment of inner ear infections will depend on the cause. Bacterial inner ear infections are treated with antibiotics and symptom-relief medications. Viral infections are treated with symptom-relief medications as no antibiotics treat viruses. These include antihistamines and benzodiazepines to reduce vertigo and antinausea drugs to decrease nausea. Healthcare professionals generally limit benzodiazepines and antihistamines because of their side effects. Some clinicians may prescribe corticosteroids to reduce swelling, but studies dispute their effectiveness as a treatment. 

Lingering symptoms can be treated with vestibular rehabilitation therapy (VRT). These exercises train the vestibular system to interpret head movements and head position correctly. A physical or occupational therapist helps determine the appropriate regimen and teaches the correct form.

Living with inner ear infections

Both labyrinthitis and vestibular neuritis can have chronic phases that can last for months. This is when the infection is over, but the symptoms linger. Vertigo symptoms interfere profoundly with daily life and may be debilitating. Unfortunately, there is no cure for these symptoms, but they can be managed:

  • A healthcare professional may prescribe medications to decrease vertigo symptoms. Take medications as instructed.

  • In some cases, prescription medications may help minimize symptoms but slow recovery. Follow the doctor’s instructions about discontinuing medications.

  • Vertigo exercises are simple and can help speed up recovery. A healthcare specialist or physical therapist can demonstrate these exercises.

  • Simply occasionally turning the head from side to side is a vestibular rehabilitation exercise that can help retrain the vestibular system

  • Stand up slowly from a sitting or lying position

  • Avoid bending over

  • Move the head slowly, carefully, and deliberately—no sudden head jerks

  • Understand your limits—avoid driving or risky activities if vertigo may impact your ability to respond

RELATED: Vertigo treatments and medications

Most importantly, see a doctor if vertigo doesn’t go away

Anyone with symptoms of an ear infection should see a healthcare professional. The defining symptom of an inner ear infection is vertigo that doesn’t go away. If vertigo doesn’t go away, that’s a sign that medical help is needed. The cause may be an inner ear infection, or it may be worse. No one knows until a diagnosis is made.

FAQs about inner ear infection symptoms

How do you know if an ear infection is viral or bacterial in adults?

Bacterial infections typically cause symptoms for a longer time than viral infections. This is usually true for both middle and inner ear infections, but not always. Vestibular neuritis, a viral infection, typically resolves in a few days, but symptoms can linger for weeks or months afterward. Bacterial infections of the middle ear are also more likely to cause a fever, but this is not true of bacterial infections of the inner ear.

Can inner ear infection symptoms cause ringing in the ears (tinnitus)?

Hearing loss and tinnitus are common symptoms of labyrinthitis, inflammation of the inner ear labyrinth due to bacterial infections, viral infections, and, in some cases, autoimmune disorders. 

Are dizziness and vertigo symptoms of an inner ear infection?

Vertigo is the distinguishing symptom of an inner ear infection. Everyone with an inner ear infection will experience vertigo. Now, vertigo is a type of dizziness. Still, healthcare professionals like to use more precise terms like vertigo (spinning sensation), lightheadedness (wooziness), unsteadiness (feeling like falling over), and faintness (feeling like fainting). These more precise terms help with diagnosis. In the case of inner ear infections, people experience vertigo, a sensation that the room is spinning.

What’s next? Additional resources for people with inner ear infection symptoms

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician

Leslie Greenberg, MD, is a board-certified practicing family physician with more than 25 years of doctoring experience. She was a psychology major at Northwestern University near Chicago, then graduated with an MD from the University of Nevada School of Medicine. She completed her family medicine residency at St. Joseph Hospital in Wichita, Kansas. She has trained more than 350 family medicine resident-physicians, been in private practice, and delivered babies for 22 years.

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