The incidence of intralabyrinthine hemorrhage is not known, and may be underdiagnosed due to its rarity and difficulty to diagnose without magnetic resonance imaging. It is associated with hematological disorders such as coagulopathies, patients on anticoagulants 2,3, and sickle cell disease 4, as well as secondary to trauma, tumors or inflammation 1.
Presenting features primarily include sudden onset of:
The inner ear comprises both bony and membranous labyrinths containing the cochlea and vestibular system, respectively responsible for hearing and balance. Hemorrhage in these structures may disturb these fluid-filled spaces interfering with the mechanisms of hearing and balance.
MRI is the imaging modality of choice and is most sensitive for the diagnosis of intralabyrinthine hemorrhage.
T1-weighted imaging shows hyperintensity in the area of the cochlea/vestibular apparatus due to the presence of methemoglobin from blood 1,5.
Treatment and prognosis
Treatment largely consists of management of the underlying condition (e.g. correction of coagulopathy) 1. While oral and intratympanic steroid injection have shown some success, treatment is controversial and most therapies show no benefit over conservative management 5.
- 1. Park JJ, Jeong SW, Lee JW, Han SJ. A Case of Sudden Deafness with Intralabyrinthine Hemorrhage Intralabyrinthine Hemorrhage and Sudden Deafness. (2015) Journal of audiology & otology. 19 (3): 178-81. doi:10.7874/jao.2015.19.3.178 - Pubmed
- 2. Kothari M, Knopp E, Jonas S, Levine D. Presumed vestibular hemorrhage secondary to warfarin. (1995) Neuroradiology. 37 (4): 324-5. doi:10.1007/bf00588347 - Pubmed
- 3. F. Callonnec, J. P. Marie, E. Gérardin, K. Marsot-Dupuch, J. Andrieu Guitrancourt, J. Thiébot. Haemorrhage in the labyrinth caused by anticoagulant therapy: case report. (1999) Neuroradiology. 41 (6): 450. doi:10.1007/s002340050783 - Pubmed
- 4. Whitehead RE, MacDonald CB, Melhem ER, McMahon L. Spontaneous labyrinthine hemorrhage in sickle cell disease. (1998) AJNR. American journal of neuroradiology. 19 (8): 1437-40. Pubmed
- 5. Salomone R, Abu TAA, Chaves AG, Bocalini MCC, de Oliveira Vicente A, Riskalla PE. Sudden hearing loss caused by labyrinthine hemorrhage. (2008) Brazilian journal of otorhinolaryngology. 74 (5): 776-779. doi:10.1016/S1808-8694(15)31390-2 - Pubmed