Intralabyrinthine haemorrhage is bleeding within the labyrinth of the inner ear and is a rare cause of sudden onset sensorineural hearing loss and vertigo ¹. 

Epidemiology

The incidence of intralabyrinthine haemorrhage is not known, and may be underdiagnosed due to its rarity and difficulty to diagnose without magnetic resonance imaging. It is associated with haematological disorders such as coagulopathies, patients on anticoagulants ^2,3, and sickle cell disease ⁴,  as well as secondary to trauma, tumours or inflammation ¹.

Clinical presentation

Presenting features primarily include sudden onset of:

• unilateral sensorineural hearing loss
• vertigo
• dizziness
• tinnitus ¹

Pathology

The inner ear comprises both bony and membranous labyrinths containing the cochlea and vestibular system, respectively responsible for hearing and balance. Haemorrhage in these structures may disturb these fluid-filled spaces interfering with the mechanisms of hearing and balance.

Radiographic features

MRI is the imaging modality of choice and is most sensitive for the diagnosis of intralabyrinthine haemorrhage.

MRI

T1-weighted imaging shows hyperintensity in the area of the cochlea/vestibular apparatus due to the presence of methaemoglobin 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.

Differential diagnosis

• labyrinthitis
• Ménière disease
• stroke