Inner Ear Infections: Symptoms, Diagnosis, and Treatment Options

There are three categories of ear infections, which are based on the part of the ear that’s affected. When people talk about ear infections, they’re likely talking about a middle ear infection (otitis media) or an outer ear infection (swimmer’s ear). 

Inner ear infections are the least common, so many people are less familiar with what they feel like. But the symptoms can come on quickly and be quite unsettling. Let’s take a closer look at the causes of labyrinthitis and vestibular neuritis — two types of inner ear infections. 

Causes of inner ear infections

Inner ear infections are usually caused by viruses. Certain viruses — like COVID-19 or herpes virus (HSV) — have been known to cause some inner ear infections. These viruses can sometimes be identified and treated. But most inner ear infections are caused by common cold viruses, which don’t usually get tested for or named.

Every once in a while, bacteria is the cause of an inner ear infection. When this happens, it’s usually because a nearby bacterial infection, such as a middle ear infection or meningitis, doesn’t get treated properly with antibiotics. These worsening bacterial infections can sometimes spread to the inner ear.

Infections of the inner ear cause inflammation to the inner sensors that help with movement and balance. This inflammation can lead to the less familiar ear infection symptoms noted below.

There are two main types of inner ear infections, which are different because of the structures involved:

• Labyrinthitis: This is inflammation of the inner ear canals and the cochlea. The inner ear canals sense balance and movement and the cochlea helps you hear sounds. 

• Vestibular neuritis: This is inflammation of the vestibular nerve. This nerve carries movement and balance information from the inner ear to the brain.

Inner ear infection symptoms

Regardless of which type of inner ear infection you have, symptoms will usually come on gradually over a few hours. Often, they’ll follow a viral cold. They’ll be at their worst for the first couple of days, and then gradually get better over the next few days. And the symptoms will be continuous. This means the symptoms won’t come and go. 

Symptoms of an inner ear infection include:

• Dizziness

• A feeling that the ground is moving or spinning

• Nausea

• Vomiting

• Vertigo 

It’s important to note that ear pain is not a symptom of inner ear infections.

Vestibular neuritis vs. labyrinthitis

Although both types of inner ear infections cause the symptoms listed above, only labyrinthitis affects your hearing.

Because of this, labyrinthitis can cause all the symptoms listed above and:

• Ringing in the ears

• A sense of ear fullness or of the ears being plugged

• Hearing loss in one or both ears

Sometimes the hearing changes are subtle, and you might not notice your hearing is different.

How an inner ear infection is diagnosed 

To diagnose an inner ear infection, a healthcare professional will ask about your symptoms and do a physical exam. Many times, they can diagnose an inner ear infection based on your symptoms alone. And that’s good, because it’s impossible to look at the inner parts of your ear with regular office tools. They may also examine your eyes, hearing, and balance. 

Most of the time, no specific testing is needed to diagnose an inner ear infection. But if the diagnosis is a little less certain, you may need further evaluation. This may include:

• Viral testing for COVID-19 or HSV

• Imaging of your head, such as a CT scan or an MRI

• A formal hearing test 

• Referral to an ear, nose, throat (ENT) specialist

How to treat inner ear infections

Treatment for an inner ear infection will depend on the specific cause. Since inner ear infections are mostly caused by common cold viruses, they usually don't require antibiotics (which treat bacteria). Many inner ear infections resolve on their own in a few days. So, treatment often focuses on managing symptoms and staying safe while the vertigo improves.

That said, some medicines can help with inner ear infection symptoms: 

• Antiemetics: These medications can help with the nausea and vomiting that may occur. Examples include ondansetron or promethazine. 

• Antihistamines: These include diphenhydramine (Benadryl) or meclizine. In addition to helping the dizziness, many antihistamines cause sleepiness. This will help you get some rest. 

• Antiviral medications: When HSV is believed to be the cause of your inner ear infection, antiviral medications such as valacyclovir may be prescribed. 

Sometimes, steroids are prescribed to decrease the inflammation from inner ear infections. But there’s no convincing evidence that shows this helps. So, this treatment remains controversial.

Home remedies for an inner ear infection

Since inner ear infections are often caused by common cold viruses, you may still be dealing with cold symptoms when your inner ear infection begins. You’ll feel better if you:

• Stay hydrated

• Get plenty of sleep

• Eat simple, nutritious foods

Often the most troublesome part of an inner ear infection is the vertigo or dizziness. These symptoms can make it difficult to walk, work, or even move. Much like motion sickness, vertigo can make you feel sick to your stomach and cause vomiting. 

You may get some relief from vertigo if you do the following:

• Limit your activity and movements.

• Sleep as much as you can.

• Keep your eyes closed whenever possible.

• Avoid using electronics or screens.

• Try ginger lozenges or ginger candy.

• Chew peppermint gum or use peppermint oils in your environment.

• Sip chamomile tea or lemon water.

Above all, you’ll want to stay safe if you’re experiencing severe symptoms from an inner ear infection. Take extra care in situations that could result in falls, like showering or going down stairs. Driving a car or operating machinery when you’re dizzy could also be dangerous to you and others.

When to get help

Most of the time inner ear infections go away on their own in a few days. That said, the symptoms of an inner ear infection can sometimes point to a more serious condition. You’ll want to get medical attention right away if you have symptoms of an inner ear infection and:

• Pain in your ear

• Headache

• Weakness

• Changes in your vision

• Changes to your speech, such as slurred speech

• Symptoms that come and go

• Symptoms that last longer than a few days

Why trust our experts?

Written by:

Jill L. Jaimes, MD

Jill L. Jaimes, MD, is a board-certified pediatric emergency medicine physician with over 20 years of clinical experience. She received her medical degree from Baylor College of Medicine and completed her residency and fellowship training at Texas Children’s Hospital.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Kerry R. McGee, MD, FAAP

Kerry McGee, MD, FAAP, has over a decade of experience caring for babies, children, and teenagers as a primary care pediatrician. She has a special interest in adolescent health, particularly in adolescent mental health.

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